Inspection on 29/01/08 for Harewood Court Nursing Home

This inspection was carried out on 29th January 2008.

CSCI found this care home to be providing an Adequate service.

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 22/02/07

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 29th January 2008 09:40 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.V357427.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.V357427.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.V357427.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 40 2. Physical disability - Code PD, maximum number of places: 3 The maximum number of service users who can be accommodated is: 40 22nd February 2007 Date of last inspection 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. 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 people living at the home, 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. Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 5 The home has a comprehensive fee structure in place and information about this is included in the service user guide. The fees currently range from £518.79 to £556.79 although charges can vary according to individual contracts, 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 about current fees was provided at the January 2008 visit. Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced visit by two inspectors who were at the home from 09.40 until 17.40 on 29th January 2008. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people who live there and in accordance with requirements. Before the inspection accumulated evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the inspection visit. A number of documents were looked at during the visit and all areas of the home used by the people who lived there were visited. A good proportion of time was spent talking with the people at the home as well as with the manager and the staff. An Annual Quality Assurance Assessment (AQAA) had been completed by the home before the visit to provide additional information. This is a selfassessment of the service provided. Survey forms were sent out to the home before the inspection providing the opportunity for people to comment on the service, if they wish. Information provided in this way may be shared with the provider but the source will not be identified. A small number of surveys were returned from relatives and healthcare professionals. Their comments are included in the report. What the service does well: The home is purpose built and all the rooms are spacious with good sized ensuite facilities. The environment is maintained to a high standard and the people live in a comfortable and safe environment. People moving into the home are able to bring items from home to help personalise their rooms. The home has a pleasant, welcoming atmosphere. People are treated with respect and are cared for in a friendly and caring manner by the staff. Visitors are able to visit at any time and are made to feel welcome by the staff. Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 7 • ‘Carers genuinely seem to care and look after my mum extremely well in the difficult circumstances of her illness. They also immediately inform me of any concerns they have and keep me in the picture’. People have their needs assessed before they are admitted to the home and specialist equipment is available if needed. • (The new manager is) ‘excellent in her assessments of people in hospital’ – ‘she is thorough, demonstrates expertise around health and social care issues, provides good and clear feedback and is totally honest whether or not the home can meet the persons care needs’ Staff also know the people living at the home well, as reflected by a visiting consultant: • ‘The nurse at Harewood Court gave me an excellent history’ What has improved since the last inspection? The new manager has built up effective relationships with other healthcare professionals: • • ‘Renewed confidence is developing with regard to placements at this home’ ‘A warm welcome afforded to the reviewing officers’ There has been a significant improvement in the standard of recording information in people’s individual care files. This means that staff have detailed information about people and clear instructions on how to care for people. There are good systems in place reviewing the information in records. This means that staff have access to up to date details about care. What they could do better: Staffing levels and skill mix in the home did not seem to be sufficient to make sure that people’s needs would be consistently met. The staffing numbers need to be reviewed in order to make sure that they are kept at levels, which take into account the numbers and identified needs of people at the home as well as the size and layout of the building. There is a risk with the current staffing levels and skill mix that some care needs might be overlooked. The differing ethnic and cultural needs of people living at the home were being identified in records but there was little evidence to show that these were being met. For example, although there were records indicating which people would prefer a Caribbean diet there was no evidence that it was available. Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 8 There was good identification about how people wanted to spend their time but again no indication that this was happening. Staff were working under pressure trying to meet social needs whilst trying to make sure that care needs not overlooked. There were some health and safety practices that needed to be reviewed where cupboards containing potentially toxic substances were unlocked. There were some practices that placed people at potential risk of cross infection. The manager was advised of these and agreed to address these areas of concern. Requirements and recommendations appear at the end of the report. 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.V357427.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.V357427.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): 3. Standard 6 does not apply to this service. People who use the service experience good quality outcomes in this area. All people have their needs assessed before they are admitted to the home. The written information available to people and their families gives them the information they need to decide if they want to move into the home. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA did not reflect the good practice seen at the home regarding pre-admission assessments. Comments from one healthcare professional were extremely positive about the assessment process: • (The new manager) – ‘excellent in her assessments of people in hospital’ – ‘she is thorough, demonstrates expertise around health and social care Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 11 • issues, provides good and clear feedback and is totally honest whether or not the home can meet the persons care needs’ ‘Renewed confidence is developing with regard to placements at this home’ A range of pre-admission information was seen in individual care files and included the home’s own pre-admission assessment. These were detailed and contained enough information for care plans to be developed so that staff knew how to look after people’s care needs. Harewood Court Nursing Home DS0000001345.V357427.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 and 10 People who use the service experience good quality outcomes in this area. The information within records and the knowledge of the staff means that the physical and healthcare needs of people are being met. Overall, staff respect the dignity and privacy of the people living at the home. People are protected by the safe medication practices in place at the home. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA gave no detail of how personal healthcare needs are met. There was no information on any improvements over the previous twelve months or plans for the next twelve months. However, after looking at a small selection of care records as part of the case tracking of some of the people living at the home it became clear that there has been a significant improvement in the standard of recording. Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 13 Care plans were in place for all areas of daily living. These were clear and concise and showed the individual needs and problems. There were precise instructions for staff about what they should do to assist and support individuals. Care plans were being updated and amended. In one person’s case the care plan had been updated and amended after a visit from an Occupational Therapist. A new chair had been delivered and detailed instructions on how to use it were recorded for staff. Good monthly evaluations of the care plans show how the care being given is meeting needs or if changes are needed to the plan this is made clear. There were detailed records of all visits from other health care professionals, for example, the dietician, a speech and language therapist, the chiropodist, General Practitioners (GPs) and a Consultant Physician who visited one person at the home. There was a noticeable improvement in the level of detail recorded in care plans and work is continuing to develop these further. We could see that care plans had been audited by a qualified nurse who later told us what needed doing as a result of the audit. She also explained how she is trying to involve care staff in the care planning process. Future development work on care plans should include making daily records clearer so that they give a detailed picture of how each person has spent their day and an accurate account of the care given. Statements currently recorded such as ‘safety maintained’ does not give the level of detail required. Risk assessments are completed but the nutritional assessment for one person was not accurate. The manager agreed to discuss this with qualified staff. Other risk assessments have several risks on one page, which sometimes makes it difficult to see where information about one risk ends and another one starts. The manager was aware of this and agreed to review the format. A letter from a Consultant Physician, held in one person’s care records, states, “The nurse at Harewood Court gave me an excellent history.” This shows that staff are well informed about the people they care for. Comments in a healthcare professional survey were supportive of the new manager and her approach to making sure that people’s healthcare needs are met by staff at the home: • (the new manager is) ‘responsive and cooperative, very willing to discuss issues, friendly but professional, working hard to ensure care staff are responsive not only to the resident but visitors etc’. Relatives’ comments in survey were also supportive of the care given: • ‘Carers genuinely seem to care and look after my mum extremely well in the difficult circumstances of her illness. They also immediately inform me of any concerns they have and keep me in the picture’. Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 14 • ‘Good at the basic day to day needs’ A nurse at the home has recently carried out a drug audit. This had raised a number of issues that included: • surplus stock not being removed • creams found in people’s rooms that had not been prescribed for them • medication remaining from one month not being carried over to the next month’s record • inaccurate record keeping It was noted that as a result of the audit supervision was being arranged for all qualified staff. The training plan for 2008 shows that medication management training is planned for all qualified staff. Overall during the day staff were seen to respect people’s privacy and dignity but on one occasion, when a member of staff was rushing and was under pressure, a toilet door was left open exposing one person in a state of undress. At lunchtime on the first floor some people were given a disposable plastic apron to protect their clothing, rather than a domestic type tabard or apron which would be far more dignified. Harewood Court Nursing Home DS0000001345.V357427.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience adequate quality outcomes in this area. People at the home are supported in maintaining contact with their family and friends. People’s differing ethnic and cultural needs are identified but are sometimes overlooked. People are provided with a nutritious diet but cultural foods are not always offered. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA referred to community links and plans to develop cultural awareness but did not provide any detail. Since the last visit there have been some staff changes and the person who had made some good initial attempts at addressing the diverse cultural needs at the home last year was no longer working in that capacity and her role had not been replaced. For the majority of the time there was little or no provision Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 16 for the differing cultural needs at the home, both from a dietary point of view as well as stimulation and occupation. For example, in individual records cultural and social needs and wishes had been identified but there was no evidence that these were being met. Staff were under pressure to carry out caring tasks and clearly found it hard to provide occupation and to make sure that less able people were occupied in a way that reflected their identified needs. There was a good atmosphere in the home and when staff were speaking to people it was clear that they had a good rapport with people living at the home and their visitors. Staff were kind and patient when speaking and working with people, they made good use of touch with people who had communication difficulties and knelt down to speak to people who were seated. During the day staff made an effort to occupy people, but this was rushed and was only at times when care was being given. For example, when a member of staff was rushing in a lounge she gave one person some knitting to do. Another member of staff chatted to people as she was giving out mid-morning drinks, but for most of the time people were left without any stimulation. Staff said that the amount of time they have to spend with people is determined by staffing levels and the amount of care tasks they have to do. Visitors said that they were happy with the home and one person living at the home said, “I am happy here they look after me.” There was a three-week menu in place that provided variety and choice. A diet sheet was seen on the first floor detailing individual dietary requirements; for example, those needing a diabetic diet were identified, as were those who wanted a Caribbean diet. There was no evidence that a Caribbean diet was available. The lunchtime meal on the first floor was not started until 13.30. Although there was not enough staff to give assistance to everyone who needed support, staff were relaxed and unhurried creating an atmosphere of calm. People were offered a choice of beef stew and dumplings or tuna steak with creamed potatoes, carrots and cabbage. The meal looked appetising and portion sizes were hearty. The cook was relaxed and friendly with people, making time to visit each table and chat. It was clear that people knew his name and were confident to ask questions about the menu and what was being offered. In addition to the people who needed support and assistance with their meal in the dining room, a further five people who stayed in their room, also needed help. There was only four staff on duty; this included one person who should have ended her shift half an hour before the meal was served. This meant that at 14.00 some people needing assistance had not had their lunch. Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 17 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 People who use the service experience good quality outcomes in this area. People living at the home and their relatives have their concerns taken seriously and action is taken to resolve issues. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Information in the AQAA did not reflect the systems in place at the home and provided little detail of how complaints are managed and how people are protected. There is a complaints procedure in place and it is clearly displayed at the home. The manager keeps a log of complaints received together with a plan of action taken to investigate and address any issues raised. Copies of letters responding to complainants are also kept in this file. Records show that there have been three complaints received at the home in the last year. One of these was substantiated and the other two were partially substantiated. Surveys returned all indicated that people knew how to make complaints. A comment on one survey stated that since the appointment of the new manager that the home had ‘always responded appropriately to concerns’. Adult protection training is part of the mandatory training for staff. Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 18 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 People who use the service experience adequate quality outcomes in this area. People live in a safe and well maintained environment. Some practices put the health and safety of people at potential risk as well potential risk of cross infection. We have made this judgement using available evidence including a visit to this service. EVIDENCE: The communal lounges were homely, comfortable and well furnished with good access for people who use a wheelchair. There was a variety of suitable seating. Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 19 The sluice rooms on both floors had signs on the door saying, ‘Fire door keep locked’. Both were unlocked. This created a potential health and safety risk to people because of access to hazardous substances, for example, large containers of thick bleach and other cleaning materials. Some cleaning fluids had been decanted into other containers. These containers were unlabelled, which meant that there were no instructions for use, safety precautions or information about spillages. The sluice rooms are small and it is difficult to see how staff can wash their hands properly. This is because access to the wash basin was obstructed by clinical waste bins and laundry skips. Both sluice rooms had an unpleasant odour. Soiled and used continence products in the clinical waste bins were not always double wrapped and one, although having a pedal operated foot control, had a lid that was wide open. A pedal operated foot control on a dressing bin could not be operated because of the position of the laundry skips. Most of the storage areas on the first and second floor of the home had signs on the doors that said, ‘Keep locked shut’. The majority of these were not locked and would not even close properly. Again there was the risk of unauthorised access to products that could pose a health and safety risk. This included toiletries such as toothpaste, shaving foam, deodorant, nail polish and remover. Prescribed creams, ointments and medication such as Thick & Easy, Fortisip, Cavilon cream, Betnovate cream, Polyfax ointment and Optiflow were also stored in these rooms. This is poor practice and is unacceptable. Continence products such as pads were stored in toilets and bathrooms on open shelves and over grab rails. This poses a risk of cross infection in the home. Some bed safety rails fitted to divan type beds could be moved up and down the bed. This creates a potential risk of entrapment for people who use these rails. The handyman said he knew how to fit bed safety rails correctly and had been given information about the safe use of bed rails. He was not sure however, who had responsibility for checking the bed safety rails on a regular basis. The manager agreed to rectify these issues immediately. Emergency lighting and weekly fire alarm tests are carried out and a record is made. Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 20 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 People who use the service experience poor quality outcomes in this area. The numbers and skill mix of staff are not sufficient to guarantee that the needs of people will be met. This means that there is a potential risk of care needs being overlooked. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA made no reference to any review of the staffing levels that might have been carried out since the last visit or to staff training. At the visit made to the home in July, shortly after the new manager had started, the staffing skill mix and numbers were discussed. The manager told us that she planned to carry out a major review of staffing, particularly the input from qualified nurses, over the 24hour period. The manager said at that sometimes that there was not always two qualified staff on duty. This was a real concern; particularly as the layout of the home means that it functions on two floors like two separate units. Staffing levels and the skill mix were found to be largely unchanged. There was one nurse rostered to be on duty with six carers for the two floors. The Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 21 night nurse stayed on shift to do the medication round on one floor. She had been on shift from 20.00hours the previous evening and finally went off shift at 11.15. It was indicated on the rota that out of the week there were four day shifts when there was planned to be only one nurse on duty. The other three days had a second nurse but only until 13.00. On the rota for week commencing 21st January 2008 the night nurse was rostered to work from 20.00 to midday the following day and worked 64 hours over the week on day and night duty. There was no cover for the manager while she was on sick leave. On the day of the visit one member of the care staff went off shift at 13.00 and another off shift at 14.00. No additional staff were due to come on duty until 16.00. This left one nurse with four carers to care for 20 people on the first floor and 16 on the second floor. The majority of these people need two staff to care for them. The current staffing arrangements mean that people are not guaranteed to have their needs met and that there are significant periods of time when they might have to wait for staff and are not properly supervised in the lounges or in their rooms. The staffing arrangements for the night shift were unchanged with just one nurse supported by two carers for the two floors. 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 overnight. The recruitment records of two people employed since the last key inspection visit were looked at. The records showed that all of the required preemployment checks take place before people start work at the home. The information in each person’s file was sequenced and easy to find. There was evidence in these files to show that there is a structured system of staff supervision in place. Information provided in the AQAA stated that 33 of care staff have achieved a National Vocational Qualification (NVQ) in care at level two. This is short of the expected standard that there will be 50 care staff with NVQ 2. The home is in the process of developing a new training matrix that when completed will show what training each person has completed and when mandatory training updates are needed. As information was still being transferred it was difficult to see whether all staff had received mandatory training and updates in areas such as moving and handling, fire safety, infection control etc. Work should continue so that this information is available. A training and development plan for 2008 shows that planned training for staff includes mandatory training, medication management, principles of care, activities management, palliative care, reminiscence, Mental Capacity Act, nutrition and diabetes. Training providers include Age Concern, Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 22 Primary Care Training, and health care specialist such as a pharmacist, tissue viability nurse, diabetic nurse and community psychiatric nurse. Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 23 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 and 38 People who use the service experience adequate quality outcomes in this area. The manager provides clear leadership; guidance and direction to staff. But overall staffing levels are such that there are some practices that do not always promote the health, safety and well being of the people using the service. We have made this judgement using available evidence including a visit to this service. EVIDENCE: A new manager was appointed in July 2007. She has yet to apply to us to be registered as manager of the home. There have also been other changes Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 24 within the company and there is a different responsible individual for the company. Information provided in the AQAAA makes no reference to these changes; their effect or to the qualifications or experience of the new manager. It was clear from information gathered before the visit and from survey information that the manager has had a positive effect at the home: • • ‘A warm welcome afforded to the reviewing officers’ ‘Renewed confidence is developing with regard to placements at this home’ The new manager has only been in post a few months but she has already had a positive influence over practice and record keeping. Further developments and progress is dependant on getting the staffing numbers and skill mix right. The manager was away on sick leave on the day of the visit and had been for about two weeks. There were no contingency plans in place for the day to day management of the home in her absence, which was being managed by two full time nurse one of whom was a regular night worker and on the day of the visit stayed on shift to help with medication administration. The manager did attend the home late morning and stayed until the completion of the inspection. This was not expected by us but proved helpful during the course of the visit. There is an established system of internal audits carried out to monitor the effectiveness of the service. These include thorough regular audit of the care plans and the drug administration system. In addition, the responsible individual for the company visits the home regularly and the reports of these visits were available for inspection. The manager has worked at identifying priorities and has developed an action plan to address the shortfalls in the service provision. A monthly summary is produced of accidents occurring at the home to help identify any trends or issues which might need addressing the number of accidents. Satisfaction surveys were circulated and as there was a poor return the manager is planning to re-design the format and re-circulate it later in the year. Meetings are held with all designations of staff and notes are kept. The most recent meetings were at the end of 2007. A relatives and residents meeting was held about two months ago, although the notes could not be found. Information to support the internal monitoring systems were in the process of being re-organised to make the information easier to access. Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 25 Some issues around health and safety were identified and have been detailed in the section concerning environment, in particular, concerning the use of bed safety rails. The manager needs to make that all staff are aware of their responsibilities regarding health and safety practices and are given the training they need. Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 26 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 27 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 OP27 Regulation 18(1)&(3) Requirement The staffing arrangements must be reviewed to make sure that there are enough staff and the right skill mix to meet the needs of the people living at the home. 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. This must also include a review of how staff are deployed and supervised to make sure that staff are working effectively for the benefit of people at the home. Previous timescale of 07/01/08 extended to allow the new manager time to address the staffing issues. The manager must make sure that staff follow safe infection control practices at all times to make sure that people living at the home are protected from DS0000001345.V357427.R01.S.doc Timescale for action 30/06/08 3 OP26 13(3) 30/06/08 Harewood Court Nursing Home Version 5.2 Page 28 infection. Further relevant training must be provided if necessary. Previous timescale of 07/01/08 extended to allow the new manager time to address the staffing issues. The manager must make application to the CSCI without further delay to be registered as manager of the home. This is to demonstrate her dayto-day accountability at the home. 4 OP31 CSA Part II, section 11, paragraph s (1) and (5) (a) 03/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations The manager must make sure that all prescribed medication is properly stored in locked cupboard to prevent unauthorised access so people are not put at potential risk. Guidance and advice should be given to the activities organiser to help her provide stimulation and activities for those less able people living at the home. The provision of stimulation and occupation should take into account the differing cultural needs of people living at the home. Food provision should be reviewed to make sure that the different cultural dietary needs of people are provided for. The provider should make sure that all staff receive training in order to maintain the health, safety and well being of themselves and the people living at the home. This is with particular regard to the use of bed safety rails and access to COSHH products. Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 29 2 OP12 3 4 OP15 OP30 5 OP38 Clear records of training should be developed to provide evidence of staff training. The manager should make sure that arrangements are in place for the safe storage of products, which, if ingested, could put people under potential risk. Harewood Court Nursing Home DS0000001345.V357427.R01.S.doc Version 5.2 Page 30 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. 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