Inspection on 25/04/05 for Harefield Nursing Centre

This inspection was carried out on 25th April 2005.

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

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

Other inspections for this house

Harefield Nursing Centre 25/06/07

Harefield Nursing Centre 11/09/06

Harefield Nursing Centre 08/05/06

Harefield Nursing Centre 14/11/05

Harefield Nursing Centre 05/10/04

Harefield Nursing Centre 15/04/04

Harefield Nursing Centre 10/09/03

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

CARE HOMES FOR OLDER PEOPLE Harefield Nursing Centre Hill End Road Harefield Middlesex UB9 6UX Lead Inspector Rekha Bhardwa Announced 25th&26th April 2005 at 09.50am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 Nursing Centre Version 1.10 Page 3 SERVICE INFORMATION Name of service Harefield Nursing Centre Address Hill End Road, Harefield, Middlesex UB9 6UX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01895 825 750 01895 825 760 ANS Homes Limited Vicky Dobin Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Harefield Nursing Centre Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Old age, not falling within any other category (40) Date of last inspection 5/10/04 Brief Description of the Service: The Harefield Nursing Centre is a purpose built home to accommodate 40 service users. It is situated in a semi-rural setting close to Harefield Hospital and Harefield Village and is served by public transport. The home was built in 1995 and all bedrooms are single occupancy with en suite facilities. The home consists of two floors with a lift. The first floor houses the kitchen, laundry and staff facilities and the ground floor is the living area for the service users. There are two spacious communal lounges and a dining room. The gardens are well maintained. Public transport in the form of Bus services are available in Harefield village and there are shops available in the village also. Harefield Nursing Centre Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out as part of the regulatory process. Rekha Bhardwa Lead Inspector undertook the inspection. A total of 13.15 hours was spent on the inspection process. The Inspector carried out a tour of each floor of the home, and inspected service user plans, staff files and maintenance records. 8 service users, 8 visitors and 8 staff were spoken as part of the inspection process. At the time of the inspection there were 36 service users. The pre-inspection documentation completed by the home was also examined to inform the inspection. What the service does well: What has improved since the last inspection? What they could do better: The home must ensure that service users that are not within the category of registration are admitted. Shortfalls in the recording of why medication has been omitted must be addressed. Systems for the recruitment of staff are not robust; this must be addressed as a matter of priority. Staff working in the home must receive fire drill training; there must be on each shift a staff member who has received training in First Aid. Malodours must be addressed. Harefield Nursing Centre Version 1.10 Page 6 An action plan on how the shortfalls in the environment are to be addressed following assessment must be formulated. The Registered Manager must undertake management training. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Harefield Nursing Centre Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Harefield Nursing Centre Version 1.10 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 standard(s) 1,3,4 and 5 Service users and their representatives are provided with written information about the home. Service users are assessed prior to admission to ensure that their needs can be met, where the service user is not within the category of registration they must not be admitted to the home, as the home would not be able to meet their specialist needs. Prospective service users and their representatives are encouraged to visit the home in order to allow them to make an informed choice. EVIDENCE: Service users, their relatives and representatives are provided with information regarding the home in the form of a Statement of Purpose and a leaflet directing them to the full. Copies of the Statement of Purpose and Service User Guide are available in the main entrance. Harefield Nursing Centre Version 1.10 Page 9 Pre-admission assessments were viewed on three service users files, these were comprehensive and contained information on the service users needs. Two Needs Led Assessments were also viewed. It was noted that on one preadmission Assessment that the service user had a diagnosed dementia. It was evident that several of the service users had dementia. The Registered Manager said that the home had established good links with the Woodlands Centre, which is attached to Hillingdon Hospital, and that staff had received some training in dementia care. Where service users do not fall within the current category of registration, the Registered Manager is required to provide an application for a variation of registration. The Registered Manager said that whenever possible, prospective service users are encouraged to visit the home, and meet other service users and staff. If the service user should not be able to make such a visit, the representative of the service user would also be encouraged to visit. Relatives who spoke with the Inspector confirmed that they had visited the home prior to their relative being admitted. The home does not accept emergency admissions at this time. Harefield Nursing Centre Version 1.10 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 standard(s) 7,8,9,10 The health and personal care needs of service users had been identified and were being met. Improvements were noted in the completion and content of the service user plans. Generally the medications systems were in place and being followed. Shortfalls in the recording of the reason for omissions were identified and were to be addressed. Service users were treated with respect and courtesy, and the changing needs of service users were being identified and met. EVIDENCE: Individual service users plans were available and samples were viewed on both floors. Overall these were comprehensive and detailed how the service users’ identified health, personal and social care needs would be met. The service users plans are reviewed monthly or sooner if the needs of the service user change. Assessments for moving and handling, nutritional screening, skin care, risks of falling and continence assessments were in place. One bedrail assessment had not been signed by the service users representative, however the Director of Harefield Nursing Centre Version 1.10 Page 11 Nursing was aware of this, as it had been identified during the audit of care plans. Where a service user had had a fall the risk assessment on falls had been reviewed following the fall. The records also indicated input from the GP, optician, chiropodist and other health care professionals. Wound care documentation was available, contained information on the type of dressing to be used and details of the progress of the wound. Daily records were available, signed and dated. Samples of the medication administration records were tracked. Overall these were satisfactorily recorded with the exception of one MAR sheet where the reason for omission had not been recorded. The Controlled Drugs register was viewed and was well recorded. Liquid medications were dated when opened; fridge and room temperatures were recorded. A policy and procedure on the administration of medication was available. Trained Nurses follow the NMC guidance on the administration of medication. Staff were seen to address service users in a courteous manner. Service users and visitors spoken with were generally satisfied with the care given and the attitude of the staff. Service users are encouraged to exercise choices within all aspects of their daily lives, some service users choose not to participate in activities and choose to spend time in their bedrooms rather than communal areas. Harefield Nursing Centre Version 1.10 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 standard(s) 12, 13, 14 and 15 Social activities are in place and an activities co-ordinator is required to fully meet the service users needs in this area. Visiting is encouraged for service users to maintain contact with family and friends. Service users choices in their care and routines are respected within the homes capabilities. Meal provision in the home is good offering variety and catering for special dietary needs. EVIDENCE: Information regarding activities was on display in the home. External entertainers also visit the home. Service users spoken with said that they enjoyed the activities arranged, and others said that they could choose which activities they wished to participate in and that their wishes are respected. Newspapers are delivered daily to some service users. The activities coordinator post was still vacant, and was due to be advertised. Relatives and friends were seen visiting service users throughout the day. Service users can choose to see whom they wish to see and their wishes are respected. Choices in relation to daily routines and care provision are offered to all service users. Service users spoken with indicated that choices are offered in relation Harefield Nursing Centre Version 1.10 Page 13 to all aspects of their daily lives, this included where they chose to spend their time and what activities they participated in. Bedrooms viewed were personalised and several service users had their own telephones. The lunch menu was sampled on the first day of the inspection; this was well presented and tasty. Menus were available and these reflected the main meal on offer, where a service user does not want the meal on offer the cook would prepare something different for them. Service users spoken with indicated that they were satisfied with the meal provision in the home. Snacks and hot and cold drinks are offered to service users throughout the day. The kitchen was viewed, this was clean, well maintained and all records were in place. Harefield Nursing Centre Version 1.10 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 standard(s) 16,17 and 18 The home has clear complaints procedures and service users and relatives were confident that their complaints would be listened to, taken seriously and acted upon. Systems were in place for the protection of vulnerable adults. Service users legal rights are protected. EVIDENCE: The home has a clear complaints procedure, which includes details for the CSCI. Complaints records viewed clearly recorded the action taken by the home to investigate the complaint, address any shortfalls, the outcomes and copies of all correspondence. Service users and visitors spoken with said that any concerns are taken to the Director of Nursing, senior nurse on duty or the Registered Manager. The Registered Manager said that at the present time no service users had advocates, but that she would contact Age Concern in Hillingdon should the need arise. Postal votes are arranged for any service users able and wishing to vote. The home has a clear procedure for the protection of vulnerable adults (POVA), and this dovetails with the Local Authority documentation. Staff within the home had received training in abuse awareness further training in this area was to be planned for new staff. Harefield Nursing Centre Version 1.10 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 standard(s) 19,20,21,22,23,24,25 and 26 The standard of the décor, environment and wear and tear within the home is poor and does not present as a homely, safe and comfortable environment for service users. The malodours throughout the home were not well managed and impact on the service users daily lives and environment. EVIDENCE: The home is purpose built. The living accommodation is situated on the ground floor. Wear and tear throughout the ground floor was evident. Door frames had been damaged by wheelchairs and hoists. A complete environmental assessment needed to be undertaken and an action plan formulated. A plan of routine maintenance and renewal was available. Harefield Nursing Centre Version 1.10 Page 16 There is a passenger lift for access to the first floor, which houses the laundry, kitchen and staff room. A tour of the home was undertaken and a sample of rooms viewed. These were well maintained and had been personalised by the service user residing in the room. There are two communal lounges, a dining area and an activities room on the ground floor. The grounds are well maintained and service users have access to the garden and suitable seating is available in the courtyard area. Suitable adaptations were available throughout the home, communal areas and bathroom and toilet areas. The home has a call bell system and generally the calls were being answered promptly by the staff. Service users are assessed to ensure that the correct moving and handling equipment is identified. The assisted bathrooms and communal toilets viewed were satisfactory with the exception of the ground floor shower room. Water had permeated through the shower wall and damaged the wall into the corridor. Mould and mildew were present around the shower area and the shower floor had lifted and was potential hazard. The shower room was not adequately ventilated. There are forty single bedrooms and all have en suite facilities to include a toilet and wash hand basin. The home was comfortably warm with satisfactory lighting at the time of inspection. Hot water temperatures are checked and recorded by the maintenance man on a monthly basis. Emergency lighting is in place and is also checked monthly, plus an external company checks and services it every 6 months. Policies and procedures for the control of infection were available. Protective clothing is provided and was seen on each floor and in the laundry. Malodours were noted throughout the home. A plan was in place to replace carpets throughout the home. A review of the continence management systems was needed. Harefield Nursing Centre Version 1.10 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30 The home is adequately staffed and service users receive consistent care and Staff have a good understanding of the service users needs. The standard of vetting and recruitment practices are poor, with appropriate checks not being carried out and potentially leaving service users at risk. Staff receive regular training and this ensures that staff have the necessary skills and knowledge to meet the service users needs. EVIDENCE: Staffing levels have not changed since the last inspection. The Registered Manager was aware that she needed to keep staffing levels under review in order to ensure that the changing needs of service users are met. Ancillary, domestic and catering staff are employed in sufficient numbers. The staff employment files viewed contained details of the applicants completed application forms, photograph, medical declaration, 2 references, copies of passports, plus terms and conditions of contract. One staff member had commenced employment on 7/2/05 and their POVA First check was returned on 14/2/05, another staff member had also commenced employment prior to a POVA First check or Criminal Records Bureau had been obtained. For another staff member a Criminal Records Bureau check from a previous employer had bee used. Since July 2004 these are no longer portable. Harefield Nursing Centre Version 1.10 Page 18 There was no system in place to track and monitor when POVA First or Criminal Records Bureau checks had been applied for or received by the home. Induction and foundation training to meet recognised standards was in place. In house NVQ training had started, and one carer had started this training. Harefield Nursing Centre Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,36, and 38. The home is well managed and meeting the service users needs is a priority for the management and the staff team. Lack of management training provision does not allow for management development of skills to further develop the home in the interests of the service users. Staff work together to meet the needs of the service users. Clear systems are in place for quality assurance so as to enhance the quality of life for service users. The arrangements for fire drill training and first aid training are unsatisfactory and potentially leave service users at risk. EVIDENCE: The Registered Manager is a First Level Nurse and has over 5 years experience in care home management. She has been in post for 18 months. Little Harefield Nursing Centre Version 1.10 Page 20 progress has been made in undertaking the NVQ level 4 in Management. The Registered Provider (Allied Nursing Services) does not offer formal management training. This issue must be addressed as a matter of priority. Visitors and service users spoken with were generally complimentary about the management and staff working in the home. There are clear lines of accountability within the management structure of the company. The notification of inspection poster was displayed. The Registered Manager and Director of Nursing undertake internal audits. An external audit was undertaken on 22/9/04, a report was available with an action plan detailing how any shortfalls would be addressed. Since the last inspection service users and representatives meetings have started. These meetings have been arranged in order that service users and their representatives can voice any concerns. Minutes of these meetings were available. A business and financial plan were available. Staff supervision records were viewed and overall were found to be satisfactory. The Director of Nursing was clear that supervision had to be undertaken every two months. Servicing records were viewed at random and were up to date. In house maintenance records were available and up to date. No fire drill training had taken place since 12/10/04. It was not clear when night staff had undertaken fire drill training. Two staff had received training in First Aid. The need to have a member of staff on each shift trained in First Aid was discussed. Harefield Nursing Centre Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 2 3 3 3 3 2 STAFFING Standard No Score 27 3 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 3 3 3 x 3 x 2 Harefield Nursing Centre Version 1.10 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 4 Regulation 12(1)(b) 14(1)(d) Requirement Where a service user is incorrectly placed, a variation of registration must be applied with evidence of how the home will meet the needs of that service user. Where medication has been ommitted, the reason for the omission must be recorded. A full environmental assessment must be undertaken and a copy of the assessment report and planned action sent to the CSCI. The shower room must be repaired and refurbished. The Registered Manager must ensure that systems are in place to manage malodour. These must include appropriate cleaning schedules and evidence of continence management. Staff must not be employed until a POVA First check has been obtained, and evidence of this must be available in the home (timescale of 17/1/05 not met). The Registered Manager must obtain a place to undertake NVQ level for management training or equivalent. All staff must receive regular fire Version 1.10 Timescale for action 4/07/05 2. 3. 9 19 13(2) 12 1/6/05 4/7/05 4. 5. 21 26 12 16(2)k 4/7/05 4/7/05 6. 29 Schedule 2(1)7,9,1 9 18 1/6/05 7. 31 4/7/05 8. 38 17(2) 1/6/05 Page 23 Harefield Nursing Centre 9. 38 Schedule 4.14 23(4)(c)(e ) 13(2) drill training, including night staff. records of this training must be maintained and available for inspection. The Registered Manager must ensure that a person with a recognised First Aid Certificate is on duty on each shift, in keeping with Health and Safety (First Aid) Regulations 1992. 4/7/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Harefield Nursing Centre Version 1.10 Page 24 Commission for Social Care Inspection Ground Floor 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Harefield Nursing Centre Version 1.10 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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