Inspection on 06/07/05 for Harbour House

This inspection was carried out on 6th July 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Harbour House 06/11/07

Harbour House 06/06/06

Harbour House 27/01/06

Harbour House 28/02/05

Harbour House 18/10/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Harbour House 6 Margaret Street Folkestone Kent CT20 1LT Lead Inspector Julian Graham Announced 6 July 2005 9:30 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 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 Stationary 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 H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Harbour House Address 6 Margaret Street, Folkestone, Kent, CT20 1LT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01303 211180 Mrs Tina Dennison Mrs Tina Dennison Care Home only 4 Category(ies) of Learning Disability x 4 registration, with number of places Harbour House H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 28/02/05 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, three of whom moved from Mrs Dennison’s other registered Home for people with a learning disability which she owns and manages, and which is located nearby. Harbour House H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection of Harbour House which started at 09.30. The registered provider has another care home, Anchorage House, located not far from Harbour House, and in the interest of consistency, inspections of both homes were jointly undertaken on the day by the respective inspectors of the homes, Julian Graham and Wendy Mills. The inspection lasted seven and three quarter hours. Residents of both homes were spoken with by the inspectors, and most were able to clearly express their views of the care and service they are receiving. They were in good health and spirits. Other than the two team leaders of the homes, the company’s staff team work shifts in both the homes as there is a lot of social interaction between the residents in both the homes. On the day of inspection, the inspectors spent time with the registered person who manages both homes, and interviewed the team leader of Harbour House and a support worker in private. A tour of the premises was undertaken and some records and documentation examined. Feedback questionnaires from relatives of two of the residents living in Harbour House were received by the inspector prior to the inspection, and these were generally very positive. Since the last inspection, a resident living at Anchorage House has moved into Harbour House. The inspector wishes to thank the residents, manager and staff for their welcome and assistance during the inspection. What the service does well: There is a very friendly, open and easy going atmosphere in Harbour House, and the residents were observed as being very comfortable and at ease in their home. Staff were seen interacting with the residents kindly and respectfully. The home continues to support residents in making very good use of local facilities and amenities and the residents are very much part of their local community. Residents are leading active and busy lives, and are also encouraged to take part in the running of their home, including participating in household chores. The home is good at looking out for new social and leisure activities for the residents to try. Good liaison with health care professionals is being maintained in order to promote residents’ health and well being. Staff have access to regular training opportunities thereby raising their understanding and awareness. Harbour House H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Harbour House H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Harbour House H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 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 standard(s) 2,4 Prospective residents and current residents and their relatives and supporters are clear about what to expect from the home. Residents understand their rights and responsibilities whilst living at the home. EVIDENCE: The home has a statement of purpose, a service user guide and written assessment and admissions policies and procedures. Previous inspections have confirmed that these are sound and give appropriate information to the residents and their relatives and supporters. Responses to the relatives’ questionnaires were all positive. They indicated that they understand what they can expect from the home. The residents told the inspector that they invite prospective residents to visit and have a meal with them at the home. They said that they can always talk to the manager or any of the staff about any concerns they may have. Harbour House H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 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 standard(s) 6,7,8,9 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. EVIDENCE: Three care plans were examined and two of these were generally informative documents which outlined a range of needs and how these can be met. The third care plan was less detailed and did not refer to known specific behaviours that present challenges to the service and need to be subject to risk assessment. All three, to varying degrees, need to more clearly reflect all the assessed needs and how these can best be managed, for example, detailing how residents are being enabled to make choices whilst at the same time not potentially compromising any personal or health care needs. It was evident through talking to staff and reading care plans that the residents’ right to make decisions is respected. For example, the inspectors were told that one resident, now living in Harbour House, asked to move there from Anchorage House, the company’s sister home. This decision was documented in the person’s care plan. The staff spoke enthusiastically about another resident’s emerging confidence in being able to say “no”. One resident made the decision not to go camping, but instead opted for another holiday destination. The inspectors observed a staff member encourage a resident to help prepare her Harbour House H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 Page 10 lunch. They also saw some cakes and popcorn which a resident had helped make the previous day. Residents are given the opportunity to undertake routine household chores, like cleaning their rooms, filling and emptying the dishwasher and so on. Residents are taking a keen interest in recycling, and one has made a poster on this subject which is displayed in the kitchen. Residents are asked for their views on the home’s running in regular house meetings and in feedback questionnaires. Support to take risks is given to residents and those who are able to, go out on their own. The team leader gave assurance that as required from the last inspection, this activity has been risk assessed. The written risk assessment was not checked on this visit. Harbour House H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 Page 11 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 standard(s) 11,12,1314,15,1617 Residents are supported in being more independent and in taking part in a range of social, leisure and work activities. EVIDENCE: There was evidence to show that staff are supporting residents in maximising their independence. One resident, for example, who formerly was resistant to going out, is now no longer needing to be reliant on staff driving her to her day care placement, but is content to walk there instead. This person is also now able to tolerate queuing up for things, something she found very difficult before. Activity schedules were viewed by the inspectors who saw that opportunities available to residents include attendance at a local college, day centre, gardening project and so on. Encouragement is given to residents to maintain links with family and strong efforts are made to enable residents to see their friends, who are welcome to visit when they can. Very good use is made of local facilities and amenities, and it was noted on previous inspections that friendly neighbourly relationships have developed. Residents told the inspectors that they are free to spend time in their rooms when they wish, and this was observed at the time of the visit. Residents are consulted each week regarding the menus, and one resident said she likes the food and has plenty Harbour House H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 Page 12 to eat. The inspectors saw that snacks such as fruit and crisps are readily accessible and staff said residents can and do help themselves when they like. Harbour House H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 Page 13 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 standard(s) 18,19,20 Residents receive sensitive personal support and their healthcare is promoted. Some medication practices still require improvement, and are potentially putting residents at risk. EVIDENCE: It was evident that staff strive to ensure that any personal care support is given to residents in a sensitive and discreet way that respects their privacy and dignity. Whilst it is commendable that residents are being supported in seeing to their personal care needs themselves where this is preferred, any risks associated with this must be properly assessed to ensure that any potential medical condition is not overlooked. There was very good evidence in residents’ files that access to and consultation with healthcare professionals is maintained and promoted where this is needed. On the day of inspection, for example, staff accompanied one of the residents to the epilepsy clinic. The policies and procedures, storage and documentation in respect of the control and administration of medication were examined. Some matters requiring attention from the last inspection have not been properly addressed. These include; records of medicines received into the home are not being maintained; handwritten entries are not being signed and countersigned; internal medications are not being kept separately; a more detailed assessment of staff competence to administer medication is required. Other matters noted at this inspection which require attention include: label not affixed to a ventolin inhaler; criteria for administering PRN medication not Harbour House H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 Page 14 available; medication transferred from the original container into another container when a resident goes on leave, which is unsafe practice; some overstocking of creams. Harbour House H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 Page 15 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 standard(s) 22,23 The home deals with complaints in a satisfactory way. Staff have a good understanding about Adult Protection issues and know how to protect the residents from all forms of abuse. However, some of the home’s policies and procedures are not sufficiently robust or clear to protect the residents. EVIDENCE: The residents said that they can talk easily, and at any time, to the manager or other staff if they have any concerns. Conversation with staff confirmed that they are very aware of the varying needs of the residents and they will complain on their behalf if necessary. Although risk assessments are contained in the care plans, some activities involving risk for example, visits to the bank by individual residents, do not have written procedures of risk assessments. The home must review the care plans to ensure that all activities involving risk, and particularly those where there is potential for abuse, are risk assessed and clear procedures put in place. Unfortunately, a theft by a member of staff at the home revealed a flaw in the way the home was supporting the residents to manage their money. This resulted in an Adult Protection Alert. The home acted immediately to reimburse those who had suffered loss and to change policies and procedures to ensure further safeguards are in place. Examination of the financial records revealed however, the need for a clearer system of documenting residents’ financial transactions to allow for an accurate audit trail. Conversation with staff showed that they have a very good understanding of adult protection issues but were less clear about when they could guarantee a resident confidentiality and when they would have to pass on information to appropriate authorities even if a resident or a colleague had asked them not to. Harbour House H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 Page 16 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 standard(s) 24,25,26,27,28,30 The standard of the environment within the home is good and provides the residents with a homely and welcoming place in which to live. There is plenty of communal space and toilet and bathing facilities. Investment has recently been made to make further improvements to the home. EVIDENCE: A tour of the premises was undertaken by the inspectors, who noted a clean, comfortable and homely environment for the residents. Since the last inspection, the lounge has been redecorated. A fourth resident has moved in since the last visit, which necessitated changing the room formerly used as an office and which also contained the medication cabinet, into a bedroom. This room was upgraded at the time of the person’s admission. Bedrooms were viewed and were seen to be personalised in line with the residents’ tastes and wishes. The maintenance person was fitting a new double glazed window in one of the bedrooms at the time of the visit. Bathrooms and toilets were clean and suitable for the residents living in the home. Harbour House H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36 Residents are benefiting from a settled staff team who are well trained and supported. Staffing levels are satisfactory, although staff rotas do not always reflect who is on duty and in which of the two homes. Recruitment practices are sound. Care staff and team leaders need more frequent one to one formal supervision. EVIDENCE: There are generally two staff on duty when all residents are at home. These numbers are sufficient to enable residents to go out and to undertake activities they want to do. Staffing rotas, however, must always reflect which staff are on duty in the home, including when the manager works a shift. Two staff were interviewed in private and demonstrated very good awareness of their role and responsibility. They presented as kindly people who are working hard to support the residents in being as independent as they can be and to enable them to lead interesting lives. Staff turnover is low, which provides consistency and continuity of care, which is of benefit to the residents. Including the manager, seven of the thirteen staff employed have a NVQ which is commended. Staff also have regular access to other training which enables them to gain new skills and understanding to help them work more effectively with the residents. Both staff members who were interviewed, for example, said they understand the behaviours of one of the residents much better since attending a course on autism. Whilst some one to one formal supervision is Harbour House H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 Page 18 being undertaken with staff, this needs to be happening more consistently. The two team leaders in each of the homes, who are new to the role, need more input, training and assistance from the manager. This will enable them to carry out their responsibilities with greater confidence and effect, for example, in the developing of detailed care plans, keeping accurate financial records of residents’ monies. A sample of staff files were examined which revealed sound recruitment practice. The manager is reminded that CRB checks are not transferable unless within companies. Harbour House H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40,41,42 The management of the home is mostly satisfactory. There is an open management culture and the independence, health, safety and welfare of the residents is promoted. However, more attention is needed to ensure key documentation is kept up to standard and that CSCI requirements are met. EVIDENCE: The manager for the home has maintained her continuing professional development. She attends training sessions with staff and actively seeks out new opportunities both on behalf of the residents and for staff training. She has an open and honest management style and the residents are clearly confident in talking to her about anything that might worry them. Staff say that they are very happy working in the home and believe that the residents have a very good quality of life. Inspection of documentation showed that there are still some procedures that require review and some activities that require risk assessments. No health and safety hazards were noted on the day of inspection. Harbour House H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Harbour House Score 3 3 1 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 3 x H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 Page 21 yes 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. 3. Standard 6 9 20 Regulation 15 15 13 Requirement Timescale for action 06/09/05 4. 23 17, Care plans to be reviewed and to reflect all assessed needs. Risk assessments to be reviewed 06/09/05 and include all activities and behaviours involving risk. 06/08/05 With regards to medication: a) A record to be maintained of all medicines received into the Home (timescale of 28/03/05 not met; b)Handwritten entries in MAR sheets to be signed and countersigned (or initialled) by two staff (timescale of 28/03/05 not met; c)internal medications to be kept separate from external medications (timescale of 28/03/05 not met); d) a detailed assessment of staff competence to administer medication to be maintained and periodically reviewed;e) labels to always be affixed to ventolin inhalers;f) criteria for PRN administration to be available; g) medication not to be transferred from original container to secondary container/ Policy on taking medications on leave to be provided. Auditable financial records to be 06/07/05 H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 Harbour House Page 22 5. 23 Schedule 4.7 13 6. 7. 8. 33 36 17, Schedule 4.9 18 37 maintained with regards to residents monies. Adult abuse policy to include when information given to staff in confidence must be shared with the manager or others. Staff rotas to accurately reflect the staff on duty at any given time. Staff to receive formal supervision at least six times each year. All notifiable incidents and important changes to be reported to CSCI without delay 06/08/05 06/07/05 06/09/05 06/07/05 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 Good Practice Recommendations Harbour House H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford, Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Harbour House H56 H05 S58814 Harbour House V228083 060705 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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