Inspection on 15/09/06 for Harewood Court Nursing Home

This inspection was carried out on 15th September 2006.

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

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

Other inspections for this house

Harewood Court Nursing Home 20/01/10

Harewood Court Nursing Home 21/01/09

Harewood Court Nursing Home 29/01/08

Harewood Court Nursing Home 22/02/07

Harewood Court Nursing Home 07/03/06

Harewood Court Nursing Home 21/04/05

Harewood Court Nursing Home 13/10/04

Harewood Court Nursing Home 08/07/04

Harewood Court Nursing Home 24/02/04

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

CARE HOMES FOR OLDER PEOPLE Harewood Court Nursing Home 89 Harehills Lane Leeds Yorkshire LS7 4HA Lead Inspector Catherine Paling Key Unannounced Inspection 09:40 15 September 2006 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 Harewood Court Nursing Home DS0000001345.V303974.R02.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. Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harewood Court Nursing Home Address 89 Harehills Lane Leeds Yorkshire LS7 4HA 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) 0113 2269380 0113 2285697 Solutions (Yorkshire) Limited Mrs Pearl Jackson Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (3) of places Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th March 2006 Brief Description of the Service: Harewood Court opened in 1995. It is situated in a busy residential area of Leeds, which is well served by public transport. There are a range of local amenities within close proximity. The home is registered to provide care with nursing for up to forty older people and three younger adults with physical disabilities. All bedrooms are for single occupancy and have en-suite facilities. The home covers three floors. Residents’ accommodation is on the first and second floor. Each floor has a separate lounge and dining room, with a kitchenette available for making snacks and drinks. The main ancillary services, on the ground floor, do not intrude on the facilities and accommodation available to residents. There is a patio area accessible to service users, by means of a ramp from the first floor lounge. A passenger lift allows access to all floors and the home is accessible to people with disabilities. Harewood Court promotes a smoke-free environment; people are made aware of this verbally and through the statement of purpose. A covered smoking area is available in the grounds. Information about the services provided by the home in the form of a Statement of Purpose and Service User Guide is available at the home. Information about the fees and any additional charges had not been given to the CSCI at the time of writing this report. Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. All regulated services will have at least one key inspection between 1st April 2006 and 1st July 2007. This is a major evaluation of the quality of a service and any risk it might present. It focuses on the outcomes for people using it. All of the core National Minimum Standards are assessed and this forms the evidence of the outcomes experienced by residents. On occasions it may be necessary to carry out additional site visits, some visits may focus on a specific area and are known as random inspections. The visit took place on 15 September 2006 and was unannounced. Two inspectors were at the home from 9.40 until 18:50. The registered manager was at the home briefly on the morning of the visit. Some feedback was provided to the nurse in charge during the visit. Telephone contact was made with the registered manager the following week to feedback on areas of serious concern that have also been detailed in a letter sent in advance of the full report. The purpose of the inspection was to ensure the home was operating and being managed for the benefit and well being of the residents and in accordance with requirements. Before the inspection accumulated evidence about the home was reviewed. This included looking at the number of reported incidents and accidents and complaints. This information was used to plan the inspection visit. A number of documents were inspected during the visit; some areas of the home were seen, such as bedrooms and communal areas. Inspectors also spent a good proportion of their time talking to residents, staff and visitors. Residents who were unable to comment on their experiences were observed. The home was asked to complete a pre-inspection questionnaire (PIQ) to provide additional information about the home. This was not returned before the inspection. A further copy of the PIQ was handed to the registered manager at the visit. At the time of writing the report it had not been returned. Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Following the visit areas of serious concern were shared with the registered provider/manager by telephone and in a letter in advance of the full report. Care plans were not up to date and did not reflect the current care needs of residents. Where there had been serious concerns about skin damage other healthcare professionals had been involved but their detailed instructions had not resulted in care plans being updated. Records of regular positional changes for the most dependant residents were not up to date The manager must make sure that staff have access to up to date information about the care needs of residents. Records are an essential part of care and must be accurate and up to date Nutritional risk assessments had been done but were resulting in misleading results that were not being questioned by staff. Records of the fluid and food intake for those residents at nutritional risk must be accurate and up to date. Staffing levels in the home must be reviewed in order to make sure that they are kept at levels, which take into account the numbers and identified needs of residents as well as the size and layout of the building. This must include all designations of staff and take into account resident’s social and cultural needs. Appropriate action should be taken to make sure that resident’s social, cultural and religious needs are met. The staff training programme must make sure that all staff receive training in order to maintain the health, safety and well being of themselves and residents and to meet the specialist needs of residents living in the home. Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 7 The registered provider/manager said that she had planned to franchise the home. An interested person had been identified and had worked at the home for a short time over the summer. However, this had not proved successful and she now needs to provide direction and leadership to the staff team to make sure that the care needs of residents are met and that residents are not put at risk by care being overlooked. Additional information can be found in the body of the report. Requirements made as a result of this visit can be found at the end of the report. The requirements include the production of an improvement plan that must detail the actions the provider intends to take to improve the service for the residents living at the home. 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. Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 8 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 Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 9 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): 3 and 4. (Standard 6 does not apply to this home) Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ needs are assessed before they are admitted to the home but people with needs outside of the homes registration categories are admitted and staff have not received appropriate training to meet those needs. There is a risk that these specialist care needs will not be met. EVIDENCE: The certificate displayed in reception was a photocopy and not the original. The pre admission assessment for a resident who had been admitted in August 2006 was carried out a week before they were admitted to the home. It provided enough information about their needs for a decision to be made as to whether or not the home would be able to meet their needs. But it was clear that their main reason for needing 24 hour care and support was because they had dementia. The home is not registered to admit residents with dementia and staff have not received appropriate training in this specialist area of care. Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 10 The local authority funds most residents in the home and there are three way contracts in place between them, the resident and the home. For those residents who are self-funding there are appropriate contracts and terms and conditions of residence in place. Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 11 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, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans were not up to date and information from other healthcare professionals had not been transferred onto care plans and was not being followed. This means that there is opportunity for care needs to be overlooked and residents put at risk. Some medication practices are unsafe and place residents at potential risk. Service users are treated with respect and their dignity is upheld. EVIDENCE: A small number of care plans was looked at. One for a resident who had been at the home for three years and another for a resident admitted in August 2006. There was evidence that the residents and relatives were aware of the care plans, as they had signed the plans. Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 12 The care plans did not provide staff with clear and detailed information about how to meet resident’s needs. The plans were not individual or person centred the same information for some needs was seen in both plans. There was no indication, for example, whether English was the first language of the resident. The plans about communication only said to speak slowly and clearly, use family as advocates and use touch to reassure. Both residents were insulin dependant diabetics. The care plans said that blood glucose levels were to be checked twice daily but did not give clear information about: • What were acceptable blood sugar levels. • What action staff should take if blood sugar levels were not within acceptable limits. • Care and monitoring of the injection sites. Steps must be taken to contact the diabetic nurse specialist to make sure that care provided to diabetic residents is in line with current good practice. The care plans are set out around the activities of daily living, which follows headings such as elimination, mobility, personal care and maintaining safety. The information in the plans under these headings was not individual to the clients and could have related to most residents in the home. The plans also addressed two separate care issues under one heading and did not give staff enough information about how to meet resident’s needs for either issue. For example: • The care plan for elimination looked at urinary catheter care and constipation. These are two very separate issues needing more detailed information. The details about catheter care did not say what size or type of catheter was being used, what date it had last been changed, when the next change was due, what type of drainage bags were being used and how staff should keep it clean. • Care of a suprapubic catheter and a colostomy were covered in the same plan. Again there was no information about what type of catheter was being used and when it had last been changed. It said that the bag contents should be checked for output and odour – but it did not say which bag. There was nothing about the size and site of the stoma and what products were being used to cleanse and protect the skin or what type of bags were used. These are two specialised areas of care that need detailed individual care plans providing staff with guidance. • One of the residents was immobile and at risk of developing pressure sores but this was addressed in the care plan for mobility. The care plan said that they were on a specialist mattress but not what type or what setting it should be on. It said that the resident should be repositioned two to three hourly but there was no information as to how this would be evidenced and there were no position change records available. • Information about one resident’s nutritional needs was found in the diabetic care plan. The resident needed help to eat and a soft diet. The Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 13 • • • plan did not provide any information about what types of food they preferred to eat or if any specialist equipment such as feeder cups could be used to help them retain some independence when eating. There was no information seen about how dementia affected two of the residents and what staff should do to meet these needs. The mobility care plan for a resident said that they could not mobilise independently and needed to walk using a zimmer frame with the supervision of a member of staff. But the daily records showed that they were ‘wandering ’ after the evening meal on more than one occasion. There was no guidance for staff on what to do with the resident on these occasions or how to occupy their time. The nutrition care plan for a resident with dementia said that they were not choosy about food and they should have ‘high nutritious diet with proteins, fibre and carbohydrates’. But the plan does not say anything about enriching the meals provided, providing small frequent meals and snacks or what type of foods they do like to eat or how much help was needed. A key worker system is in operation at the home. One of the carers spoken to had a good insight into the needs of the residents allocated to them. They said that they would look at care plans if they had time but that they were not involved in the care planning process. It would be good practice to get their input when writing care plans as they have more contact with residents and could provide nurses with valuable insights into an individuals needs. The care plan for a resident at risk of developing pressure sores showed that they had developed a small superficial sore and a dressing had been applied but the medication administration record (MAR) chart did not show that the dressing used had been prescribed for them. A diabetic resident had been given ‘Hypostop’ when their blood sugar was low but this was not prescribed on their MAR chart or included in the care plan as an action to follow. Other care plans did not reflect the current needs of the residents. For example, the tissue viability nurse (TVN) has visited one resident, who has extensive skin damage. Instructions and guidance about their care were left and included checking the setting of the specialist mattress. The setting had been too high when the TVN had visited the home. This information had not been transferred to the care plan and there was no evidence that the mattress setting was being checked. Turn charts did not provide evidence of two hourly turns and only included entries from the night time for the previous seven days. Turn charts did not provide evidence of regular positional change for another resident. This resident had a grade 3/4 sore to her sacral area, which had deteriorated rapidly. The TVN has been involved who has left instructions to Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 14 record positional changes and dietary and fluid intake. There was little evidence that these instructions were being followed Although there is a nutritional risk assessment in place it is not being used correctly and providing misleading results which staff do not seem to be questioning. For example, one resident is assessed as being ‘low risk’. This resident records state that they have a poor appetite; have lost 5kgs between June and July and extensive skin damage including a grade four pressure sore to the sacrum. The most recent fluid chart was dated 13/09/06 and indicated an intake of 240mls. There was no food diary providing any evidence of food intake. This resident had not been weighed since July. The nutritional risk assessment for another resident suggests a ‘low risk’. This is at odds with their condition as this resident is being nursed in bed and ‘requires full assistance with diet and fluids’. Recording of diet and fluids was poor with no chart for the day of the visit and others showing poor fluid intake. The most recent dietary intake recorded was for 02/09/06. Concerns about this resident were shared with the nurse in charge on the day of the visit. In June 2006 the manager carried out a medication audit and identified that there were some problems with the records kept. Memos were sent to the nurses and one to one sessions were to be held to discuss medication practices. Medication updates were also to be arranged for the nursing staff. Supervision and training records indicated that this had not been done for all the nurses at the time of this visit. The MAR charts were looked at. These showed that: • Some of the charts had been handwritten and the information section only showed the residents name. • Some of the prescribed medications had been handwritten on the charts but there was no signature from the person transcribing the information. • Not all the charts showed how much and on what date stocks had been received into the home. • There was no system in place on the MAR charts for carrying forward stocks of drugs that were used ‘as required’. • On one chart there was a ‘tick’ instead of a signature and it was not clear if this was to show the drug had been given or not. Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 15 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, 14 and 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. The more able residents are able to make choices about their day-to-day lives. Staff need to work at ensuring less able residents are encouraged to exercise choice wherever possible. Residents are supported in maintaining contact with their family and friends. Visitors are welcomed at the home. Although information had been gathered about individual social care needs the records of activities did not indicate that these assessments were used to inform the planned activities. There were poor records of food served to the more highly dependent residents making it difficult to establish whether a varied and nutritious diet was being provided to them. EVIDENCE: Information about residents social care needs was found at the back of the care plan. These were completed by the support worker who is employed part Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 16 time and divides their time between the two floors. The initial evaluations were detailed and provided an insight into individual social, cultural and religious care needs. But the evaluations and entries about what had been done to meet them were not in line with the original assessment. For one resident the religious information said that they were Baptist and very involved with the church, but their visitors said that they part of an entirely different type of Christian church. There were eight entries made by the support worker since January 2006 and they did not mention visits from church members or other members of black community groups and organisations. The entries were about chatting or doing their nails. In the case of another resident, one nationality was recorded within the personal information section but the social plan referred to a completely different nationality. Although it appeared that attempts had been made to meet the religious needs of this resident, after more than a year in the home there was no record of them having taken part in communion or having been visited by a minister. There were no social activities taking place on the day of the visit. Staff said that the support worker does do all kinds of activities with the residents and that a ‘motivation’ person comes in each week and visits alternate floors. At 09:00 four residents were sat in the dining room waiting to have their breakfast. Two of them said they had not had anything to eat or drink and one said they had been up since 06:45. A care worker came in to give out breakfasts at 10:00. The residents were offered drinks, cereals and toast. The kitchen was not in use as it was being deep cleaned and alternative arrangements had been made for meal provision. Three residents in their own rooms were asked if they had had any breakfast or a hot drink since getting up and they said not. On the second floor a lot of residents were sat in the dining room waiting for their breakfast. The carer here said they were later than normal because of the kitchen being cleaned. They said usually it was served from 09:00am and that if residents wanted a drink or cereals earlier than this they could have it. There are a number of Afro Caribbean residents living in the home. Staff said that the chef would make Afro Caribbean meals on request and that often relatives would bring meals in. As already referred to in the outcome group ‘Health and personal care,’ records of the food served to the more dependant residents were poor. Records did not provide evidence that their nutritional needs were being met. Visitors are welcomed at the home at anytime. Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 17 Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 18 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a clear complaints procedure. However, residents are placed at potential risk by poor management and organisation of the home and a lack of staff training about adult protection. EVIDENCE: The complaints procedure is displayed in the reception area. This was clear and easy to follow. Information about the complaints dealt with since April 2006 was looked at. There had been three and one was still being investigated. One of the complaints was about a resident being sent to hospital without an escort because the home was short staffed. The complaint was upheld and instructions were given that all residents going to hospital must be escorted and if there was a problem the ‘on call’ manager must be contacted. However there was no detail as to where this information would be kept and during this visit it was clear that staff in the home were not clear about who was in overall charge of the home. The issues about management of the home have been addressed in the sections about staffing and management. Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 19 The complaints records were handwritten and difficult to follow and not all entries were dated and signed. These records are required for inspection and should be legible. Some of the staff spoken with had not yet had any training about abuse or adult protection. But they said they would not hesitate to report suspected or actual abuse to the person in charge. One carer knew they could also contact CSCI but did not know about the local authority adult protection unit and their policies and procedures. Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 20 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall residents live in a safe and well-maintained environment. EVIDENCE: The maintenance schedule provides evidence that there are regular checks of equipment and that there are systems in place for the routine maintenance of equipment. The carpet on the first floor is badly marked and stained. The registered manager said that it was a fault with the carpet and that it was to be replaced. One room had an underlying odour of urine, staff said it was because the person had just got up but there was still a slight odour at the end of the day. Most areas of the home were clean. The care staff had to clean the dining rooms after lunch and there was food debris on the floor for some time after the lunchtime meal. Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 21 Bedrails were fitted incorrectly in a bedroom on the first floor. The bedrails were broken with a part missing. The rails were not securely fitted to the bed base and an air mattress was directly on top of them and the bed base. This posed a danger to the person in the bed as the rails were easily dislodged. This was pointed out to the registered manager and the handy man at the time of the visit. Staff responsible for fitting and checking bed safety rails must be clear about what safety checks are needed to make sure that the resident is not placed at greater risk through their use. Records should be kept of checks carried out. Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 22 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): 27, 28. 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff are not sufficient to meet the needs of the residents. Staff have not received appropriate training about specialist care needs of residents and there is a risk that these will not be met. The recruitment procedures protect residents. EVIDENCE: It was not clear who was in charge of the home and the receptionist and trained staff clearly did not know. Inspectors were told that the nurse on the first floor was in charge. It was his second day at the home but his first time working as nurse in charge for the first floor. He had been in for induction/orientation the day before. He did not consider himself as in charge and referred to the nurse on the second floor as being in charge. The nurse in charge on the second floor had been on duty since 20:00 the night before and said she was waiting for the registered manager to come and take over at 10:00. The registered manager arrived at 10.30 and said that an agency nurse had been arranged was coming to take over from the night nurse. Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 23 The rota indicated that two of the carers on duty did not arrive until 09:00 and were only rostered to work until 13:00. When these two staff went off duty it left the agency nurse and an inexperienced carer on the second floor to manage the busy lunchtime period. The nurse was occupied with medication administration. The registered manager was only at the home for a short time and the nurse in charge did not know that she had left the building. The manager said that the homes team of domestic staff are now working to a rota so that cover is provided at the weekends. The available rotas did not reflect this. Staff said that sometimes there are not enough of them on duty. At mealtimes they set the tables, serve and give out meals, help residents to eat, clear the tables/trays, tidy the dining room and do the washing up. Staffing levels fall after 13:00 when there are usually three staff on each floor. There is not always a nurse on each floor throughout the daytime hours and on-call arrangements are not clear. A carer said that over the last twelve months they had done health and safety, moving and handling and fire safety training. They had started a distancelearning course about infection control but this had not been completed because the college providing the course had had staffing problems. They had not yet done any training about diabetes or dementia care. Five staff files were looked at. These showed that: • Application forms had been completed and included a request for a full employment history. • All staff are interviewed and completed an interview assessment. • Two references had been requested in all cases but these were not always from the current or most recent employer. Written references were not in place for all staff but dated and signed notes of telephone conversations with the named referees were available. The administrator said that all efforts were made to get written references but this was not always possible. • Terms and conditions of employment were issued. The administrator said that Criminal Records Bureau (CRB) disclosures were in place for all staff. All new staff had done an in house induction, which included an introduction to the home, the building and the policies and procedures. The most recently employed care assistant had started a TOPSS (Training Organisation for Personal and Social Skills) course. These standards have now changed and Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 24 advice about the Common Induction standards should be sought from the Skills for Care website. Personal development plans were kept in the staff supervision file but none of the ten looked at were completed. The only ones with any information on them about planned or received training were for the nurses and included wound care, pressure area care and the need for medication updates. Training records in staff files were not up to date. The training matrix showed that there were large gaps in training provision to staff. Not all had received moving and handling training and many had not received an update annually as required. Other areas of training where there were shortfalls included fire safety, health and safety, food hygiene and adult protection. Staff had not had training with regard to specialist areas such as stroke, diabetes, dementia or physical disabilities. They need to be provided with this specialist knowledge to effectively care for the residents. Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 25 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, 32, 33, 35, 36 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home is not well organised. The manager does not provide clear leadership, guidance and direction to staff to ensure that residents receive a consistently good level of care. This results in some practices that do not promote the health, safety and well being of the people using the service. EVIDENCE: The responsible individual/registered manager was at the home at about 10.30 for about an hour before going on leave and spoke with the inspectors. There had been some changes in the management arrangements earlier in the year that had not proved to be successful. The responsible individual and Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 26 registered manager had wanted to relinquish day-to-day control and had tried to recruit a suitable manager to take over this role. There is a ‘Quality File’ that contains information about the in-house quality assurance programme. There was some evidence that ‘quality questionnaires’ are completed. Blank questionnaires were seen in the entrance foyer and a completed, undated one was seen in the file from a physiotherapist who was satisfied with her experience of the home and had no suggestions for improvement. The file also contained the Annual Quality Plan 2006 and provided information about the areas that are audited on a regular basis throughout the year. For example, care plans and medication audits carried out twice a year. There is also an annual external audit of the home. The business review for 2006/07 included the intention to stabilise staffing, reduce agency costs and to keep staffing costs to below 50 of income. Minutes of the last residents/relatives meeting were dated 2nd November 2004. Minutes of the last staff meeting were dated 6th May 2005. The home has a system for one to one meetings with nurses and care staff at least six times and other staff twice a year. There is an in-house format for recording formal supervision. However, this was not being fully utilised. The sessions appeared to be used more if there were disciplinary issues with an individual. The topics discussed were not carried forward to the individuals personal development plan even when areas for training or support had been identified. All those providing staff supervision and appraisal should receive appropriate training in order to make sure that the process can be used effectively to monitor staff performance and help them with personal and professional development that will benefit themselves and the home. The administrator looks after the financial affairs of one resident. Appropriate records were kept of all financial transactions and the administrator has produced a protocol about how the resident’s bank and savings accounts are to be managed and monitored. There is an in-house form to record resident accidents. One recorded accident included reasonable detail but was undated and unsigned. This form also indicated that relatives had not been informed of this accident. Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 27 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 X X 3 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 3 X 3 3 X 2 Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 28 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 2 Standard *RQN OP4 Regulation Requirement Timescale for action 06/11/06 3 OP7 Section 28 The original certificate of CSA 2000 registration must be displayed at the home. 14(1) The provider must be able to 18/12/06 demonstrate that the home can meet the needs of the residents living in the home. 15 Care plans must set out in detail 04/01/07 the action which needs to be taken by care staff to make sure that all aspects of the health, personal and social care needs of residents are met. Where other healthcare professional are consulted the provider must make sure that their instructions are include in care plans. The provider must make sure 27/11/06 that any unnecessary risks to the health and safety of service users are identified and, as far as possible eliminated by means of detailed risk assessment together with a detailed plan of management where a risk is identified. Nutritional risk assessments DS0000001345.V303974.R02.S.doc Version 5.2 4 OP8 13(4) Harewood Court Nursing Home Page 29 5 OP9 13(2) 6 OP12 16(2)(m) 7 8 OP13 OP14 16(2)(m) 12(2)(3)& (4)(a) 9 OP15 16(2)(i) 10 OP18 12(1)(a) 13(6) 18(1)&(3) 11 OP27 should be reviewed to make sure that they provide accurate information. The provider must make arrangements for the safe recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The provider must consult the service users about their social interests and make arrangements to enable them to engage in local, social and community activities. The provider must make sure residents have contact with the local community as they wish. The provider must make sure systems are in place for all residents to be able to make choices and have control over their lives. A review must take place of the provision of food and drink to make sure that all residents receive suitable and nutritious food and an adequate fluid intake. The provider must make sure all staff have received appropriate training in relation to adult protection. The provider must review the staffing numbers and skill mix of qualified and unqualified staff to ensure that these are appropriate to the assessed needs of the service users, the size, the layout and purpose of the home, at all times. Care staff must not be taken away from caring duties to carry out domestic tasks. There must be sufficient ancillary staff on duty at key times for example, for all meal times. 27/11/06 08/01/07 15/01/07 15/01/07 27/11/06 05/02/07 18/12/06 Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 30 12 13 OP28 OP30 18 18(1) Timescale of 30/04/06 not met The provider must ensure that there is a minimum ratio of 50 trained care staff to NVQ level 2. The provider must make sure that all staff receive training in order to maintain the health, safety and well being of themselves and residents and to meet the specialist needs of residents living in the home. Training must be provided by people who are qualified and competent to do so. Records must be kept. 05/02/07 05/02/07 14 OP31 15 16 OP32 OP33 17 OP38 18 *RQN Timescale of 30/04/06 not met 9 The manager must provide clear supervision and leadership to all staff including the trained nurses to make sure that that can effectively meet the needs of the residents 9 The provider must make sure the home is managed properly. 24A The provider must produce an improvement plan setting out the methods and timetable of how they intend to improve the services provided at the home. 23(2)(c) There must be a system in place for the checking of bed safety rails and records kept. Persons responsible to fitting and checking bed safety rails must be trained to do so. Section 31 The provider must complete and CSA 2000 return the pre-inspection questionnaire. 27/11/06 27/11/06 18/12/06 27/11/06 06/11/06 Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 31 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. 2. Refer to Standard OP12 OP16 Good Practice Recommendations The registered person should make sure that the identified social, cultural and religious needs of residents are met. The provider should make sure that records of complaints are clear and legible. Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Harewood Court Nursing Home DS0000001345.V303974.R02.S.doc Version 5.2 Page 33 - 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!