Inspection on 06/09/07 for Harefield Hall

This inspection was carried out on 6th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 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

Harefield Hall 14/12/06

Harefield Hall 07/12/05

Harefield Hall 12/05/05

Harefield Hall 31/01/05

Harefield Hall 17/09/04

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

CARE HOMES FOR OLDER PEOPLE Harefield Hall 171 Bath Road Willsbridge South Glos BS30 9DD Lead Inspector Jon Clarke Key Unannounced Inspection 09:30 6 & 7 September 2007 th th 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 Harefield Hall DS0000003326.V343257.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. Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harefield Hall Address 171 Bath Road Willsbridge South Glos BS30 9DD 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) 0117 9323245 0117 9328884 Banff Securities Limited Ms Susan Anne Evans Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 21 persons aged 65 years and over requiring personal care only 14th December 2006 Date of last inspection Brief Description of the Service: Harefield Hall is a well-established care home situated in its own large grounds, between the villages of Longwell Green and Willsbridge. The centre of Bristol is six miles away and can be accessed by the buses that stop at the bottom of the driveway. The home is easily accessible to the local shops and the post office, plus there are two areas of interest nearby, namely the Willsbridge Mill and the Bitton Railway Station. Both have tearooms and provide a pleasant area where visitors can take their relative. The house has been extensively adapted to provide accommodation for 21 people, both male and female. The private rooms are spread over three floors and there is a passenger lift ensuring that all areas are accessible. The home has a pleasant lounge and dining room and the large hallway is also able to accommodate seating for several of the service users. The kitchen is on the ground floor; the laundry and the storerooms are in the basement The home provides care for older people and aims to do this in a personalised way, ensuring that as much independence is retained and that a fulfilling and meaningful lifestyle is offered. Fee: £475-525 not including laundry. Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit to the home as part of an inspection the manager was present throughout the inspection. As part of this inspection a number of documents were looked at including: care plans, staff records (training and recruitment), health and safety and medication. There was an opportunity to talk with individuals who live and work in the home about living and working at Harefield Hall. “Have Your Say” questionnaires were sent and responses were received from 11/20 residents, 7/10 health professionals and 7/15 relatives. As part of this inspection the manager completed a Annual Quality Assurance Assessment (AQAA) which set out the areas of practice based around the National Minimum Standards summarising what the home does well, the evidence for this, what they could do better and how they improved in the last 12 months. The information form the AQAA and questionnaires have been used to help make a judgement about the quality of care provided at Harefield Hall. What the service does well: A real strength of Harefield Hall is the friendly, warm and inviting environment alongside a strong stable staff group with a number of staff who have worked in the home for over 5 years. This helps in providing a consistent level of care from experienced staff. There has also been an increasing emphasis on staff undertaking NVQ qualification and this with training is and has led to a competent and knowledgeable staff. Individuals I spoke with spoke of being able to “trust” and “feel confident” “can’t speak highly enough of them” about staff and all were very positive about the care they receive “as soon as I came in I knew it was the place for me”. Two comments received from a GP and relative also illustrate the quality of care in the home: “It is a friendly caring home and standards are very high.” (GP) “I feel that Harefield Hall is extremely well run by very experienced staff. I am very impressed by their friendliness as well as their professionalism.” (Relative) The care planning practice in the home is of a high standard and importantly not only provides information about health and physical care needs but also tries to give a real personal picture of the individual. Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 6 There is an important emphasis in the home on supporting individuals whose health is deteriorating or has changing needs relating to their health or physical state. This is evidenced by the strong links with community health services and the real effort of the home to provided care to individuals with support of these services. At the time of my visit an individual who the home had made strenuous efforts to continue providing care reluctantly had to be moved to a nursing home. It was very clear to me that this had been a very difficult decision made by the manager but nevertheless was in the individual’s best interests. 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. The summary of this inspection report can be made available in other formats on request. Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 7 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 Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 8 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): 1,3 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The home’s Statement of Purpose whilst giving full and detailed information about the service individuals can expect on living in the home should be accessible to individuals who live in the home or prospective residents. The home undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs. EVIDENCE: Individuals who live in the home are provided with a Welcome Pack which gives information about staffing and day to day information, activities and routines, i.e. “You may retire to your room whatever time suits you.” Also individuals who come into the home are given information about making a complaint and one person I spoke too confirmed this “I was given a complaints procedure in writing”. Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 9 A number of admission records were looked at and they provided good information about the health and social care needs of the perspective resident. Where an individual is known to the local authority a copy of their assessment is obtained. At the time of my visit an individual was being admitted for respite to the home and a member of staff sat with the relatives and went through in details the routines and care needs of the individual. It was also noted that the member of staff made an effort to make sure that they were aware of the likes and dislikes of the individual. Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 10 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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care Planning and arrangements for meeting health care are generally good providing staff with the necessary information so that the health and social care needs of residents are met. Arrangements for managing resident’s medication make sure that resident’s health needs are protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. EVIDENCE: A number of care plans were looked at and provided clear and detailed information about the individual’s circumstances. Importantly the care plan was person centred in that there were sections on hobbies, previous employment and personal history. Other information included social, medical and hygiene care needs. Information about the wishes of the individual on their death or contact details was also included. Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 11 Risk assessments had been completed, as had moving and handling assessments. Reviews had been regularly held including yearly review involving the individual and/or their representative. Individuals who live in the home have good access to community health services such as chiropody, dental and optician. The home has strong links with the local GP practice and community nurses. Records showed that where there had been concerns about individual’s health prompt contact is made with the GP or other service such as physiotherapy. A comment from an individual who lives in the home was: “If ever I need a doctor he is always here within the day”. All resident responses to Have Your Say questionnaire said that they “always” receive the medical support they need. In looking at the arrangements for the administering, storage and management of medication in the home it was evident that there are secure systems in place. Administering records including that of control drugs were completed as required. There is good stock control in place. I spoke to the pharmacist who had completed an inspection who confirmed that he was fully satisfied with the medication arrangements in the home. The home has a Home Remedy procedure in place so that individuals can have this type of medication i.e. paracetamol, simple linctus for limited period. The recording of the use of such medication was good and the staff member I spoke to about this was very clear about the circumstances and limitations of their use and actions to take after a certain period namely the referring to GP for advice and recommendation of further medication. All staff who have responsibilities around the administering of medication have undertaken the necessary training. Individuals where able can manage their own medication and the home had completed a risk assessment where one individuals had chosen to do so. I spoke to a number of individuals about how they felt they were treated by staff specifically whether they felt they were treated with respect: there was very positive response from all I spoke too: “they always treat me as I would want to be treated”, “ Yes they do, always knock on my door, very much so”, “definitely can’t fault how they talk to me couldn’t ask for more”. During my visit I was able to observe staff talking and assisting individuals. This was always done in a sensitive, caring and respectful manner. Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 12 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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for meeting the social and recreational needs of residents are good and there are opportunities for residents to maintain links with family, friends and the local community. The home’s practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. EVIDENCE: The home makes a good effort to provide activities on a daily basis and this was confirmed by records and in talking with individuals: “we have games, bingo, skittles nearly every day something or other”, “most days staff do something”. Contact has been encouraged with the local churches and a monthly service is held in the home. In response to Have Your Say questionnaire 8 individuals said “always” and 3 “usually” to ‘Are there activities arranged by the home that you can take part in?’ Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 13 The home recognises the importance of individuals maintaining contact with family and friends and there is an open visiting policy. In speaking with individuals who live in the home they spoke of how their visitors “are always made welcome” “no problem with people visiting me, always friendly” “staff all very friendly”. All relative respondents to questionnaire said that they were welcomed by staff when visiting the home. The menu showed that the home offers a wide range of meals and an importance is placed on meals being appetising and nutritious. Individuals confirmed that there is always a choice available. “The choice is excellent and always very well cooked”. An individual who was vegetarian said that their meals were always varied. Resident respondents to the questionnaire said that they “always” 10 and “usually” 1 “like the meals in the home”. On the day of my visit the meal was well presented and there was a relaxed and unhurried atmosphere. Staff were available to offer assistance in a sensitive and supportive way if this was necessary. The home has received a 5 star Food Safety Award by Gloucester Count Council recognising the high standard achieved by the home. Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 14 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has procedures in place enabling individuals to make a complaint and voice their views about the service they receive and to know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible residents are protected from harm by having policy and procedure about the Protection of Vulnerable Adults and providing training to all staff in this area. EVIDENCE: In talking with individuals who live in the home they were all very positive about their ability to make a complaint and aware of the complaints procedure which is included in the home’s Welcome Pack and displayed in the home. One individual said they had been “given complaints procedure in writing”. Records showed that individuals had been given copies and signed declaration to this effect. When asked what they would do if unhappy about anything individuals said, “would tell staff”, “would speak to someone” and importantly, “staff listen”, “they listen to you here”. All respondents to the questionnaire said they knew how to make a complaint. No complaints have been made since the previous inspection. The home has an Adult Protection policy and procedure and there has been a focus on staff undertaking Adult Protection training. Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 15 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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe, well-maintained and hygienic environment for the residents and staff. EVIDENCE: In walking around the home it was evident that there is a good standard of maintenance and the décor and facilities are of a high standard. There are plans to improve bathroom facilities. All respondents to the Have Your Say questionnaire said that the home is “always” fresh and clean and individuals I spoke to also confirmed this to me. Procedures are in place to deal with potential infection and relevant staff undertake infection control training. Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 16 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing arrangements in the home are good so that the needs of residents can be met in an efficient way with care being provided by skilled and competent staff. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of resident is protected. EVIDENCE: A real strength of the home is that there is stable staff group with a number of individuals having worked at the home for a number of years. A member of staff I spoke with said how there was always a good atmosphere in the home, that there was good team working and the management was open and “would always put things right if we asked”. In talking with individuals about staffing in the home specifically their availability and response to requests for assistance those I spoke to said that “nothing was too much trouble” “on the spot when I call for help” “can’t speak too highly of them” “always available when you need them”. All respondents to the Have Your Say questionnaire said staff were “always” available when you need them. Over 50 of staff have completed NVQ Level 2 or above training and this is an area of improvement for the home over the past two years reflecting a commitment from staff and management to raise the level of skills and knowledge of staff in the home. Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 17 The recruitment and selection records were looked at for a member of staff employed since the last inspection. They showed the required checks had taken place including two references, Criminal Record check and the application form supplied full and detailed information about their employment history. Training records for the 9 night duty members of staff were looked at and showed that all had completed the required “mandatory” training: Moving & Handling, Fire, First Aid, Adult Protection, Food Hygiene. Staff have also received Dementia and Care of Aging Skin training. Only four of the nine had undertaken medication training and this needs to be completed by all staff who have any responsibility to administer medication. It is noted that there has been a real effort to maintain training in the home this could be further improved by providing additional training in more specialised areas relating to the care of older people such as specific conditions i.e. Stroke, Parkinson’s and disability awareness. Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 18 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): 31,33,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good opportunities for residents and others to express their views about the service they receive. The practices of the home help to make sure that the health, safety and welfare of residents and staff are protected. EVIDENCE: The manager of Harefield Hall has extensive experience over a number of years of caring for older people. Individuals I spoke with were all very positive about her approach and how they “could always go and talk to her about anything”; “she is someone we can talk to”. Staff also described her as “approachable”. The manager and deputy are currently undertaking NVQ 4 in care. Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 19 Quality Assurance questionnaires are sent to residents (the last being Aug 06) a relatives questionnaire was completed in March 07. It was discussed with the manager the need to have such questionnaires on a minimum yearly basis and that looking at specific areas of care in home such as meals, activities, staffing may address what is perceived by the manager as questionnaire overload. Information from such questionnaires provide important evidence as to the quality of the care provided in the home and crucially give individuals in the home a real opportunity to comment and make suggestions about the quality of care they receive. The relative’s questionnaire provided very positive feedback about care provided in the home including the following comments: “I find all the staff friendly and approachable and always welcoming.” “I am very satisfied with the excellent care received and have no complaints at the moment.” Other written compliments seen on this visit: “She (individual’s relative) was made most comfortable by the kindness of the staff.” “We could not have found a better place for my relative to live.” Residents meetings are held monthly and one individual I spoke too said she found them helpful and “useful we can talk about anything that we may be unhappy about”. Minutes showed that suggestions had been made about the menu provided in the home and in talking with the cook she confirmed that she is always informed of these suggestions and trys to provide what is requested and make changes to the menu. Health and Safety records were looked at and showed that equipment is regularly maintained and services. The required fire risk assessment has been completed. Fire alarm tests are undertaken weekly and emergency lighting monthly. The last fire drill was undertaken October 2006 for night staff (however there is no record of those that were present and this should be recorded). Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 20 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 2 X 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 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 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 X X 3 Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 21 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 © 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 Harefield Hall DS0000003326.V343257.R01.S.doc Version 5.2 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!