Inspection on 02/09/08 for Harecombe Manor

This inspection was carried out on 2nd September 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Harecombe Manor 16/10/06

Harecombe Manor 09/12/05

Harecombe Manor 13/01/05

Harecombe Manor 08/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Harecombe Manor Southview Road Crowborough East Sussex TN6 1HG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rebecca Shewan     Date: 0 2 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Harecombe Manor Southview Road Crowborough East Sussex TN6 1HG 01892-652114 01892652114 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Mohamed Biby Gulamaideen Type of registration: Number of places registered: Mr Alexandre Ollivier,Mrs Evelyn Ollivier care home 51 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: A maximum of ten (10) service users in receipt of personal care only can be accommodated. Service users may also have a physical disability. Service users must be older people aged sixty-five (65) years or over on admission. That the home may from time to time accommodate service users under sixty-five (65) years of age. That the maximum number of service users to be accommodated is fifty-one (51). Date of last inspection Brief description of the care home Harecombe Manor is a privately owned care home that is registered to accommodate up to 51 residents. Nursing care is provided whilst a maximum of 10 places can be Care Homes for Older People Page 4 of 25 Over 65 51 0 0 51 Brief description of the care home utilised to accommodate residents in receipt of personal care only at any given time. The home is located opposite Crowborough Hospital and is on the outskirts of town and there are some local amenities within walking distance of the home. The home comprises of 41 single bedrooms (21 of which have en-suite facilities) and 5 double bedrooms (3 of which have en-suite facilities). There are additional toilet and bathroom facilities throughout the home. Rooms are located over two floors, accessible by two passenger shaft lifts. The home has a number of specialist equipment in use such as mobility aids, specialist nursing beds and bath and moving/handling hoists. There are extensive attractive gardens to the rear of the property that are accessible to residents. There are car-parking facilities to the front of the premises. Potential new service users can obtain information relating to the home via the internet, CSCI Inspection Reports, Care Managers, Placing Authorities, by word of mouth and by contacting the home direct. The range of fees charged (at the time of this report) are #500 - #650 per week, with additional charges made for newspapers, hairdressing, dry cleaning and chiropody. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place during the morning and afternoon of the 2nd September 2008. Incident reports and previous inspection reports, held by the Commission for Social Care Inspection, were read before the inspection. The inspection of the home took five and three quarter hours. Records such as care plans, staff files and medication records were also viewed. Forty two service users were accommodated at the home at the time of the inspection. A tour of the whole home was undertaken and the Registered Provider, Registered Care Homes for Older People Page 6 of 25 Manager, a Registered Nurse, a Cook, three service users and two relatives were spoken with. The CSCI also conducted Service User and Staff surveys. What the care home does well: What has improved since the last inspection? Medication procedures and processes have been improved to ensure that all omission codes on MAR sheets are recorded on the back of the MAR sheet, medication fridge temperatures are maintained and recorded on a daily basis and all medications administered including ointment/cream/lotion/shampoo are signed for as either administered or omitted. The Registered Manager and staff of the home have improved cleaning schedules to ensure that the home is odour free throughout. The health, safety and welfare of service users has been further promoted by means of the window restrictor in bathroom No 7 having been repaired and rendered safe. The window in bedroom 32 has also been repaired and rendered safe for use. Fire doors are no longer wedged open. The Statement of Purpose and Service User Guide has been amended to reflect the current range of fees, the correct complaints procedure and now refer to service users by one form of address. Daily menus and alternatives are displayed within the dining area and other areas of the home, allowing service users to have appropriate information before making a Care Homes for Older People Page 8 of 25 choice in their meal options. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Potential new services are given comprehensive information relating to the home, in order to make an informed choice as to whether the home will be able to meet their individual needs. There are good processes in place for assessing potential new service users prior to admission with services being offered to only those service users whose needs can be met. Evidence: The homes Statement of Purpose and Service User Guide were viewed and it was evidenced that following the previous inspection of the home in October 2006 both documents have been updated to reflect the current range of fees, to reflect the correct complaints procedure and to refer to residents by one form of address. Both documents are given to potential new service users and/or their relative/representative during the assessment process. Care Homes for Older People Page 11 of 25 Evidence: The home’s Registered Manager or a Senior Nurse carry out pre- admission assessments. Copies of care management assessments from the placing authority are obtained, where these exist. The Registered Manager addresses any issues, which are highlighted within this assessment. Documented records are maintained of all correspondence with the placing authority. Records inspected showed that preadmission assessments are carried out on all new and potential service users. Intermediate care is not offered by this home. Care Homes for Older People Page 12 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are offered a good provision of health and personal care support by the home, with individuals needs being met and their wishes being respected. Whilst improvements are required to medication recording to ensure that service users are not put at high risk of medication errors. Evidence: Care plans were sampled and it was evidenced that care plans are written in a manner that allow the assessor to gain a good overview of individuals medical, nursing, social and personal care needs. It was observed that service users and/or their representative are involved in the care plan review process. Care plan reviews are conducted on a consistent monthly basis. The health needs of service users are well met with evidence of good multi disciplinary working taking place, on a required basis. All service users are registered with a GP from one of three local surgeries. One of two chiropodists attends the home on a two weekly basis. The home also has direct access to Audiology, Speech and Language Care Homes for Older People Page 13 of 25 Evidence: Therapy, Physiotherapy, Tissue Viability Specialists, District and Palliative Care Nurses, Incontinence Nurses and Occupational Therapy. The home has access to pressure relieving equipment. The home has good procedures in place for the monitoring and recording of all drugs administered, disposed of and those entering and leaving the home. The stores for medication were viewed and these were found to be maintained in a clean and orderly manner. Medication administration records (MAR) sheets were viewed. It was evidenced that the majority of omission codes on MAR sheets are now recorded on the back of the MAR sheet. Significant progress has been made to ensure that all medications administered including ointment/cream/lotion/shampoo are signed for as either administered or omitted. The Registered Manager reported that the recording of creams and lotions administered has been difficult to overcome as Care staff apply such medications during personal care. In order to address this issue the Registered Manager is currently in the process of devising a recording tool for care staff, that will work in conjunction with the MAR sheet and provide evidence that the cream/lotion has been administered. (See Recommendations). Medication fridge temperatures are maintained and recorded on a daily basis, this was required at the inspection of October 2006. Recordings had highlighted a problem with the current fridge used for drug storage and a new fridge has been purchased by the home. MAR sheets viewed also highlighted a shortfall in the manner in which handwritten entries onto MAR sheets are recorded. The majority of these entries are written in an unexplained manner and are not signed by two nurses, making it difficult to ascertain where the information for the prescription for such medications has been authorised. Therefore an Immediate Requirement was made. (see Immediate Requirement Section). Staff were observed providing personal support to service users in such a way that promoted and protected residents privacy and dignity. Service users and relatives commented that ‘individuals are treated with respect and dignity’. Care Homes for Older People Page 14 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a good variety of social, cultural and recreational facilities, including a specialist diets to Service users. Service users independence is encouraged and individual choice and wishes are respected. Evidence: A published list of activities is made available to service users, with service users being informed of special events being held in the home. Activities include: Basket Ball, Memory quizzes, number quizzes, magnetic darts, bingo, horse racing games, arts and crafts, walks in the garden and visiting music man. Service users are also offered 1:1 sessions. Records of all activities attended are maintained. Service users religious wishes are observed and arrangements are in place for residents to receive Holy Communion, if they wish. The management of the home believes in promoting an equal and diverse culture among staff and residents. Contact with family and friends is positively encouraged with visitors being able to attend the home at any time and in accordance with the services users wishes. Trips to local events and places of interest are also arranged. Service users spoke of how they enjoyed the recent trip to the school fête. Care Homes for Older People Page 15 of 25 Evidence: Service users are treated with respect and there is a good rapport between staff of the home and service users. Service users and their relatives reported that the home assists individuals to maintain their independence with their daily living and daily routines. The home’s menus are devised on a four week rolling programme. All meals are home cooked with an alternative option available for each mealtime. Mealtimes can be varied upon request and service users guests are also welcome to have meals at the home. Meals can be taken in the individuals bedroom or in the communal dining room. Medical, therapeutic or religious diets are provided as needed. Drinks and snacks are available at all times. published list of activities - observed. Activities include: Basket Ball, Memory quizzes, number quizzes, magnetic darts, bingo, horse racing games, arts and crafts, walks in the garden and visiting music man. 1:1 sessions. Records of all activities attended viewed. Holy Communion held on day of inspection - RC service user receives communion from local priest. Friends and family - open visiting - service user choice. Recent trip to school fête - enjoyed by those who attended. Further trip to Bexhill planned. &dollar week menu. Alternatives available. Specialist diets catered for. Flexible meal times. Recordings viewed of food consumption for each meal. Meals can be taken in the individuals bedroom or in the communal dining room. Drinks and snacks are available at all times. Service user states free to be as independent as possible. Care Homes for Older People Page 16 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users’s benefit from a robust and efficient complaints procedure, whilst the home’s procedures, processes and staff training should protect service users in the event of an allegation of abuse. Evidence: The home has an established complaints procedure in place. The home has received seven complaints within the past twelve months, all of which have been recorded as addressed. Each of the complaints have been resolved and appropriate action was taken by the Registered Manager to address the concerns raised. Staff have attended training in the Protection of Vulnerable adults within the last twelve months. This was evident from the staff files were viewed. There have been two Safeguarding Alerts raised by the home in the last twelve months. One of which is currently being investigated. Both Criminal Records Bureau (CRB) and Protection of Vulnerable Adult (POVA) checks are carried out on all new staff. Nursing and Midwifery Council (NMC) PIN checks are also conducted on all nursing staff. Care Homes for Older People Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides accommodation to service users that is well decorated, hygienic and odour free, whilst infection control procedures are adhered to at all times. Evidence: The location and layout of the home are suitable for its stated purpose. The home is well maintained and all areas of the home, including the garden, are accessible to service users. The home has an ongoing plan of refurbishment in place, a walk-in shower has recently been installed. The home has an infection control policy in place and staff are trained in infection control procedures, staff training records viewed confirmed this. Staff were observed adhering to infection control procedures. The home was clean and odour free throughout therefore the previous inspection requirement has been met. There is a daily cleaning schedule in place. It was evidenced that a clinical waste contract is in place. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a staff team that are sufficient in number and that have the necessary skills and experience to the meet the needs of current service users. Evidence: A competent staff team, sufficient in number, meets the resident’s needs. There is a staff rota in place, which details staff designations and hours of working. The home has a permanent staff team of the Registered Manager, eight Registered Nurses (RN), twenty one Carers, two Cooks, a Maintenance Person, a Gardener, three Domestics, three Kitchen Assistants, one Laundry Person, an Activities Coordinator, a Business Manager and three ancillary staff. Six care staff are trained in National Vocational Qualification (NVQ), level 2 or above in care. Whilst a further eight care staff are currently completing the NVQ level 2 or 3 in care, training. Staff recruitment files were viewed and it was evidenced that these files contain all items required under the Care Homes Regulations 2001. Some of the current staff team are from abroad. All necessary visa and Home Office related documents were found to have been obtained and kept on file for these employees. Satisfactory Nursing and Midwifery Council (NMC) checks had been conducted for all nurses employed, documented evidence viewed confirmed this. The home has an Equal Care Homes for Older People Page 19 of 25 Evidence: Opportunities policy in place and is an equal opportunities employer. Staff induction training is conducted in line with Common Induction Standards guidance. Mandatory training consists of Infection Control, Moving and Handling, Health & Safety, Protection of Vulnerable Adults, Induction (Common Induction Standards) and Fire Safety. Additional training is conducted in Tissue Viability, Pressure Area Care, NVQ’s, Nutrition, Continence and end of life training. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users experience the benefits of a home that is well managed and administrated. Consideration is given to service user’s choice and opinion in all aspects of provisions provided. The health, safety and welfare of service users and staff are protected. Evidence: The Registered Manager has been employed in this position for many years. She is an RN level 1, is NVQ level 4 qualified and has achieved the Mentorship certification and the Registered Managers Award. Staff, service users and relatives spoken with said that the Registered Manager was friendly, approachable and always takes concerns or comments about the home seriously. There is a Quality Assurance policy in place, that involves an annual development plan and continual self-monitoring of the home by the Organisation. Quality Assurance questionnaires are distributed to residents, their representatives and other interested Care Homes for Older People Page 21 of 25 Evidence: parties on an annual basis. The results of which are published and made available to all upon request. Staff and service user meetings are held, the minutes of which were viewed and these were found to be detailed in content and included actions taken to address previous issues raised by staff, service users and relatives. The home does not take any responsibility for many of the service user’s finances and most service users have family, friends or representatives who protect their financial affairs. Personal Allowance accounts are maintained for some service users, the accounts of which were viewed and found to be managed and maintained appropriately. Staff are appropriately supervised and detailed records are maintained of all supervision sessions held. Staff records viewed conformed this. Staff spoken with stated that they feel appropriately supervised by the Registered Manager and can approach at anytime outside of their usual alloted time. Improvements have been made following the inspection of October 2006. From the tour of the premises it was evident that the previous inspection requirements that; The window restrictor in bathroom No 7 must be repaired and rendered safe, the window in bedroom 32 must be repaired and rendered safe for use and that all fire doors must not be wedged open in the interests of the health safety and welfare of residents and staff have been addressed. The home’s maintenance files were viewed and it was evident that fire drills, fire alarm testing and fire equipment checks, health & safety checks and water checks had been carried out. An Immediate Requirement was made during the inspection, in that the window restrictor in bedroom 32 was too long and allowed the window to be fully opened. (See Immediate Requirements). Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 That all handwritten entries onto MAR sheets are explained and signed for by two nurses. This will provide a clear audit trail of where information is sourced and as to who authorised the prescribed medication. 03/09/2008 2 38 13 That the window restrictor in 03/09/2008 bedroom 32 is shortened. This will reduce the risk of hazard associated to a window on an upstairs room being opened fully. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 That the plans in place to develop a recording tool for the administration of creams/lotions by Care Staff, is completed and implemented. Care Homes for Older People Page 24 of 25 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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