CARE HOMES FOR OLDER PEOPLE
Harefield House 47 Harefield Road Brockley London SE4 1LW Lead Inspector
Sean Healy Unannounced Inspection 25th November 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Harefield House DS0000025622.V258048.R01.S.doc Version 5.0 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 House DS0000025622.V258048.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Harefield House Address 47 Harefield Road Brockley London SE4 1LW 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) 0208 6926923 maggiestone@tiscali.co.uk Mrs Margaret Rose Stone Mr Raymond Julian Stone Mrs Margaret Rose Stone Care Home 13 Category(ies) of Dementia (2), Old age, not falling within any registration, with number other category (13) of places Harefield House DS0000025622.V258048.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. This home is registered for 13 elderly people of whom up to 2 may have dementia 20th January 2005 Date of last inspection Brief Description of the Service: Harefield House is a privately owned registered care home located in a quiet residential area of Brockley, South London. The home provides support and care for up to 13 older women, with elderly care support needs. The home takes only women, two of whom can be suffering from dementia. The home also provides respite care for up to one service user. There is lots of street parking available near the home. The home is comprised of three floors, with bedrooms on the ground floor and first floor. All accommodation is in single rooms, all of which have a sink and one of which has a shower en-suite. There is no lift access between the ground and first floor. The ground floor has four bedrooms, two large living rooms, and a dining room. There is a toilet/bathroom with a hoist, which is wheelchair accessible, and a separate toilet. The first floor has nine bedrooms and one bathroom/toilet with a mobile hoist. The second floor consists only of an office/sleepover room for staff, with toilet facilities. There is a basement, which is used mainly for freezer storage. There is a garden to the rear of the home. Public transport links include a bus service, which stops in Harefield Road, with main line train service and Docklands Light Railway in nearby Lewisham. Lewisham centre is also close by with a selection of shops, cafés and bars. Harefield House DS0000025622.V258048.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced, and took place over one day. It was facilitated by the assistant team manager, with the registered care manager also in attendance. The inspection included a tour of the home and examination of records on care plans of four service users, building maintenance and staff training and recruitment records. Observations were made of staff working with service users in the living room/dining room area where many of the service users were present throughout the inspection. Two staff contributed information and there was a group discussion with all service users present. At the time of this inspection there were three service user vacancies and one respite room vacancy. What the service does well: What has improved since the last inspection?
Information on all service users’ personal histories are now available for staff to help improve discussion between staff and service users and to provide information for planning which now helps activities for service users to be more tailored to their individual needs. The information available to prospective service users about the services offered has been updated. There has been a new system for planning care and support introduced, which is better for planning social and leisure activities, and the manager and assistant have completed training in risk assessment and started work on revising risk assessments. Service users commented that they are generally happy with the current activities on offer. This should help service users to be safer in their home. Monthly reviews now happen with service users and their families for the service users who use the stairs, to monitor their abilities and any identify any risk. These reviews currently show that all service users are
Harefield House DS0000025622.V258048.R01.S.doc Version 5.0 Page 6 safe in using the stairs. Radiators are now boxed in to protect service users from accidental burns. Employment checks now include two verifiable references for all staff employed. Good work is now being done to ensure that staff are trained to the appropriate NVQ qualifications. 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. Harefield House DS0000025622.V258048.R01.S.doc Version 5.0 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 House DS0000025622.V258048.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 5 Prospective service users have complete information to make a choice about where they live. Service users have complete assessments of need prior to moving into the home. Prospective service users and their family and friends do have an opportunity to visit the home to assess the quality of care offered prior to moving in. EVIDENCE: The home has updated the Statement of Purpose and Service User guide, which now has all the information, needed. It is recommended that the home consider putting in more information on the ethos and values of the home when next reviewing this information to include empowerment, inclusion and consultation with service users. (Refer to Recommendations OP1) The manager assesses all service users before admission and the assistant manager now assists in this process. The home has developed a better system for carrying out assessments, which has better information on risk assessments, and social and leisure care needs. Assessments are now in place for all service users. Trial visits to the home are now being facilitated. The respite room is vacant and the manager assured that any future admissions
Harefield House DS0000025622.V258048.R01.S.doc Version 5.0 Page 9 would be supported by an assessment prior to admission including emergency admissions. There have been no new admissions since last inspection. Harefield House DS0000025622.V258048.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 and 9 Service users’ health and personal care needs are set out in a personal care plan but are not being fully met in respect of risk assessments. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies for dealing with medicines. EVIDENCE: The home has done a lot of work to gather information on service users’ individual histories as an aid to planning and enabling meaningful reminiscence to happen between staff and service users. Some service users were not happy to provide extensive information and this has been noted and respected by the home. The planning system has improved to include better social care and activities planning, but there is a need to consider using more individual activities plans for each service user and monitor individual levels of activity to check that service users are having maximum opportunity to do the things they want to. (Refer to Recommendations OP7) Risk assessments have improved and the manager and assistant manager have attended risk assessment training for trainers facilitated by the Guardian Training Partnership. Risk assessment formats have changed and are now more comprehensive and are better at identifying risk individual to each
Harefield House DS0000025622.V258048.R01.S.doc Version 5.0 Page 11 service users rather than only the environment as had previously been the case. However, the care assessments contain some areas of risk, which is not properly assessed under the risk assessment process, such as falling down stairs or use of equipment. This needs to be addressed. (Refer to Repeated Requirement OP7 partially met) Service users’ plans are reviewed monthly and families and service users are involved in agreeing these plans twice yearly. However, all service users do not have an annual care review involving their social worker. The home’s management need to write to relevant social workers to prompt these reviews to ensure that the service is meeting the support and care needs of service users. (Refer to Requirements OP7) Service users have regular visits from dentists and opticians and are enabled to keep their own GP if they wish. The inspector found that the carers now have access to detailed information on service users continence needs and all service user plans include continence assessment, which are reviewed every six months. It is recommended that all service users be offered the opportunity to have dental visits at the home and that possibilities of facilitating this are explored. (Refer to Recommendations OP8) The home’s medication policy and practices are safe and properly managed and monitored. The policy needs to have the date of last review included. (Refer to Recommendations OP9) Harefield House DS0000025622.V258048.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 and 15 Service users feel that the lifestyles experienced in the home matches their preferences and social, cultural and recreational interests and needs. Service users maintain contact with their families, friends and local communities and service users receive wholesome and appealing balance diets. EVIDENCE: It was found that daily life in the home is flexible and that there were activities that the service users could take part in. Service users confirmed that they are happy with current activities, which are suitable for their age and abilities. One of the staff now takes on the role of activities co-ordinator and this responsibility should be expanded to include more individual weekly or daily plans for each service user and a means of recording when activities don’t happen as planned and the reasons why. (Refer to Recommendations OP12) Service users can have visitors at any time without restriction and they can entertain visitors in one of the home’s two sitting rooms or privately in their bedrooms. Service users confirmed this. The home takes care to record all visitor’s names and times of visits to protect service users and for fire safety purposes. Information regarding involvement of family and friends is included in the home’s Statement of Purpose and Service User Guide.
Harefield House DS0000025622.V258048.R01.S.doc Version 5.0 Page 13 Service users have contact with the local library and a local entertainer visits the home for social evenings. Some service users visit a local social club, and children from a local school have supervised visits every two months to meet service users who want to. The level of outdoor activity seems appropriate for this service users group but further individual planning in consultation with service users is recommended. (Refer to Recommendations OP7) Meals are served morning, midday and evening and service users are consulted weekly regarding the menu and are offered choice of food each day. Menus are maintained and service user assessments reflect their individual dietary needs from admission to the home. All service users spoken to say the food is very good and they get to eat things they like. Harefield House DS0000025622.V258048.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Service users can be confident that their complaints will be acted on and taken seriously, but may not always feel that they are protected from abuse by the home’s policy, which may allow inadequate reporting of abuse, as the policy needs to be reviewed. EVIDENCE: The home has an adequate Complaints and Compliments policy and there have been no complaints reported since last inspection. Service users confirmed that they are aware of the policy and would speak with the owner if necessary, as she is available on a daily basis. The home has an appropriate adult protection policy and training for this is provided. Staff reported that they had already received training on Adult protection and the assistant manager said that all staff have now received this training. The inspector saw that the home now has a clear statement precluding staff involvement in assisting in the making of or benefiting from service users’ wills. However, the local authority’s policy on Adult Protection was revised in 2005 and this is not reflected in the home’s policy. This may cause some confusion regarding the requirement to report to the Adult Protection Team immediately and regarding POVA requirements, which are not reflected in the home’s policy. (Refer to Requirements OP18) Harefield House DS0000025622.V258048.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,25 and 26 The environment is generally safe and well maintained but fire safety is not fully compliant. Service users have the specialist equipment they require to maintain their independence, and live in safe comfortable clean and pleasant surroundings. EVIDENCE: The home is active in maintaining safety for staff and service users and carries out regular health and safety checks. There is documentation to show that the following tests are regularly done and are up to date: Full electrical wiring five year test done 16/10/02, Gas test done 18/8/05, Emergency lighting and fire equipment tests done 3 monthly, Pest control checks done at least monthly, hoist maintenance is up to date, and service users using the stairs have abilities and risks reviewed monthly to ensure that mobility issues in respect of using the stairs are monitored. The London Fire Brigade visit approximately every five months. The last report of 7/11/05 showed that there is now a requirement for the home to ensure that some fire doors and closers are repaired or replaced, to ensure that all fire doors are functioning safely. The
Harefield House DS0000025622.V258048.R01.S.doc Version 5.0 Page 16 deadline for this as appearing in the LFEPA report is 7th January 2006. (Refer to Requirements OP19) Service users are currently fully mobile. As the home does not have a lift there is an ongoing need to monitor the abilities and risks regarding service users who use the stairs and this is being done monthly involving service users and families. The hoists in bathrooms are being well maintained. Various handrails are installed in bathrooms and the equipment in use appears to meet the requirements of service users. However, as it has been some time since the home has engaged an Occupational Therapist to assess the environment, and there have been a number of new service users move in since then, it is recommended that an Occupational Therapist be engaged to review the home, and the equipment used to ensure service users needs are being appropriately met. (Refer to Recommendations OP22) Heating and lighting is sufficient and all radiators are now boxed in to ensure risk of accidental burning is minimised. The home is maintained to a high level of cleanliness and all laundry is done off the premises. Harefield House DS0000025622.V258048.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 29 Service users are in safe hands at all times, but are not fully supported and protected by the home’s recruitment policy which could leave service users at risk. EVIDENCE: The home employs twelve care staff and does not employ nursing staff. Currently five care staff have achieved NVQ level two and the assistant manager is half way through the NVQ 4 course. Two other care staff are due to start an NVQ course in January 2006. The home therefore currently meets the target of having at least 50 of care staff holding an NVQ qualification. The home’s recruitment records have improved and two references are being taken up for all staff employed. The manager and assistant manager are now both involved in conducting interviews. CRB checks are being done including POVA checks prior to appointment. The home’s recruitment practices now protect service users, however the homes recruitment policy does not. The recruitment policy does not have a review date and important recruitment procedures do not appear in the current policy, such as POVA checks, a minimum of two people conducting interviews, references being taken up prior to appointment, health screening prior to appointment, maintaining appropriate records on staff proof of identity, probation period and review prior to confirmation in post. The policy must be reviewed to take these issues into account. (Refer to Requirements OP29) Harefield House DS0000025622.V258048.R01.S.doc Version 5.0 Page 18 The home should also consider using a recruitment checklist to monitor and record each check being done prior to appointment. (Refer to Recommendations OP29) Harefield House DS0000025622.V258048.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 and 38 The home is well managed but the registered manager does not hold the appropriate NVQ qualification, which is now a requirement of this post. The home cannot currently demonstrate that it is run in the best interests of service users, which may result in important decisions being made without their involvement. Service users’ health, safety and welfare are generally being promoted, but fire safety facilities need improvement. EVIDENCE: The present registered manager is a registered nurse but does not have and does not intend to obtain a management qualification at NVQ 4 level. She and the joint provider are working to ensure that there is a registered manager who is qualified at this level, and to this end the assistant manager is currently on an NVQ level 4 course, due for completion in June 2005. She has expressed an interest in progressing to become manager of the home but formal agreement on this has not yet been reached. Until this happens the previous requirement still stands. (Refer to Repeated Requirement OP 31)
Harefield House DS0000025622.V258048.R01.S.doc Version 5.0 Page 20 The home does engage in conducting service user meetings about twice a year and regularly meet with families who are included in reviews and risk assessments. At least one service user survey has been carried out in the past year. However, there is not currently any system in place for ensuring that all service users’ views are included, and there is no system for bringing together findings from these systems to plan for development at least annually, or to feed back findings and proposed action to service users or their families. (Refer to Requirements OP33) All health and safety systems checked were working to ensure the health and safety of residents, with the exception of the London Fire Brigade’s assessment that “Emergency routes are insufficiently safe due to inadequate protection from fire doors protecting escape routes which are below the required standard”. (Refer to Requirement OP Standard 19 in this report) Harefield House DS0000025622.V258048.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 3 X X 3 3 STAFFING Standard No Score 27 X 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 2 Harefield House DS0000025622.V258048.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 Standard OP7 Regulation 15.1 Requirement The registered person must ensure that all care plans are full, cover all risk areas and be reviewed with the service user and their relative at least six monthly. This was the subject of a previous requirement, Timescale 31/05/05, partially met. The registered manager must write to relevant social workers to prompt them to carry out annual care reviews. The registered person must revise and update the homes Adult Protection and Whistle Blowing policies in accordance with the local authority’s written policies. The registered provider must ensure that all fire doors are functioning safely in accordance with the requirements made by the LFEPA report of 07/11/05. The registered provider must review and update the home’s recruitment policy to ensure it reflects best practice and current legislation, especially in relation
DS0000025622.V258048.R01.S.doc Timescale for action 31/01/06 2 OP7 14.2 & 15.2 b 13.6 31/01/06 3 OP18 28/02/06 4 OP19 13.4 a 07/01/06 5 OP29 17.2 28/02/06 Harefield House Version 5.0 Page 23 6 OP31 9.2 7 OP33 12.3 & 24.1,2 ,3 to the protection of service users. (Refer to issues discussed in OP Standard 29 of this report) The registered person must ensure that by 2005 the home has a manager with qualification to the level of NVQ 4 in management and care. This is a repeat of a requirement from the last inspection, Timescale 31/12/05 unmet. The registered individuals must ensure that an appropriate, professionally recognised quality assurance system based on seeking the views of service users is operated within the home, to include an annual audit and annual development plan. 30/06/06 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations It is recommended that the registered provider and manager consider adding more information on the ethos and values of the home, when next reviewing the Statement of Purpose, information to include empowerment, inclusion and consultation with service users. The registered manager should consider using more individual activities plans for each service user and monitor individual levels of activity, in order to check that service users are having maximum opportunity to do the things they want to. The registered manager should try to ensure that all service users are offered the opportunity to have dental visits at the home, as opposed to having to travel to the dentist. The registered manager should review the home’s medication policy to include the date of last review
DS0000025622.V258048.R01.S.doc Version 5.0 Page 24 2 OP7 3 OP8 4 OP9 Harefield House 5 OP12 6 OP22 7 OP29 The registered manager should consider expanding the role of the activities co-ordinator to include more individual weekly or daily plans for each service user, and a means of recording when activities don’t happen as planned and the reasons why. The registered manager and provider should engage an Occupational Therapist to review the home and the equipment used to ensure service users’ needs are being appropriately met. The home should consider using a recruitment checklist to monitor and record each check being done prior to appointment. Harefield House DS0000025622.V258048.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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