CARE HOMES FOR OLDER PEOPLE
Harbour House Penberthy Road Portreath Redruth Cornwall TR16 4LW Lead Inspector
Paul Freeman Unannounced Inspection 3rd May 2006 10:00 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 Harbour House DS0000053837.V292946.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 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. Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Harbour House Address Penberthy Road Portreath Redruth Cornwall TR16 4LW 01209 843276 01209 313680 info@anson-care-services.co.uk 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 Mary Allison Anson Mr John Robert Anson Sarah Joanne Eustice Care Home 18 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (18) of places Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Service users to include up to 5 adults aged over 65 with dementia (DE(E)) To accommodate one named service user outside the registered categories of the home To accommodate one named service user outside the registered categories of the home Total number of service users not to exceed a maximum of 18 Date of last inspection 3rd October 2005 Brief Description of the Service: Harbour House cares for 18 older people and is a two story detached property that has been extended and stands in its own grounds close to the harbour. It is set in a residential area near to local amenities and a reliable bus service provides access to local towns. There is disability access on the ground floor and three lifts are provided internally. One is a full shaft lift, the second a stair lift providing access to the bedrooms on the first floor and a third upstairs to compensate for the different levels on the first floor. Sixteen of the bedrooms are single and two have en-suite facilities. The one double bedroom exceeds the recommended size. Communal space is good with a choice of two sitting rooms and two dining rooms and toilets and bathrooms are located throughout the care home. The home is committed to delivering care in a manner that meets the needs of each service users and recognises individual choice and preference. Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A planned unannounced inspection took place on 3 May 2006 and 4 May 2006 Eighteen residents were residing at Harbour House at the time of the inspection. The purpose of the inspection was to consider the work that had been undertaken on the requirements and recommendations set at the last inspection on 3 October 2005 and to inspect the key standards. Therefore some of the key standards that were considered include assessment and care planning, health and safety and staff recruitment. The registered manager, residents and staff were consulted about the services and facilities provided. The environment, records and documents were also considered. The requirements and recommendations set at the last inspection had mostly been worked upon and the provider, staff and residents fully cooperated and were very helpful throughout the inspection period. What the service does well:
A care plan is in place for each resident that is regularly reviewed with them to make sure that all of their needs are being met in a manner that is appropriate and acceptable to the person concerned. Residents stated they were very satisfied with the manner in which their health needs are met. Residents had confidence in the staff diligence about their health and said that health services were accessed promptly and efficiently whenever required. The records also indicate that General Practitioners, District Nurses and other health professionals regularly visit the home. Residents were also complimentary about the sensitive and reliable support and assistance that staff provide during the periods they are unwell. Residents’ health needs are also taken account of when any assessment of need occurs or their care plan is reviewed to make sure there are no outstanding needs. Residents are able to administer their own prescribed medicines if they wish and it is safe to do so. Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 6 Residents said the staff always treated them with dignity and respect and made sure their privacy and dignity was not compromised. The residents stated they found the staff to be attentive, flexible, efficient and responsive to any assistance they require. Many of the residents said they felt in control of their day-to-day lives and the manner in which there care and support needs were met by the staff. The staff said they found the care plans to helpful and informative in providing care in a manner that reflects the resident’s choice and also makes sure their needs are clearly understood. A range of social and recreational opportunities is provided at the care home and in the local community that reflect residents’ preferences and choices. The Providers continue to consult residents about their individual preferences and are keen to provide support and assistance where resources allow. Residents said they were treated with dignity and respect at all times. It is also evident that positive and trusting relationships have been established between residents, staff and the managers of the care home. A varied and nutrition menu is provided that reflect residents preference and choice. Residents are given a choice of the food they have at each mealtime and residents said they were satisfied with the portions and quality of the meals. Any concerns or complaints are dealt with positively and the staff and managers are committed to making sure that residents are protected from abuse. A homely, comfortable environment is provided and the registered persons continue to consider ways of further improving the facilities available. The furnishings and fittings are domestic in nature and of a high standard. The decor in communal areas is looking tired in certain places but residents’ bedrooms are decorated to a good standard. Residents said they were very satisfied with facilities provided. Two communal lounges and two dinning rooms are located on the ground floor and are valued by the residents. Toilets and bathrooms are located throughout the home and within a reasonable distance from the communal spaces. Residents stated they were also very pleased with their bedrooms. Many of the bedrooms are personalised and residents are able to bring their own possessions if they wish. Some of the rooms also have ensuite facilities and the Providers continue to increases this provision. The home is clean, hygienic and free of offensive odours. Residents said a good standard of cleanliness was maintained at all times and any issues that arose were dealt with promptly.
Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 7 The staff at the home are an enthusiastic workforce who work well as a team and are mutually supportive. Sufficient numbers staff is employed during waking hours and each night to meet the needs of residents. Additional staff is also employed if this is required to maintain a good standard of care and support. Robust recruitment, selection and vetting arrangements are in place in order to make makes sure that new staff has the appropriate skills and abilities to provide the care and support required. New staff are also provided with a job description and terms and conditions of employment which sets out their roles and responsibilities. Each staff member is regularly provided with training and this helps to maintain and improve the standard of care and support provided. The home is well managed and run for the benefit of the residents. Residents are encouraged to comment upon the facilities and care and support provided in order to further improve the services and facilities provided. Residents said they had confidence in the management arrangements. Two residents described their experiences at the home as “ very happy ” and “wonderful staff and food”. The Providers have established policies and procedures to make every reasonable effort to offer a safe environment for residents and staff. Staff also undertakes training on a regular basis to make sure their skills and knowledge are up to date. Equipment and services at the home are also regularly maintained in good working order. What has improved since the last inspection?
Managers at the home complete an assessment of each prospective residents needs to make sure the service is able to provide the care and support required. The information provided in the assessments has improved but in certain instances more detail is required. This will make sure the prospective residents needs, choices and preferences are clear to staff. In completing an assessment the opinions of the prospective residents relatives or representatives are taken into account as well as any professionals that are involved with the person concerned. Residents that have recently moved to the care home said they had been fully involved in the assessment process and this had given confidence they would be well cared for at the home. The residents’ care plans outline the care and support they require to meet their needs, preferences and choices. Initially the plan is based upon the
Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 8 assessment that takes place for prospective residents. Consequently any shortfalls in the assessment process are reflected in the individuals care plan. The staff has improved the information provided in order that plans comprehensively outline the needs, choices and preferences of each individual. This means that clearer advice, guidance and direction are provided to each member of staff. In certain instances the information provided in the care plans needs to be more detailed to make sure that comprehensive guidance is provided to staff. Daily records are maintained for each resident that detail the events of the day, any concerns and any actions that have been taken. The records have continued to improve and now meet the standard required. The risk assessment and risk management arrangements also continue to improve but in certain cases the records do not reflect the action the Registered Manager states occurs. Following a visit for the Fire Officer the procedures have been improved which has resulted in more robust arrangements for residents and staff. The staff also receives regular training about fire but records do not reflect the events the Registered Manager said had taken place What they could do better:
A number of residents said they would benefit from more opportunities to socialise and “chat” on a one to one basis. Many of these residents commented they would like to be able to regularly meet with the staff to socially converse. Other residents commented that the menu could be further improved so that their individual preferences would more suitably met. The Providers have continued to consult with residents about their choices and the menu and this is an area that requires further attention. The records regarding staff training were incomplete and there was no evidence to indicate that each staff member had an individual training programme for the year ahead. The Registered Manager also confirmed that a written training programme for the year ahead had not been established. The records about the Induction for new staff were also limited and insufficient in scope and detail. The Registered Manger was confidant that each new staff member had experienced a comprehensive Induction. The current arrangements to store and administer prescribed medicines are not satisfactory and require a detailed review to make sure that robust and safe procedures are in place.
Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 9 The policies and procedures about fire would benefit form review to make sure that robust arrangements are in place. It would also be positive to establish written guidance for staff about managing aggression in the workplace. This will help to further promote the health, welfare and safety of residents and staff. 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 DS0000053837.V292946.R01.S.doc Version 5.1 Page 10 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 Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 11 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, 3 and 6. Each prospective resident is assessed before moving to the home but some of the assessments would benefit from more detail. This will make sure the prospective resident and the Providers are confidant the persons needs, preferences and choices can be met. EVIDENCE: The Providers have established an appropriate statement of purpose that details the services and facilities provided at the home. It planned this document will be reviewed during 2006 to make sure it is a comprehensive account and to comply with the regulatory requirements. The revised document will also take account the Providers plan to further improve the facilities and service. It is positive that the Providers continue to improve the assessment arrangements. The assessment records of some of the residents that had moved to the care home recently were considered. Each prospective residents needs are assessed
Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 12 by the Providers to sure the services and facilities are appropriate to provide the care and support required. In completing an assessment the staff consult with the prospective residents and take account of the opinions of their relatives or representatives and of any professionals that are involved with the person. At this time the individual needs in respect of equality and diversity are identified and appropriate arrangements about the care and support required are considered. The information provided could in certain instances be more detailed and also include any preferences and choices the prospective residents many have regarding the care they receive. Residents that had recently moved to the home said they had been fully consulted about their assessment and had felt their views, preferences and choices and been properly taken into account. The Providers do not offer a dedicated intermediate care or rehabilitation service. It is evident that every reasonable effort is made to make sure that residents are able to maintain and maximise their independence. Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 13 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, 8, 9 and 10. The care plans require further improvement in order to provide staff with the information, direction and guidance about meeting all of the persons needs. The health needs of residents are well met with evidence of good multi disciplinary working taking place. The arrangements to administer medicines are not satisfactory and require improvement so that residents’ health and welfare is not potentially compromised. Residents are treated with dignity and respect and in a manner that makes sure their privacy is upheld. EVIDENCE: Each resident has a care plan that details the persons care needs and where appropriate any particular preferences or choices they may have about the care and support required. The information provided in care plans has continued to improve and provides staff with a clearer picture of the residents needs. There are some instances where more information is required to make
Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 14 sure that a comprehensive picture is provided to guide and direct the staff about the service they provide. Residents said they were satisfied with the care and support provided and commented that staff was attentive and respond positively to any assistance required. The staff said they found the plans to be informative and provide the appropriate information and direction about the care and support required. The resident’s key worker reviews the care plans each month with the resident to make sure that needs are being met appropriately and in an acceptable manner. In addition a formal review is undertaken with the resident on a six monthly basis. At this time relatives or representatives and any professionals involved would also be consulted. Each review is recorded but in certain instances more detail is required to make sure that any conclusions or agreed actions are shared with the wider staff group. There are no barriers to residents accessing their care plans at any time. Residents were very positive about the manner in which their health needs are met. Residents are confidant that medical services are access promptly when required and said staff was attentive during periods of poor health. The records show that General Practitioners and District Nurses regularly visit the home when necessary. A Chiropodist also visited to see residents during the inspection. Residents’ health needs are also taken account at reviews and when any assessment of need is undertaken and where required are included in each individual care plan. Staff is clearly very aware of the importance of diligently monitoring residents health and of taking positive action when any situation arises that causes concern. Residents can elect to administer their own prescribed medication when it is safe to do so. In other situations the staff assist residents and the staff concerned have all been suitably trained. The Registered Manager stated that a recent review of the arrangements with the Pharmacist had highlighted a number of areas that required improvement. The current arrangements are not satisfactory and a number of improvements are required. The current shortfalls include incomplete records and it was found that staff is not completing the records at the time the medicines are administered. The arrangements to store medicines that require refrigeration
Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 15 are also unsatisfactory given they stored in a domestic refrigerator on top of food. The storage arrangements were also not completely secure given ointments, creams and other preparations were not in a locked facility. Policies and procedures have been established for medicines which detail the actions required. The arrangements would however benefit for a comprehensive review given it is the view of the Inspector that forms of secondary dispensing are in place. It is therefore necessary the Providers review and develop the current arrangements to make sure that safe robust arrangements are in place for the storage and administration of medicines. Residents stated the managers and staff at the home always treated them with dignity and respect. The residents said they felt in control of the care and support provided and were able to determine where they met with visitors and felt fully consulted about their day to day lives. Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 16 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, 13, 14 and 15. Residents are treated with dignity and respect and have access to a range of social activities. There is scope to improve and develop social opportunities that will further enhance stimulation and residents life experiences. A varied and nutritional diet is provided which generally satisfied the residents. Some of the residents would benefit from further improvements in order that their preferences are better accommodated. EVIDENCE: The residents said they able to decide how they spend their time in terms of leisure and recreational pursuits. Many of the residents decide not to participate in organised activities and prefer to make their own arrangements. The Providers do offer certain opportunities on an ongoing basis that are well supported and it is clear that residents enjoy entertainers visiting the home and regular trips in the community. Wherever possible the Providers will support residents to participate in activities of their choice but this needs to occur within the resources available. Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 17 A number of residents commented they would like additional opportunities to socialise on a one to one basis and a number commented they would welcome the opportunity of more time to chat to staff socially. Visitors at the home also said they believed that more opportunities for residents to socialise on a one to one basis would further enhance the residents quality of life. The assessment and care planning arrangements are also not robust in relation to addressing residents’ individual needs regarding their hobbies, interests and leisure pursuits. Residents said the daily living arrangements were flexible and it is evident that residents are encouraged and supported to be as independent as possible. There are also no barriers to residents accessing their records when they wish and there are no restrictions to maintaining contact with external advocates when required. A varied menu is provided that operates on a four weekly cycle. Residents have a choice of the food they have each mealtime and the Providers have continued to consult with residents about the menu. Residents said the quality of the food was good and all were satisfied about the portions. Some of the residents commented that the menu could be further improved in order that their personal preferences could be accommodated further. A number of residents are also diabetic and a suitable menu is provided. A number of staff and residents commented that the diabetic menu should be reviewed to make sure meals are as appetising as possible. This is an area the Registered Manager said continued to be part of the ongoing review of the menu. The kitchen area presented as clean and hygienic and all the equipment was said to be in good working order. Appropriate health and safety practises are in place and the kitchen staff is suitably trained. The requirement set at the last inspection to improve the kitchen flooring had not been completed and is renotifed in this report. Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 18 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 and 18. Robust arrangements are in place to protect residents against abuse. There are no barriers to residents raising any complaints or concerns with the staff or providers and the evidence indicates that all issues are dealt with in a satisfactory manner. EVIDENCE: Robust policies and procedures are in place to deal with complaints and make sure that residents are protected. Residents and staff comments showed that people are very comfortable about discussing any concerns with the owner or the registered manager. The staff is clearly aware of the action they are required to take if any complaints are made or any concerns arise about a residents protection. Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 19 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 and 26. Continued investment provides a homely environment that is maintained to a good standard and is comfortable for those living there and visiting. Plans need to be established to maintain the standard of décor and to provide adequate storage facilities at the home. The garden area at the side of the home also need to be maintained in an orderly fashion that does not potentially compromise healthy and safety or undermine the value of the setting. Suitable standards of cleanliness and hygiene are maintained that promotes the residents health. EVIDENCE: Residents said they were very satisfied with the environment and the facilities provided. The home is a detached property that has been extended over time and is evidently maintained to a reasonable standard. The Register Providers have continued to improve the facilities and this has included additional ensuite facilities and a new roof.
Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 20 Car parking facilities are provided at the front of the home and an accessible garden for residents is situated at the side of the property. There were a number of items in the garden that gave the appearance of untidiness and undermined the positive nature of the area. This included fences that had blown down or been removed. In addition the area for drying clothes would also benefit from improvement. Inside the home there are two communal lounges and two dining rooms on the ground floor. The furniture, fittings and furnishings are of a high standard and domestic in nature. Residents said they found the home to be warm and welcoming and appropriately furnished. The decor in the communal areas and some corridors is beginning to look tired and would benefit from redecoration. The Registered Manager said that no formal programme of redecoration has been established for 2006. Bathrooms and toilets are located throughout the home and within a reasonable distance of communal areas. Some of the bedrooms are also provided with ensuite facilities and the Registered Providers are planning to increase this provision in the future. A number of bedrooms were sampled and found to meet the standards required. A good standard of decor was evident and many of the rooms were personalised by the occupants. There are also no barriers to residents bringing their own furniture and possessions. The home was found to be clean, hygienic and free of offensive odours. Residents said their rooms were regularly cleaned and they were very happy with the standard attained. The services and equipment provided at the home are regularly maintained and serviced and suitable arrangements are in place to provided a satisfactory level of warmth and heat for residents. The storage arrangements at the home need further consideration particularly given one of the communal toilets on the ground floor was being used as a store. The Registered Providers are considering plans to further extend and improve the facilities. Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 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, 28, 29 and 30. Staff morale is high resulting in an enthusiastic and skilled workforce that work positively with residents to provide the care they need and require. The staff group have regular opportunities to develop their skills through training but the records of the training and future plans are not satisfactory. The Induction arrangements are said to be robust but the records in place do not evidence that new staff have a comprehensive introduction to their roles and responsibilities. EVIDENCE: Staffing levels meet the minimum requirements during waking hours and overnight and additional staff is provided when this is needed to meet the needs of residents. Residents said they were extremely well looked after and described the staff as “wonderful”, and also said “they will do anything for you”. The staff group have a wide range of experience, complementary skills and clearly work well as a team. In addition regular training opportunities are provided to each staff member to further develop and enhance the services provided. There is however no definite training plans for each staff member or an annual training programme in place. Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 22 Staff was also very positive about working at the home and are clearly committed to providing a high standard of care in a manner that is individually acceptable to the resident concerned. The recruitment records of staff that had recently commenced employment were considered. The Providers have established a robust policy and procedures to make sure that residents are protected. The records indicate that certain elements of the procedure have not been followed. Generally the procedure had been followed but in some instances the records were incomplete. The Providers said they have a comprehensive induction programme for new staff to make sure to make sure staff have a clear understanding of their roles and responsibilities. However there was limited evidence of what Induction had been provided and in one case the induction does not appear to have commenced until sometime after they started work at the home. Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 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, 35, 37 and 38. The home is well run and organised for the benefit of the residents. Residents are encouraged to contribute and comment on the manner the home is run on a regular basis. This provides residents with the opportunity to improve the services and facilities provided. Further attention needs to be given to improving the record keeping arrangements. This will further improve the quality of the services provided. A range of safe working practices has been established to promote the health and welfare of residents and staff. Further improvement can be made to make sure that every reasonable step is taken to provide a safe setting. EVIDENCE: Residents said the home was well run and they had confidence in the Providers. One of the Registered Providers also plays an active role that
Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 24 supports the work of the Registered Manager. The Registered Manager is suitably trained and is clearly valued by the residents. The manager is supported well by the senior staff in providing clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. This also means that a senior member of staff is on duty for all waking hours. Reliable on call arrangements are also in place each night. The home is well run and organised for the benefit of the residents. Residents are encouraged to contribute and comment on the manner the home is run on a regular basis. This provides residents with the opportunity to improve the services and facilities provided. Therefore the Providers have also established Quality Assurances measures in order to consult with residents, their relatives or representatives and other professionals that have contact with the home about the services and facilities provided. This is an annual process but a report detailing the finding of the last review has not yet been completed. In addition residents are regularly consulted about their views during the regular care plan reviews that occur. The Providers are keen to promote equality and diversity for residents and staff. The individualised approach to assessment, care planning and review enable the Providers to deliver services and facilities that reflect each person’s requirements. In addition a range of policies and procedures are in place to promote a positive experience for people at the care home. The Providers take a responsible attitude towards any assistance they provide to residents to manage their finances. At the time of the inspection no assistance is provided. As detailed in this report certain records required by regulation need to be improved. The daily records maintained about residents have improved and outline the events of each day, any issues or concerns and any particular action that has been taken. There are also no restrictions to residents accessing their records. The records regarding residents also comply with the DATA Protection Act. The Providers have also established a range of policies and procedures that promotes safe working practices for staff. Generally residents and staff said they had no concerns about their safety or the manner in which the care is provided. Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 25 Equipment and services at the home is also regularly maintained and serviced. The Registered Manager also stated that regular training is also provided to safe in respect of a range of health and safety practises. The risk assessment and risk management arrangements have also been improved and the improvement is reflected in the reduced incidence of accidents that occur. There are however occasions when comprehensive risk assessments are not completed at the assessment stage or following n accident or incident. The Registered Manager said that appropriate account was taken of risks at all times but this is not reflected in the records. The fire precaution arrangements have also recently been improved. This followed an inspection by the Fire Officer who identified certain areas of noncompliance with the Fire Regulations. The Registered Manager said that steps had now been taken to ensure compliance with the Regulations. The Providers have established policies and procedures to promote fire safety. The documents summarise the arrangements in place and the action required by staff in the event of an incident. There was no policy or procedure that provides detailed direction to staff about their roles and responsibilities. In addition the Registered Manager said that staff undertake fire training and fire drills on a regular basis. However the current records do not adequately detail the events that have occurred. Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 26 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 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 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 3 X 2 X 3 X 2 2 Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 27 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. 2. Standard OP3 OP7 Regulation 14(1) (a-b) 15(1) Requirement More detailed assessments of need must be completed. Timescale for action 30/09/06 All care plans must set out in 30/10/06 detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service user are met. Robust arrangements must be in place to store and safely administer medicines. Accurate and detailed records must be maintained about the administration of medication. 30/06/06 3. OP9 13(2) 4. OP9 13(2) 30/06/06 5. OP12 16(2) (m-n) Services users must be consulted 30/09/06 about an improvement in their social and recreational opportunities. The kitchen flooring must be replaced. (Previous timescale of 30 December 2005 not met). An appropriate standard of decor
DS0000053837.V292946.R01.S.doc 6. OP15 13(3-4) 30/07/06 7. OP19 23(2)(d) 30/12/06
Page 28 Harbour House Version 5.1 must be maintained throughout the care home. 8. OP30 18(1)(a) (2)(a-b) 24(2) A suitable record of the “comprehensive” induction programme must be in place The annual review of the quality of care provided must be published and available to service users. Records required by regulation must be in place. Risk assessments and risk management plans must be completed when any situation arises that could potentially compromise the health and safety of service users or staff. A robust policy and procedure to guide and direct the staff regarding fire safety and precautions must be in place. 30/06/06 9. OP33 30/07/06 10. 11. OP37 OP38 12(1)(a) 17(1-3) 13(a-c) 30/09/06 30/07/06 12. OP38 23(4)(e) 30/08/06 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. 2. 3. Refer to Standard OP1 OP7 OP19 Good Practice Recommendations The statement of purpose and service users guide should be reviewed during 2006. Service users reviews should be recorded and detail any agreed actions or conclusions. Sufficient storage areas should be provided to make sure residents are safe and are not prevented from using the registered facilities.
DS0000053837.V292946.R01.S.doc Version 5.1 Page 29 Harbour House 4. 5. 6. OP19 OP19 OP28 A safe and appropriate garden area should be available to service users. A annual programme of redecoration should be in place. Each staff member and the providers should have a annual training programme that records that plans for the year ahead. Robust and comprehensive recruitment records must be in place. A policy and procedure should be established about aggression in the workplace. 7. 8. OP29 OP38 Harbour House DS0000053837.V292946.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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