Inspection on 14/02/06 for Harewood House

This inspection was carried out on 14th February 2006.

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

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

Other inspections for this house

Harewood House 13/07/07

Harewood House 10/08/06

Harewood House 30/08/05

Harewood House 17/11/04

Harewood House 26/05/04

Harewood House 02/12/03

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

CARE HOMES FOR OLDER PEOPLE Harewood House 66 Plymouth Road Tavistock Devon PL19 8BU Lead Inspector Graham Thomas Unannounced Inspection 14th February 2006 09:30 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 House DS0000032457.V273151.R01.S.doc Version 5.1 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 House DS0000032457.V273151.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Harewood House Address 66 Plymouth Road Tavistock Devon PL19 8BU 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) 01822 613130 Devon County Council Brian Burley Care Home 28 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (20), of places Physical disability (8), Physical disability over 65 years of age (14) Harewood House DS0000032457.V273151.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The Home can accommodate no more than 14 people with a physical disability at any one time. Anyone with a Physical Disability must be 50 years of age or over. The Home can accommodate no more than 8 people with dementia at any one time. Any one with dementia must be 55 years or over. 30th August 2005 Date of last inspection Brief Description of the Service: Harewood House is arranged on three floors. The ground floor comprises a day centre, offices, laundry and kitchen facilities. The Kitchen provides for the day centre and meals on wheels service as well as the care home. Food is distributed to the home in heated trolleys. The first and second floors which comprise the care home are divided into four units, each offering a service. On the first floor there are two units. Edgecombe provides long term care for 6 people whose main needs relate to frailty due to their age. There are 6 large bedrooms, a lounge and a kitchen/diner. In addition there are 2 toilets (one with disabled access), a bathroom with a floor based hoist, and a sluice room. Reablement provides for 6 people who need to restore their skills and confidence following an operation, accident or period of ill health. This service is run in conjunction with the Health Service. Intensive support from Occupational Therapists and Physiotherapists is available. On the second floor Drake is a service for 8 people who have a diagnosis of dementia. There are 8 large bedrooms, a lounge and a kitchen/diner. In addition there are 2 toilets (one disabled access), a bathroom with a high/low bath, a small laundry and a sluice room. Treetops is a service for 8 people and whose main needs relate to frailty due to their age and who are staying at the home for a period of respite care. There are 8 bedrooms, 2 of which are suitable for the use of people with a physical disability and are situated on the first floor; 2 toilets (one with disabled access); a walk in shower; a kitchen diner and a lounge. Harewood House DS0000032457.V273151.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this unannounced visit was to complete the inspection of key standards for this inspection year and monitor progress in respect of previous requirements and recommendations. During the course of the inspection the Inspector spoke with twelve service users and five staff including agency carers, ancillary staff and an Occupational Therapist employed on-site by the Health Service. Records were examined including a sample of care plans and other documents. Discussion took place with the Registered Manager and an Assistant Manager. What the service does well: What has improved since the last inspection? What they could do better: Service users’ individual needs and plans for meeting them are not adequately set out. Individual wishes concerning terminal care need to be recorded. There is inadequate security in the storage of confidential records. Staff require update training in the protection of vulnerable adults from abuse. A worn bath awaits replacement. The home’s environment awaits the assessment of a suitably qualified professional. Staff do not receive adequate induction and foundation training. Systems for quality assurance and development planning require further development. Harewood House DS0000032457.V273151.R01.S.doc Version 5.1 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Harewood House DS0000032457.V273151.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Harewood House DS0000032457.V273151.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4 Prospective service users receive appropriate confirmation the home can meet their needs. EVIDENCE: In accordance with an outstanding requirement, a standard letter has been produced for prospective service users confirming that the home can meet their needs. A copy of this letter was seen which the Registered Manager stated was sent out with an information pack about the home. Harewood House DS0000032457.V273151.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Service users’ individual needs and plans for meeting them are not adequately set out. Personal and healthcare needs are generally well met and individual privacy and dignity is respected. EVIDENCE: The Registered Manager stated that since the last inspection, the key working system had been modified. Key workers now have responsibility for monitoring the review of plans. However, in practice this was found to be patchy and some plans did not appear to have been reviewed regularly. Findings in respect of the plans therefore remain substantially unchanged since the last inspection. Each service user has a plan of care. The information contained in the plans seen covered areas of personal, health, psychological and social needs. However, the quality and quantity of information contained in the files varied considerably. Some were difficult to follow. A form is included to provide a pen picture of an individual service user and their needs. In some files this contained detailed and useful information which conveyed a clear picture of service users whose past occupation, interests, likes, dislikes and personality might not otherwise be evident. In other files this was limited to one or two sentences. Not all files contained a photograph of the service user. Plans did Harewood House DS0000032457.V273151.R01.S.doc Version 5.1 Page 10 not show a clear cycle of assessment, planning, action and review. Assessment and care planning were not clearly separated in all files. Many of the documents in the plans seen had not been signed and dated. Service users’ involvement in the review process was not always clearly evidenced in the files. Service users wishes concerning terminal care and funeral arrangements were not seen in all files though this has been previously recommended. The Inspector spoke with two agency staff who confirmed that, in accordance with a previous recommendation, they were aware of the contents of individuals’ care plans and were able to act upon them. Service users confirmed that they had access to the healthcare they required including general medicine chiropody, audio logy services and sight tests. This was confirmed by the contents of care planning records. The Inspector spoke with an Occupational Therapist employed by the Health Service who works on-site. She described the assessment and rehabilitative work undertaken with service users with regard to daily living skills. Medication systems in the home were not fully examined on this occasion. However, in accordance with a previous recommendation, Patient Information Leaflets for all medicines in use are now being obtained and filed. Staff were seen knocking on service users’ doors before entering and treating service users with respect. All the service users with whom the Inspector spoke felt that their dignity was preserved and promoted by staff. Harewood House DS0000032457.V273151.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: None of the above standards was inspected on this occasion Harewood House DS0000032457.V273151.R01.S.doc Version 5.1 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Service users can be confident that they can air their concerns and that these will be acted upon. Adequate systems are in place to protect service users from abuse. EVIDENCE: Policies and procedures concerning the protection of vulnerable adults from abuse are in place. Staff files examined provided evidence that checks are made on prospective staff including references, criminal records checks and checks against the national list for the Protection of Vulnerable Adults. Upon recruitment, staff sign an agreement that they may not benefit from gifts or legacies. Records are maintained of any valuables brought to the home by a service user. Most staff have received training in the protection of vulnerable adults from abuse. The Registered Manager stated that further update training has been requested in accordance with a recommendation made at the last inspection. This is still awaited Harewood House DS0000032457.V273151.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 22 Service users are provided with a generally clean, comfortable, safe and wellmaintained environment. EVIDENCE: A tour of the home provided evidence of ongoing maintenance, redecoration and refurbishment. Some areas and individual rooms had been recently redecorated and re-furnished to provide greater comfort and convenience for service users. Records of routine maintenance were available for inspection. Some modifications to the safety of one stairwell are planned following a recent in the home. One bath identified as due for replacement at the last inspection remains in place. The home’s grounds were seen to be attractively maintained, safe and accessible. A fire risk assessment has been conducted and a fire plan has been seen. Staff files and discussion with staff confirmed that they receive training in fire safety. The main entrance to the premises is covered by a CCTV camera for security purposes and further necessary security for the rear of the building was discussed with the Registered Manager. Harewood House DS0000032457.V273151.R01.S.doc Version 5.1 Page 14 Since the last inspection, the home’s shaft lift was out of use for a protracted period due to difficulties in repair. The Local Authority’s Responsible Individual has provided the Commission with assurance that the contracting arrangements for repair will be reviewed to minimise the likelihood of a recurrence of this difficulty. Many aids and adaptations were seen around the home including electronically adjustable beds, grab rails toilet seat frames and bath hoists. Individual assessments for aids/adaptations were seen in care plans. An assessment of the premises by a suitably qualified person in accordance with previous recommendations has yet to be conducted. Harewood House DS0000032457.V273151.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 30 Service users needs are met by an adequate number of staff. New staff are do not receive adequate induction and foundation training. EVIDENCE: Of a total of 25 care staff, the Registered Manager stated that six were qualified to NVQ level 2 or above. He also stated that a further seven would have completed their courses by March 2006. New staff were being interviewed at the time of this inspection but no new staff had commenced employment since the last inspection. However, a full induction programme, compatible with national training standards had yet to be developed and implemented in the home. Harewood House DS0000032457.V273151.R01.S.doc Version 5.1 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 37, 38 The development of the home is inadequately linked to service users’ and other stakeholders’ views. Measures to safeguard service users’ confidentiality are inadequate and require improvement. EVIDENCE: Mr Brian Burley has been the Registered Manager at Harewood House for over 3 years. He is a qualified teacher, having a BA (Hons) degree in Education, and has a Diploma in Management as well as City and Guilds Advanced Management in Care Award. He has many years experience managing services in the care profession. He does not hold a Registered Manager’s Award. Findings in respect of the home’s quality assurance system remain substantially unchanged since the last inspection. The “Reablement” Unit has been accredited to ISO 9001:2000. This is an independently recognised quality assurance system that is externally audited. The service users of this unit are Harewood House DS0000032457.V273151.R01.S.doc Version 5.1 Page 17 surveyed after each visit to ascertain their views on the services provided: Social Services and the Primary Care Trust monitor the results of these surveys. The Registered Manager has ensured that the policies and procedures and best practice from this unit that relate to the other 3 units have been shared. The Service User Guide contains a questionnaire that enables service users and their families to give their views of the home. The Registered Manager stated that a quality assurance tool was being developed for use across the authority. This had been placed before senior managers and was awaiting approval. As yet, therefore, there is no formal system to ascertain the views of other stakeholders such as Care Managers, Chiropodists, GPs or District Nurses. No annual development plan, informed by the views of service users, has yet been formulated. Records in the home remain insecure in spite of a previous requirement. In one unit, the office door and cabinet in which files were stored were both open and had keys left in the locks. Since the last inspection, systems for testing and recording electrical personal appliances have been put in place. Training regarding the control of legionnaires disease has been completed and records regarding regular testing were seen. Also in accordance with a previous requirement, the home now routinely informs the Commission of events which affect the welfare of service users, as required by regulation. Harewood House DS0000032457.V273151.R01.S.doc Version 5.1 Page 18 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 X 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X 2 X X X X STAFFING Standard No Score 27 X 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X x X 2 3 Harewood House DS0000032457.V273151.R01.S.doc Version 5.1 Page 19 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 Timescale for action 31/08/06 2. OP37 17 The home must ensure that the service users care plans reflect and describe in full the service users current care needs, including personal, health, social, nutritional and diet and spiritual care needs, as well as the action required by staff to meet those needs. The home must distinguish between the preadmission assessment and the current care plan. The plans must show a clear cycle of assessment, action planning and review. The home must review the care plans monthly and record the service user and/or relatives involvement. (Requirement modified. Previous timescales of 31.1.05 and 30.11.05 not met) Service users records must be 15/02/06 securely stored (previous timescale 30.8.05 not met) Harewood House DS0000032457.V273151.R01.S.doc Version 5.1 Page 20 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 3 4 5 6 7 Refer to Standard OP18 OP19 OP11 OP22 OP30 OP31 OP33 Good Practice Recommendations Staff training in the Protection of Vulnerable Adults should be updated to include current best practice and procedures. The worn bath identified at this inspection should be replaced The home should record the Service Users wishes concerning terminal care and funeral arrangements in their care plan. A suitably qualified person with specialist knowledge of the client group should undertake an assessment of the premises and facilities. The home should provide induction and foundation training that meets the National Training Organisations specifications. The Registered Manager should undertake the Registered Manager’s Award The home should expand its quality assurance monitoring to all of the service users, their families and friends and stakeholders in the community. The home should provide an Annual Development Plan based on a systematic cycle of planning - action - review, reflecting aims and outcomes for service users. Harewood House DS0000032457.V273151.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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