CARE HOMES FOR OLDER PEOPLE
Harbour House Penberthy Road Portreath Redruth Cornwall TR16 4LW Lead Inspector
Stephen Baber Unannounced Inspection 5th March 2008 09:00 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.V360546.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. Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 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 Mrs 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.V360546.R01.S.doc Version 5.2 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 9th July 2007 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 five have en-suite facilities. The one double bedroom exceeds the recommended size and is currently used as a single room. 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 resident and recognises individual choice and preference. Current weekly fees range from £335 to £430 per week. We asked the manager to explain the philosophy of the home. She said that the home is committed to continuous improvement, quality services, support, accommodation and facilities that ensure a good quality of life and health for aal the residents that live at the home. Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes.
The Commission for Social Care Inspection (CSCI) have made changes to the way we inspect services. Known as Inspecting for Better Lives (IBL). We are now more proportionate when reporting our findings, and more focused on the experience of people using services. The purpose of the inspection was to ensure that resident’s needs are appropriately met, with good outcomes provided to them. This was a key inspection, which was unannounced. It took place on 4 and 5th march 2008 and lasted for approximately 8 hours. The purpose of the inspection was to ensure that residents’ needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that residents’ placements in the home result in good outcomes for them. The inspection included interviews, some held privately in residents’ rooms and some in the communal areas of the home, with residents and visiting relatives. Several members of staff were interviewed and there were opportunities to directly observe aspects of residents’ daily lives in the home and staff interaction with them. Other activities included an inspection of the premises, of care, safety and employment records and discussion with the manager who was present throughout the inspection. The manager explained that the organisation is making major improvements throughout so that residents’ receive quality care in a comfortable environment. The principle method of inspection was “case tracking”. This involves interviews with a select number of residents’; staff caring for them and/or their representatives, and examination of records relating to their care. This provides a useful impression of how the home is working overall. At this inspection three service users were case-tracked, with particular reference to their individual and diverse needs relating to their age, culture and ethnicity, religion, gender, sexual orientation and disabilities. Overall the home is meeting the needs of the residents’ well, in a warm and friendly, homely environment. Residents’ who were interviewed at the time of the inspection confirmed this. Observations were made when one relative was talking to the manager about her sister who was unwell. She was given lots of reassurance by the manager and some helpful information.
Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 6 What the service does well:
Harbour House provides a comfortable, safe and well-maintained home for older people. The service provides well-presented written information about the home to enable people to make a decision about whether the home can meet their needs and suits their preferences. Relatives and visitors say that the home has a warm and welcoming atmosphere. The manager carries out detailed assessments and considers carefully if the home can meet the needs of prospective residents. There have been improvements in the care planning and risk assessment with individual residents and in responding to their preferences and choices. The residents’ healthcare needs are effectively monitored and addressed. Residents report that they are well cared for and they have confidence in the registered manager. We observed the staff caring for the residents’ and it was noted that they were kind and skilled and respected their privacy and dignity. Residents said that staff obtained prompt attention and advice when they were unwell. Comments from the residents were very positive about the skills and competence of the staff and responses varied from, “ Exceptional care and kindness”, “Staff very attentive” and “I cannot praise the owners and staff too highly” “ I couldn’t wish for a better place to live”. “ After living in my own house for 51 years the manager and staff have done all they can to help me settle in”. The management of the home is effective and ensures that the aims and objectives as set out in the statement of purpose are met. The provider who visits the home almost daily supports the manager and the manager is appreciative of her support and knowledge. The providers are investing substantially in the home to improve the standard of accommodation. A new conservatory is being built. There is a continuing programme of maintenance and refurbishment of the premises and equipment. The manager actively consults residents individually and obtains their views about the services provided. They regularly evaluate the service provided and follow this up with planned improvements. There is a structured training programme, which covers induction, required statutory training and NVQ at levels 2 and 3. Staff report that they are well supported and supervised. There are arrangements in place to ensure compliance with health and safety legislation and promote the health and safety of staff and residents. Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
Comprehensive feedback was given to the manager on the findings of the inspection. Contracts It is recommended that all residents have a copy contract on their file to evidence that the full range of services and facilities has been explained to them and they sign and date the contract to evidence that they agree to it. Complaints and Safeguarding Adults policies and procedures and training. The report recommends that the complaints procedure contain the address and contact details of the Cornwall Department of Adult Social Care. The home’s internal written procedures to guide staff on how to recognise and prevent abuse should be reviewed to ensure that they are still up-to-date and contain relevant information. Environment. Throughout the home there is evidence of upgrading work taking place to improve the accommodation for all residents. There are areas of the home that
Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 8 are suffering because of this and look uncared for. The report recommends that the manager write a statement for all residents and their representatives to read that explains the current situation. The providers should also write to The Commission explaining the rolling programme of improvements and the expected timescale for completion. The resident’s communal areas look out to the car park. Visitors to the home park close to their window obscuring the residents full view. It is recommended that the providers and manager considers parking near the boundary wall and draws up chevrons so that people know that these are parking bays. The residents will have a full view of the grounds and everything that is going on. It is also recommended that the providers consider a sluice facility in the home so that it complies with good hygiene practice. Management and Health and Safety Harbour House is one of three homes owned by the providers. The provider visits the home nearly every day and is very much in touch with the day-today activity. However there is a legal requirement for the organisation to submit a Regulation 26 report to the Commission and the organisation on the conduct of the home. This will be made a requirement in the report. The manager should encourage all staff to provide evidence of fire training that they have completed. There was no evidence to show that they receive ongoing fire instructions and it is left to them to watch fire videos which does not underpin their knowledge. Supervision for all staff is not taking place at the required intervals. A requirement in this report will be made. Residents need to know that staff are properly formally supervised. It is recommended that when the next Quality Assurance is carried out that the views and opinions of other stakeholder are obtained and an action plan is drawn up based on a systematic cycle of planning-action and review. The key National Minimum Standards under outcomes groups are generally met but the areas detailed above require improvement and we are confident the manager will put them right. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request.
Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 9 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.V360546.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2 and 3 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each resident is provided with a written up to date contract, terms, and conditions of residency. The documents tell residents of their rights and responsibilities. The contracts should be signed and dated by the residents. The needs of prospective residents are assessed so that they can be assured that the home can provide good care. EVIDENCE: The files case tracked evidenced that residents are given a contract of residency. The contracts are very detailed and explain fully the services and facilities available to residents. One contract did not evidence that the resident or their representative signed and dated the contract to evidence that they agree to the terms and conditions.
Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 11 There have been few admissions of new residents in the last year. The records for a recently admitted residents were case tracked. The registered manager had recorded an admission assessment and information record and a manual handling and nutritional screening assessment. The manager had also drawn up a care plan with detailed directions and information for staff, so that the resident’s needs could be met. The manager is very aware of the need to complete thorough assessments of prospective residents to ensure that the home is able to meet their needs and preferences. The manager’s assessment format complies with the standard and permits flexibility in recording the complexity and detail of the assessment. The residents who had been admitted recently reported that the home was comfortable, clean and tidy, and the staff had been very kind in helping them feel at home. Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Written care plans direct and inform staff about the residents’ health and personal care needs so that these can be met. The manager is very attentive in monitoring the changing healthcare needs of residents and ensuring that these are addressed. The arrangements for the management of medicines now protect residents. EVIDENCE: We case tracked three residents’ records. These records all had written care plans. The manager draws up a separate care plan record for each care need, activity and risk. The plans cover the residents’ personal, health and social care needs. Each plan sets out a stated objective, the action to be taken and regular dated evaluations. The care plans provide detailed and specific directions for staff to meet the residents’ care needs. Residents sign their care plans. There is further evidence of their participation in care planning in the
Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 13 ‘Resident’s Preferences’ record and agreement for frequency of checks at night. Care staff record daily notes consistently; these are factual, legible and signed. The care plans contained regular reviews and evaluations. They documented the actions that had been taken to meet the changing needs of residents. Residents reported that staff were ‘very good’, knew what they were doing in the delivery of care, and respected their privacy and dignity. Residents were very satisfied with the quality of the care they receive. Residents see GPs and community nurses in their own rooms and this was evidenced on the days of the inspection. Residents are registered with local surgeries. The manager writes detailed individual care plans where a resident has an identified health care need. These plans set out in detail the actions and interventions required by staff to monitor and meet the healthcare need. The residents’ records detail health care contacts and appointments. Residents stated that the staff were very good at monitoring their health and well being and obtained medical attention and advice when this was required. The community nurses visit the home regularly to carry out required nursing interventions, for example dressings, and tissue viability assessment and monitoring. The resident reported that she had found the prompt response reassuring. Chiropody, dental and optician visit the home on request. Moving and handling assessments provide directions and information to staff, so that care is delivered safely. Care plans include an assessment of the risk of falling, with appropriate guidance for staff. The manager carries out nutritional screening on admission and the findings of this are included in the care plan. The provider has introduced a new recording format that includes assessment, care plans and other information. The purpose of this to establish consistency of approach throughout the three homes. It is currently being trialled in one of the homes owned by the provider. This area of management responsibility has greatly improved and was inspected by the pharmacist from the Commission in December 2007. He made requirements as a result of the inspection, which the manager will comply with. The manager said she is going to be pleased with the new medication system and staff said they will find it strange in the beginning but know that it will protect residents and staff. Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13 and 15 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported in a lifestyle, which accords as far as possible with their own expectations and preferences. There are regular activities and the manager is reviewing these so that they meet residents’ needs and preferences. The diet provided is varied and nutritious with attention to individual preferences. EVIDENCE: The manager records the residents’ preferences in food, drink and care arrangements at admission. Care plans set out the residents’ preferred activities and interests, and guide staff in supporting people in these. Residents felt that the routines were relaxed and allowed them to pursue their own lifestyle and preferred pattern of life. Breakfast and tea are flexible in timing and offer a choice of menus to suit individual preferences. A number of residents go out without staff assistance; for some this is supported by a suitable written risk assessment. One resident said that she was able to follow her preferred routine, go out in the local shop to buy things for herself.
Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 15 Residents discussed their interests and were observed engaged in enjoying listening to Radio Cornwall, television, reading books and newspapers, and conversation. One resident attends chapel weekly and is collected by one of the congregation. A religious service takes place in the home every other month. The providers and manager are currently reviewing and developing the range of indoor activities provided by the home. On the first day of the visit an entertainer visited and the residents enjoyed his brand of music. During good weather the staff support residents to go for walks in the nearby Portreath village. There are monthly trips in the home’s vehicle organised by the manager of with the Age Concern mini bus. These outings were reported to be very popular at present. The manager and staff welcome family and friends visiting at any time as long as this accords with the wishes of the resident. Visitors were coming to the home throughout the inspection. I observed the manager giving lots of reassurance and support to one relative who was concerned about her sister. Residents can receive visitors in their own rooms or the communal rooms. Residents reported that the arrangements for visiting were satisfactory and the manager and staff were helpful in this. The home provides three meals daily, and a drink and a snack for supper. Residents were generally very satisfied with the quality of meals and catering arrangements. The menu records a varied and nutritious diet. Care plans detail, where required, individual needs in relation to nutrition. The residents told us that the manager and staff give them a wide choice of menu and the manager and staff knows their likes and dislikes. Breakfast consists of a choice of cereals, toast, fruit and drinks. The main meal is taken at midday. The dining rooms are light and airy and tables have linen tablecloths, napkins and flowers. On the day of the inspection there was a choice of casserole or salad and a choice of puddings. The food was appetising and well presented and residents said how much they enjoyed their meal. The residents were not rushed. Staff provided unobtrusive and appropriate individual support. Some residents choose to eat in their rooms. A cooked meal is also provided for tea. Fresh fruit was available in the sitting room Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure that would ensure that complaints are listened to and acted upon. The provider and manager has established arrangements to protect residents from abuse EVIDENCE: The complaints procedure complies with the standard. It is recommended that the telephone number and contact details of the Cornwall Adult Social care department is recorded on the complaints procedure. No complaints have been received since the last inspection. The manager actively consults residents individually and obtains their views about the services provided. The residents told us that they were very satisfied with the service and none had felt the need to make a complaint. They stated that they found the providers and manager approachable and helpful. The home’s policy and procedure on the prevention of abuse complies with the standard. The manager has a copy of the recently issued multi agency Cornwall Adult Protection Policy. Staff receive training in the protection of vulnerable adults during induction. Two staff were due to attend the multiagency training on adult protection, and the manager intends for more staff to attend this training. Staff were aware of their responsibilities in relation to
Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 17 adult protection. The organisation has its own trainer and he reviews the provision of regular refresher training for staff in this area. Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is being improved so that residents have a good standard of accommodation. The premises are clean and hygienic providing a pleasant environment and reducing risks to residents. EVIDENCE: The home is situated in a residential area near Portreath village and a number of residents’ access local facilities independently or are supported by staff. Information about the accommodation is provided in the statement of purpose. Residents said they were very satisfied with the environment and the facilities provided. Throughout the home there is evidence of upgrading work taking place to improve the accommodation for all residents. There are areas of the home that are suffering because of this and look uncared for.
Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 19 E.g. when you enter the front hall the first thing you see are old wheelchairs, picture frames off the wall and decoration that could be improved on. The report recommends that the manager write a statement for all residents and their representatives to read that explains the current situation. The providers should also write to The Commission explaining the rolling programme of improvements and the expected timescale for completion. The decor in the communal areas and some corridors is beginning to look tired and would benefit from redecoration. The Manager said that this is going to be completed in the rolling programme of improvements. There is also evidence of dampness in the smaller lounge and other remedial works are also required in this area. The resident’s communal areas look out to the car park. Visitors to the home park close to their window obscuring the residents full view. It is recommended that the providers encourage visitors to the home to park near the boundary wall and draws up chevrons so that people know that these are parking bays. The residents will then have a full view of the grounds and everything that is interest them. It is also recommended that the providers consider a sluice facility in the home so that it complies with good hygiene practice. The providers are to be commended on the major financial investment they are making to improve facilities for the residents but the small measures outlined in the report will go some way to making the home look more presentable. At present major works are underway to further improve the facilities by adding a conservatory to the side of the building. There is a passenger lift to the first floor which serves both sides of the building. The access to one group of bedrooms on the first floor of the main house requires climbing a few stairs. There is a stair lift and a small flight of stairs to the rooms on the second floor of the main house. There is a stair lift to the first floor in the other side of the building. 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. Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staffing and training arrangements ensure that the needs of residents are met. There is a commitment by the organisation to providing well trained staff. Recruitment procedures and practice support and safeguard the residents. EVIDENCE: The staff group are enthusiastic and are well qualified. The roster shows that there are two care staff on duty throughout the waking day and one waking and one sleeping staff through the night. There is a cook every day and a domestic on duty each day. The domestic assists with breakfast, so that the two care staff can devote their time to support with personal care during the busy morning period The AQAA states that seven out of fourteen care staff are qualified to NVQ level 2 or above and the remainder are undertaking NVQ training and other training with the organisation. The organisation has its own training officer who assists the managers to develop training for all staff commencing from Induction. Each member of staff has an individual training profile with the training they have completed recorded.
Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 21 Recruitment records for recently appointed staff were inspected. These contained the required information and documents, including application forms, references, Criminal Records Bureau disclosures and PoVA first checks. The manager was unsure whether she should obtain evidence of identification. We discussed this and schedule 2 of the Care Homes regulations states that documentation and information is require in respect of persons working in the home is required. The providers issue staff with statements of terms and conditions of employment. The home has a structured programme for Skills For Induction training. The induction training is tailored to the level of qualification and previous experience of new staff. Staff reported that they received a thorough introduction to their job and sound support and supervision through a lengthy induction period. Records of induction training were on file, appropriately signed and dated by the trainer. We discussed staff signing their induction books to evidence that they understand their training. The provider delivers or arranges training in required areas. The training manager reviews the arrangements for the delivery of refresher training in food hygiene, manual handling and first aid for staff. Staff have individual training records, which do not always detail formal supervision. The manager explained that she sees all the staff regularly and informal supervision is taking place daily. This report will make a statutory requirement for formal supervision to take place so that residents know that staff are appropriately supervised and have their practice appraised. Staff showed a sound awareness of good care practices in discussing their work. Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 22 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,36 and 38 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered providers and manager are experienced and qualified, and fit to run a care home. The providers and manager use a range of methods to obtain the views of residents and their representatives. The health and safety of residents and staff are promoted and protected. EVIDENCE: The registered manager is Mrs Sarah Eustice. Mrs Eustice has completed the Registered Manager’s Award and exceeds the experience requirement for a registered manager. She regularly completes training to keep her knowledge and skills up to date. The provider Mrs Anson who is highly qualified in care,
Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 23 nursing and management supports the manager. The manager is appreciative of her support and guidance. Harbour House is one of three homes owned by Anson Care Services. The organisation does not have a responsible individual for the organisation. The provider visits the home almost daily and it is acknowledged the input they make in the smooth running of the home. The Care Homes Regulations 2001 require the Responsible Individual for the organisation to submit a monthly report (Regulation 26) on the conduct of the home to the Commission and to each director responsible for the organisation. The provider was away on holiday at the time of inspection. We wish to talk with her about the role of the Responsible Individual for the organisation and the importance of a report on the conduct of the business. The home’s information pack sets out the arrangements for quality monitoring and includes a summary of the actions taken following the last service review. The providers employ a number of quality assurance systems. These include: - an assessment form for visitors and relatives; - monthly care plan reviews with each resident. daily informal meetings with the residents to discuss any issues on their minds. We discussed drawing up an action plan as a result of the Quality Assurance exercise which would be based on a systematic cycle of planning-action-review reflecting outcomes for residents. We also discussed seeking out the views of stakeholders in the community on how the home is achieving goals for the residents. The provider’s ‘Health and Safety Policy’ sets out the responsibilities of the employer and employees, and the arrangements for managing health and safety. There are hazard analyses and risk assessments for a range of activities and equipment. The most recent Kerrier District Council environmental health officer health and safety report is dated 21 January 2008 and reported satisfactory standards with supporting records Staff felt that the provider was attentive to health and safety matters, and that, for example, moving and handling was well managed. Accidents records were appropriately completed. A range of servicing documents were sampled and confirmed against the original documents. The records show regular required checks of the fire alarm systems, emergency lighting and equipment. 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. 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. E.g. there was no evidence to show that night staff have received fire training at the recommend intervals. The manager said that they have to look through videos but she should ensure that they fully understand the fire procedures for the home and record to say that they have understood the training. Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 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 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 2 x 3 Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP36 OP32 Regulation 18(2) 26(2)(j) Requirement The registered person must formally supervise staff at least 6 times a year. The Responsible Individual for the organisation must submit a monthly Regulation 26 report to the Commission and directors of the organisation on the conduct of the home. Timescale for action 30/08/08 30/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard OP2 OP16 Good Practice Recommendations The registered person should ensure that all residents sign and date their contract of residence and keep a copy on individual files. The registered person should record in the complaints procedures the contact and telephone details of the Cornwall Department of Adult Social Care who Commission care for residents. This will assist residents to contact them if they have any concerns. The registered person should write a statement for all
DS0000053837.V360546.R01.S.doc Version 5.2 Page 26 3 OP19 Harbour House residents and their representatives to read that explains the current investment programme. The providers should also write to the Commission explaining the rolling programme of improvements and the expected timescale for completion. It is recommended that the providers and manager considers parking near the boundary wall and draws up chevrons so that people know that these are parking bays. Further, it is recommended that the providers consider a sluice facility in the home so that it complies with good hygiene practice. 4 OP38 The registered person should take all night staff through the fire training at regular intervals and encourage the staff to sign for fire training given. Harbour House DS0000053837.V360546.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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