Inspection on 22/02/07 for Harewood Court Nursing Home

This inspection was carried out on 22nd February 2007.

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 15/09/06

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 22nd February 2007 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 Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Harewood Court Nursing Home DS0000001345.V328034.R01.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.V328034.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th September 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 is 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. Resident’s 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. The home has a comprehensive fee structure in place and a guide to this is included in the service user guide. The fees range from £404.63 to £537.63 although charges can vary according to contract, prior agreements and dependency levels. Fees for younger adults admitted with physical disabilities are determined by individual assessment. Physiotherapy can be provided at a cost of £25 per hour. Additional charges are made for chiropody, hairdressing, weekly massage, outings and for dry cleaning. The information on charges was provided as part of the pre-inspection questionnaire sent to the CSCI in November 2006. Copies of previous Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 5 inspection reports are available in the entrance of the home. Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 6 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 30th June 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. Information about the CSCI can be found on the website at www.csci.org.uk 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 first key inspection was carried out on 15th September 2006 and was unannounced. A further random inspection was carried out on 18th October to look at staffing in particular following the receipt of concerns about staffing levels. Following these inspections the provider was asked to produce an improvement plan with information about how they intend to address the identified shortfalls. This was received in January 2007. This second key inspection was carried out on 22nd February 2007 and was unannounced. Two inspectors were at the home from 10.00 until 18.35. Feedback was provided to the manager after the site visit on 27th February. The purpose of this inspection was to assess progress in the implementation of the improvement plan and 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, 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. Before the September 2006 inspection the home was asked to complete a preinspection questionnaire (PIQ) to provide additional information about the Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 7 home. This was returned to the CSCI in November 2006. Information from that document has been used in this report. The general manager was available on the day of the visit. Arrangements were made to give direct feedback to the registered manager following the inspection; this took place on Tuesday 27th February 2007. What the service does well: What has improved since the last inspection? Following the last inspection the provider produced an improvement plan that described how they intended to address the shortfalls that had been identified. The registered manager is spending much more time at the home and this has had a positive effect in that she provides clear leadership and direction to the staff. The manager has reviewed the care of all the residents and has rewritten the care plans to make sure that they provide relevant and up to date information for staff. A member of staff has been appointed to oversee the provision of activities at the home. She is enthusiastic about her role and is also looking to meet the differing cultural needs of the residents at the home. The new chef has been involved in a complete review of the menus and this has included catering for the ethnic dietary needs of some of the residents. Additional training has been planned for staff to help make sure that they have the skills to meet the specialist needs of the residents living at the home. Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 9 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.V328034.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5. (Standard 6 does not apply to this service) Quality in this outcome area is adequate. 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, so all concerned can be sure their needs will be met. There is a risk that specialist care needs will not be met as staff have not yet received appropriate training to meet the needs of people at the home outside the home’s registration categories. EVIDENCE: Information is available to current and prospective residents and their families in the form of a statement of propose and service user guide, which provide information about the services and facilities available at the home. The recently revised version will also include more pictorial information. There is a large information file in the reception area containing these documents and other information relevant to the service. This includes copies Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 11 of previous reports, results of satisfaction surveys and letters and cards of thanks. The only recent admission to the home had been transferred back to hospital. In the selection of files looked at there was clear evidence pre-admission assessments are carried out prior to admission. The service user guide also included the invitation to prospective residents to visit the home for a meal or even an overnight stay. The manager said that she had reviewed the format of the pre-admission assessment so that it followed the activities of daily living in such a way as to trigger the production of care plans once the resident has been admitted. Staff have yet to receive training in the specialist area of dementia care as identified at the previous inspection. However this training has been arranged for some staff and is to take place in June 2007. Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall, staff respect the privacy and dignity of residents and needs have been reviewed to make sure that the information within the care plans is accurate. Some medication practices were unsafe. EVIDENCE: There has been an overall improvement of the quality of the information within the care plans. The manager saidthat she has reviewed the care of all the residents to make sure that the information that she has produced in the new care plans is accurate. Although there are still problems with updating the information within care plans the manager is aware of this and has plans in place to work with the nursing team to make sure that they are completed properly. There is a range of risk assessments carried out including a nutritional risk assessment. Records of weights indicated that there are a number of residents with low weight. Food diaries are not used for all those with low Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 13 weight and records of food intake were not clear and did not provide the detail of what people were eating. Records of food intake had not been completed for anyone since 17/02/07. Additional calorific snacks were given and were mostly chocolate and crisps rather than full fat yoghurts or home baking and seemed limited in choice. Nutritional care plans stated that residents should have a fluid intake of 8 glasses/mugs a day. This was not evidenced as there were no records of intake. Risk assessments also identified those at risk from skin damage. Turn charts were not in use for anyone. There is no way of evidencing that residents with skin damage or at risk of skin damage are receiving the positional changes needed. One resident has skin damage and the records were confusing and unclear. The care plan states that a three hourly positional change is needed but there was no clear record of this happening. This resident was sat in a chair all morning, sat in a wheel chair for lunch and then taken back to sit in the lounge. Another resident who had skin damage was being persuaded to spend time in bed. Records of the tissue viability nurses’ (TVN) visit to one of these residents had been recorded in the wrong records. The manager advised that she was aware that a member of agency staff had entered the information in error. It had now been corrected. Care must be taken to ensure that information within care records is accurate. Discussion also took place about the implementation of instructions from the TVN when residents were not fully compliant. Every attempt should be made to negotiate with the resident as far as possible to follow the advice given. Care plans should clearly show what instructions are being followed. The care plan of a resident with diabetes was looked at. There has been some improvement to this care plan since the last inspection in that there is reference to the care and monitoring of injection sites, acceptable blood sugar levels, and what action staff should take if blood sugar levels are not within acceptable limits. However the agency nurse on duty was unaware of the information in the care plan, and care staff have little access to the plans. Staff on the 2nd floor said that nurses write in care plans – carers might be able to glance at care plans on an evening shift when everyone was asleep. Discussions took place with the manager about getting the balance right between the security of records and making sure that staff have easy access to them. There is some good personal detail within the care plans but they could be further improved with a more person centred approach. This would be by Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 14 including some information on individual strengths for example, what resident can do for themselves such as can they dress or partly dress themselves, can they fasten buttons, what parts of their body can they wash and what are their preferred toiletries. Communication plans now include more information about how to approach residents with information for staff on how to interpret resident behaviour. One care plan included catheter and colostomy care on the same plan. The size and type of catheter and type of drainage bags was recorded. There are instructions for staff to change the night bag every 5 – 7 days. However, there was no record of when this happens. There was a record of when the catheter was changed. The site and size of the stoma was identified and type of bags to be used. ‘End of life’ plans were included in all the care plans. This is a sensitive area but had been dealt with well and there was good relevant information recorded on this plans. The evaluations and review of the care plans was limited and included entries such as “Clean and well groomed” and “No concerns expressed”. These would benefit from a review of strengths and whether the care being delivered was still meeting needs. The management of continence was task orientated and not based around the individual needs of residents. Staff described set times when pads are changed throughout the day. These times were not based on individual need or assessment. In discussion with the manager it was recommended that full and detailed individual assessments be carried out to get information about individual toileting needs. In settings where such an exercise has been carried out the rate of continence has improved. The advice of the continence adviser should be sought. The medication trolley was left open and unattended in the lounge on the second floor. Blister packs containing medication were left on top of the trolley. An agency nurse was administering medication on both the first and second floor. The morning medication round was not finished until 12.15pm. Since the last inspections regular in-house drug audits have been carried out to make sure that practices are safe. A chiropodist visited on the second floor and started to give treatment in the lounge area in full view of other service users. The senior carer did address this and the resident was moved into the privacy of their own room. Overall staff do respect the privacy and dignity of residents. However, during the afternoon one resident was sat in the lounge with their catheter drainage bag on view to all approaching the lounge area. Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 15 There were photographs of service users on bedroom doors, and whilst some symbols, photographs or pictures are good practice in helping people to orientate themselves, some of the pictures of service users were undignified; one person in particular had a distorted face. This was a view reflected by a visitor to the home. Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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. Information about individual social needs, taking into account ethnic and cultural needs, was being used to plan social activities and events at the home. Overall, residents are provided with a nutritious diet and cultural foods are offered. It was difficult to establish whether a varied and nutritious diet was being provided to the more dependant residents, as clear records were not kept. EVIDENCE: One member of staff has been assigned a role as ‘support worker and activities coordinator’ from 10.00 until 13.30 Monday to Friday. She was very enthusiastic about her new role and explained how she is trying to organise entertainers to visit the home on a regular basis. Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 17 In a short space of time she has managed to spend 1-1 time with all service users trying to find out information about their background and their past and present interests. She is also working with carers trying to inform and instruct them about using reminiscence with older people. She is addressing the diverse and cultural needs of people, for example she has searched websites searching for Latvian music for one service user. There were posters in the home advertising a Caribbean party night, with Caribbean food and local Caribbean entertainers. During the inspection some service users were having an aromatherapy massage from a practitioner who said that she used to visit fortnightly but this has recently been increased to weekly to cater for the increased number of residents who benefit from this alternative therapy. She spoke about the positive effects that Reiki had on some service users. In discussion with the manager it was suggested that if additional therapies are being given to residents the agreement of the general practitioner (GP) should be obtained. Staff said that service users had a choice about getting up and going to bed, but the current toileting routines suggest that, in practice, choice is limited. Staff also said that service users have a choice of having a bath on a morning or afternoon. It is difficult to see how this happens in practice given the staffing levels. There was information on each floor about agencies providing advocacy services along with contact telephone numbers. During the morning service users had a choice of cranberry juice, fruit smoothies or orange juice, and snacks such as crisps, chocolate bars and biscuits. There were no healthy options such as fruit or yogurts offered or even home baking, which would be more appropriate for many of the frail, underweight service users. Menus displayed in the kitchen areas on each floor showed that service users have a choice at breakfast time, and alternative meals at lunch are available. These include kedgeree, omelettes, burgers, kippers and poached eggs, pork chops and lamb cutlets, baked potatoes with assorted fillings and a selection of pies. There was a West Indian menu with food such as Jamaican rice and peas, sweet potatoes and chilli soup, mutton curry with Jamaican dumplings and Jerk chicken. The Ukranian menu showed food such as Borscht, stuffed cabbage leaves (peppers or aubergines) and poppy seed cakes. The cook said that he prepares sandwiches about 13.00 for tea and hot food for the bain-marie is prepared at approx 15.00 before he goes off shift at 16.00. In the kitchen area on both floors there was catering advice about how to enrich foods i.e. porridge with cream, mashed potatoes with cream and butter, soup with cream and milk and supper malted drink made with milk. However, the format for recording food intake for residents with low weight Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 18 was not specific about what food has been eaten and was not used for all those with a low weight. Staff on the second floor said that sandwiches for the teatime meal are delivered from the kitchen about 14.30pm and stored in the fridge. Hot food is delivered a little while later and kept warm in a heated trolley until it is served at between 17.00 and 17.30. Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a clear and detailed complaints procedure in place. Procedures and staff knowledge mean that residents can feel safe at the home. EVIDENCE: There is a clear complaints procedure displayed in the home and this is also included in the service user guide. There are notices around the home inviting people to talk with staff if they are unhappy about anything. A file is kept of any complaints received and includes details of the investigation and outcome. The CSCI was copied into the response to the most recent complaint and evidence of the home’s investigation was seen in the complaints file. When asked staff knew about the different types of abuse and how to report any suspicions or allegations of abuse. The home has booked four places for staff on an external course on ‘Protection of Vulnerable Adults’ due to take place in April 2007. Harewood Court Nursing Home DS0000001345.V328034.R01.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. 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. The residents live in a safe and well maintained environment. Some control of infection practices put residents at potential risk of cross infection. EVIDENCE: The administrative area including the kitchen and laundry facilities is situated on the ground floor. Residents occupy the first and second floor of the building and all floors can be reached by a passenger lift. All areas of the home seen on the day of the visit were clean and fresh smelling. The first floor carpet has been replaced and the home is furnished and maintained to a good standard. There are plans to have the lounge chairs and bedroom carpets professionally cleaned. Several bedroom carpets are to be replaced and some recliner chairs have been ordered for the lounges. Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 21 Although the registered manager has recently delivered training to staff on infection control, practices in the home increased the risk of cross infection. One care worker was seen assisting people to the toilet wearing the same apron and gloves. She came out of one resident’s room still wearing her apron and gloves and went straight into the dining room. She finally disposed of her apron and gloves when all the residents had been to the toilet. On another floor two carers came out of someone’s bedroom after assisting him to change a continence pad. Only one carer was wearing gloves and neither wore an apron. The person wearing gloves took the bag containing a soiled pad to the sluice. There was no disposal system in this person’s bedroom therefore no way that aprons or gloves could have been disposed of in the bedroom area. When asked staff had a theoretical knowledge of control of infection. This knowledge needs to be put into practice. The maintenance man works hard to make sure that all areas of the home are well maintained. Each floor has a sheet on which they can record any minor repairs required and he signs when they are completed. There are a number of bed safety rails in use and through discussion with the maintenance man it was clear that he was aware of the most recent Health and Safety Executive (HSE) advice regarding the fitting of these. A random check of rails in use showed that they were correctly fitted. Harewood Court Nursing Home DS0000001345.V328034.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. 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. This means that there is a potential risk of care needs being overlooked. Residents are protected by robust recruitment procedures. EVIDENCE: Since the last inspection there has been a complete review of the staffing levels, as indicated in the improvement plan produced by the provider following the previous inspection. The improvement plan states that this review has taken into account the skill mix of the staff and the dependency levels and the number of residents at the home. As part of the review the shift times have been changed and the issue of staff going off shift at busy times such as lunchtime has stopped although the shift times do not allow for handover between shifts. For example, morning staff go off shift at 14.00 and the afternoon staff start at 14.00; day staff go off at 20.00 and the night staff start at 20.00. There is a reliance on a ‘handover sheet’ containing basic information about care needs. This type of handover is not appropriate for someone with limited knowledge of service users such as the agency nurse who was in charge on the day of the visit. Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 23 On the day of the visit the general manager was on shift. An agency nurse, who had taken over from an agency nurse on night duty, was providing clinical supervision for the care staff. The duty rotas indicated that this situation was because of staff leave. The staffing complement should allow for cover for staff holidays. The agency nurse was the only nurse on shift to provide cover for both the units. She had worked at the home before and said that she was not comfortable being the only nurse on duty. There are practical difficulties in one nurse being responsible for clinical supervision of untrained staff. The nurse on shift has to do the medication rounds on both units and there is little time for her to do anything else. The morning drug round was not completed until 12.20 with the next round starting about an hour later. There were three carers on duty on each unit with two carers between 14.00 and when the night staff come on duty at 20.00. With the majority of residents requiring two carers to see to them this means that whilst residents are being seen to other residents are not being supervised or observed. Rotas for week commencing 5th, 12th and 19th February 2007 showed that whenever a night worker is on holiday their shift is not covered. There were some nights each week when there was three staff on night duty instead of the usual four. That is, one nurse on duty with two carers. This means that at any given point during the night there is just one person on one of the units. The current dependency levels indicate that most residents need two staff to meet their needs. The provider has been asked to provide detail of their staffing review and their justification for the current staffing provision at the home. The reduction in staffing levels and skill mix has been put into place without consultation with the CSCI. Of the carers on duty, one had a National Vocational Qualification (NVQ) in care at level 3; one was a trained nurse from overseas working as a carer and one had started her NVQ 2. The senior carer on duty had no formal qualifications. Care staff are being expected to care for people and put in positions for which they have not been trained. This means that there is a risk that care needs may be overlooked. Information provided following the visit indicated that 50 of the care staff have achieved NVQ level 2 in care or the equivalent. Staff said that on the second floor there are just three residents who need only one carer to assist. This means that on an evening shift when two carers assist people to bed those remaining service users in the lounge are left unattended. Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 24 Staff said at teatime on the 2nd floor four residents need assistance to eat and a few others need prompts and supervision. Staff have to serve the meal and then rinse all the crockery and send it down to the kitchen via the ‘dumb waiter’. They said, “It is very, very busy.” When staff on the afternoon/evening shift take a break, this leaves one person on the unit which is unsafe. Notices were displayed on the units with dates of some of the planned training for 2007. Two staff are to have training with regard to the Protection of Vulnerable Adults (POVA) in April, one is the general manager; four are to have dementia care training in June; two have attended wound care during February and a further two are to have some training in Parkinson’s disease in March. There is a planned training programme in place and the manager is developing one for 2007/08 in line with the business plan. The home has a volunteer who confirmed that she has had a Criminal Records Bureau (CRB) check and that she does not lift anyone, or assist with personal care or with helping individuals to eat. She was however, left unsupervised for most of the time, because staff were so busy attending to other tasks. The recruitment records of three new members of staff were sampled. Appropriate recruitment checks had been completed before any offer of employment was made. The record of the interview was only signed by the general manager. It is considered good practice for a minimum of two people to carry out the recruitment and selection interview and both should sign and date the interview record. The registered manager said that it was usual for two staff to interview, in which case, both should sign the interview record. Records suggest that staff complete the Skills for Care Common Induction Standards. However it was difficult to see how these standards are being achieved when the standards for one person were signed by the registered manager as being achieved on the 30th November 2006, and yet the person’s application form was dated 28th November 2006 and her interview did not take place until 4th December 2006. Infection control was also signed as being completed on the 30th November 2006. The induction record for another member of staff was not dated. The record of induction would be improved by the inclusion of some evidence of the understanding of the information being covered rather than each section just being ticked off. Another staff file showed that the Common Induction Standards, Moving and Handling and Infection Control training were all completed on the 30th November. The offer of employment was not made until 5th November 2006 Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 25 and it was difficult to see how the induction standards could have been completed in such a short space of time. Similarly, the value and content of the courses of Moving and Handling and Infection Control is questionable particularly as they were both completed on the same day. The registered manager said that staff had workbooks to complete and information for these was discussed and explored at group training sessions. The registered manager felt that there was some confusion in the recorded dates and said that she would look into it. Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The organisation of the home has improved in that the registered manager is spending more time at the home. The registered manager provides leadership; guidance and direction to staff. But overall staffing levels are such that there remain some practices that do not always promote the health, safety and well being of the people using the service. EVIDENCE: Since the last inspections there has been a review of the management arrangements and the general manager has been at the home for five months. There was an unsuccessful attempt at employing a clinical nurse manager. Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 27 Following this the registered manager is spending more time at the home although, according to the rotas provided this is 24 hours over five days each week and not full time. The general manager was due to leave the home, but will remain working for the company. The general manager provides good day-to-day support for the registered manager and has many years experience of working in care. However, she is not a nurse and staff need more clinical support and guidance to effectively care for the needs of the client group. The general manager carries out daily checks of all the specialist mattresses to make sure that they correspond with the current weight of the resident. This is part of the clinical input that nurses could be providing at the home. Since the last inspection the format of the home’s ‘Quality file’ has been revised and now includes a clear index to the contents. The general manager said that she and the registered manager have yet to produce the training and business plans for 2007/08. There is a whole range of in-house audits carried out to monitor the service and facilities at the home and it was evident that a great number have been carried out since the last inspections, including regular audits of the care plans and a pharmacy audit. In addition the improvement plan produced after the last key inspection was clearly being used as a working document. Arrangements are also in place for regular visits to be made to the home by a representative of the company as required under Regulation 26 of the Care Homes Regulations 2001. The reports of these visits are sent to the CSCI and are informative. There was a summary of the accident reports from January/February 2007. There had been a total of six accidents and the times were recorded for five of them. It was noted that the majority of these occurred after 14.00 when the staffing levels fall to just two carers on each floor. The was also a summary of staff turnover and this showed that two nurses had left following an unsuccessful probation and a third had been dismissed for misconduct. There is an established meeting schedule for all designations of staff and notes were seen of recent meetings. There was a senior carers meeting in October 2006 when there was a discussion about the role of the senior carers. It is of concern that one senior carer was refusing to do any NVQ training and two others had no NVQ qualifications. The most recent residents and relatives meeting was held in January 2007, no relatives were in attendance. The main topic of discussion was the review of the menus and the inclusion of ethnic foods. Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 28 Some quality surveys were seen, although these were undated and it was recommended that the forms be amended to allow for the date to be added. The feedback from relatives was very positive and included such comments as: ‘I think Harewood Court is superb. All the management and staff are brilliant’; ‘we have been very pleased with the service our mum is so much happier now she is here’. 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. The general manager said that system of staff supervision was being revised. The revised format suggests that supervision sessions consist of 1-1 sessions, observation and group discussions. The top of the stairs on a designated fire route on the second floor was being used for storage of flammable items, for example mattresses and wheelchairs. This concern was shared with the general manager on the day of the visit. There were two posters on display in the staff room alerting people to the safe use of bed rails. There were medical device alerts in a communication file on the second floor. The most recent alert referred to urine bags and was dated 26th October 2006. It is important that staff are made aware of relevant safety alerts. Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 29 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 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 30 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 Requirement Where other healthcare professionals are consulted the provider must make sure that any instructions are clearly documented and are included in care plans. Timescale of 04/01/07 not met Where risk to a resident has been identified, for example of skin damage, there must be a clear plan of management of the risk. There must be evidence of how the plan is being implemented and its effectiveness. The provider must make sure that all staff adhere to safe medicine administration practices at all times, including any agency staff employed at the home. The provider must make sure that there is evidence to demonstrate that a varied and nutritious diet is provided to the more dependant residents. The manager must make sure that staff follow safe infection control practices at all times. DS0000001345.V328034.R01.S.doc Timescale for action 04/06/07 2 OP8 13(4) 03/09/07 3 OP9 13(2) 30/04/07 4 OP15 16(2)(i) 28/05/07 5 OP26 13(3) 04/06/07 Harewood Court Nursing Home Version 5.2 Page 31 6 OP27 Further relevant training must be provided if necessary. 18(1)&(3) The provider must provide 30/04/07 evidence to the CSCI of their Section 31 review of the staffing numbers CSA 2000 and skill mix of qualified and unqualified staff. The provider must make sure that the staffing levels and skill mix are sufficient to meet the assessed needs of the service users, taking into account the size, the layout and purpose of the home. 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 OP4 OP7 Good Practice Recommendations The planned training should take place to make sure that the provider is able to demonstrate that staff can meet the needs of the residents living at the home. The work already undertaken on the development of the care plans should continue. It should involve the training of other staff to make sure that the information about care needs is known to everyone and is implemented fully. In order to provide evidence of the implementation of the care provided the manager should consider the use of turn charts, and food diaries. The management of continence and toileting practices should be reviewed to make sure that there is an individualised approach. The provider should make sure all staff have received appropriate training in relation to adult protection. The provider should 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. 3 OP8 4 5 OP18 OP30 Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Harewood Court Nursing Home DS0000001345.V328034.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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