CARE HOME ADULTS 18-65
Harewood House 8 Shrubbery Terrace Weston Super Mare North Somerset BS23 2JZ Lead Inspector
Nicola Hill Announced 26 May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Harewood House Address 9 Shrubbery Terrace Weston Super Mare North Somerset BS23 9JZ 01934 620502 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Valerie Murray Mrs Cheryl Peel Care Home - Personal Care Only 7 Category(ies) of Leaning Disability - (7) registration, with number Learning Disability over 65 - (7) of places Harewood House D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: N/A Date of last inspection 23 December 2004 Brief Description of the Service: Harewood House is a converted Victorian house within a terrace set out on the hillside above Weston-Super-Mare seafront. The accommodation is set out over three floors with the first floor accommodation offering ensuite facilities; there are bathroom facilities on each of the other floors. This is a family run home, Mrs Valerie Murray the provider and Ms Cheryl Peel the registered manager. The home accommodates service users with learning disabilities aged 18-65 years and is also registered for service users with learning disabilities over 65 years of age. Harewood House D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection for Harewood House was undertaken with the manager of the home, Cheryl Peel, and the inspector. On arrival at the home two residents were at home, the other residents had gone to their respective day centres or colleges. There were two staff on duty, Cheryl and Helen. On arrival, one of the resident was busy feeding her cat. The other resident stated that she wished to speak with the inspector in the privacy of her room. Both residents later went out, one with a member of staff and the other resident at the home went out with her friend whom she had known for a number of years. The inspection was divided into two parts, the first part of the inspection concentrated on discussion with the manager about the policies procedures in place at the home whilst all the residents were absent; the second part of the inspection was devoted to talking with residents and finding out their opinions of the home. The inspection lasted approximately 5 hours; it involved all the residents at the home, and three of the staff team. There are no outstanding issues at Harewood House, and the no requirements made following this inspection. What the service does well:
The evidence for this was obtained from comments from the residents, staff and manager. All of the residents stated that they were very happy to live at Harewood House. The reasons for this range from being supported to access community facilities such as visits to the pub, and holidays, to the prevailing happy atmosphere at the home. Other comments related to the relationship between the residents at the home, which was generally stated to be very good, and the attitude and relationships they have developed with the staff and management of the home. The other good things about the home were that residents felt they were supported to achieve the choices they made about their lifestyle, such as being
Harewood House D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 6 able to have personal computers in the rooms, and being able to make choices about how to spend their leisure time. The residents are able to self advocate, and therefore are able to voice choices about their lifestyle. There is an open supportive culture between the resident and staff team; one resident stated that if they were unhappy about anything then they would take it immediately to the staff. The residents have formal house meetings on a yearly basis, but although infrequent there is day-to-day contact between the manager and the residents. There were no outstanding issues for the resident, other than the level of attention one resident demanded from staff team, and the manager was aware of it. The residents, apart from one, were consulted with as a group, and could not identify any areas of improvement which were necessary at their home. The communal areas are well furnished and comfortable, and present a very homely environment. The resident freely access all areas of the home, and are quite happy to sort out amongst themselves leisure activities to be undertaken in the home, for example, the night before the inspection they had all sat down together to watch a DVD. The residents are also looking forward to a forthcoming holiday at Butlins in Minehead. Some of the residents had been to this holiday camp before and had informed the others of the facilities and in particular the water slides. It was stated to be nice for them to have a short holiday together, as often throughout the year resident holidays were spent with families. From the point of view of staffing, the level of support offered by the staff was sufficient to support the residents to be independent. The relationships between the residents and staff are good and create supportive and caring environment that promotes the security and well being of the residents. What has improved since the last inspection?
Since the last inspection there have been very few changes at the home. There have been no new residents admitted to the home and the staff team has been settled. The positive outcome for the staff and residents at Harewood House is that the manager, Cheryl Peel, has now decided to remain at Harewood House for the foreseeable future. This will enable the home to remain stable and provide a very positive and supportive environment for the residents. The staff team has undertaken training in the administration and recording of medication.
Harewood House D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 7 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. Harewood House D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Harewood House D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 There is clear information available about the service for potential service users. EVIDENCE: Currently there is one vacancy at home, and the manager of the home is undertaking to fill this vacancy. There have been no admissions to the home since 2001; all residents have an individual contract relating to their residence at Harewood House. Harewood House D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8 There is a clear and consistent care planning system in place to meet individual needs and aspirations. Residents’ views and choices form the basis of the dayto-day activity of the home. EVIDENCE: All residents have a detailed care plan in place. Five were randomly selected. They were found to be very detailed and comprehensive and gave information relating to residents abilities in relation to personal care, daily living skills, orientation and memory, health needs and personal likes and dislikes. The care plans are linked to the care management reviews, which take place on a regular basis and include the resident. One resident expressed a wish to go out on regular excursions, and in particular she wished to have a special friend like one of the other residents has, to take them out on a regular basis. This resident agreed the request could be discussed this with manager. The resident was offered to be taken out for the day which at first she declined, and later accepted. There is evidence of the activities timetable for the residents being directly linked to the staffing rota. The request from a resident was observed to be
Harewood House D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 11 acted on. The residents also stated that they felt able to express their views and opinions to the staff team and be confident that they were listened to. Harewood House D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15,17 Residents are able to access varied activities; links with the community are good and support residents’ access to social and educational opportunities. EVIDENCE: The residents at Harewood all follow meaningful daytime activity, either provided from a third party, or supported by the staff at the home. Currently two residents have supported employment, and the manager is working with a third resident to find a suitable part-time job. The residents were also looking forward to a planned holiday. Generally the residents follow chosen activities every day, and whilst at home use home entertainment equipment such as computers and DVD players. In order that residents are as independent as possible the risk assessments are structured to be supportive. The residents participate in all aspects of life in the home including some household tasks; several residents have pets there are two cats, one bird and
Harewood House D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 13 several fish. Residents at the home are also supported to attend People First and participate in advocating for services for people with learning disabilities. Harewood House D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 The medication at the home is well managed promoting good health. EVIDENCE: The personal care support for each individual is identified and known to the staff team. The residents have primary care needs met by the local GP practice, and specialist care needs met by the CLDT. The individual personal files have information on them indicating that the health care needs of individuals is monitored and any action needed is taken. Three of the residents have visual impairments, and a review of the premises by the Woodspring Association for Blind People is recommended. One resident currently is on a reducing diet, and is being supported by the other residents and staff team. There is one insulin dependent diabetic who is linked in to the diabetic nurse, and the diabetic clinics at the local practice. All the staff are trained to assist this resident with insulin administration, and to test blood glucose levels. One resident has been referred for a physiotherapy review because of her mobility. The medication at the home is stored correctly and was found to be wellmanaged. All the staff had a certificate in Medication Management from Health Care Training.
Harewood House D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Residents are able to access the complaints procedures; however, staff awareness of adult protection procedures should be developed. EVIDENCE: There have been no complaints made to the home by residents. The complaints procedure is available in an accessible format. The residents stated that they were able to self advocate and raise issues of concern. There were also aware that Val Murray, the registered person, was available to them. The staff team have varied experience and qualifications; some have NVQ’s in care. The manager was advised that awareness training in Adult Protection issues is available through North Somerset Council, and all staff should attend this training. Harewood House D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 28, 30 The standard of the environment within this home is good providing residents with an attractive and homely place to live. EVIDENCE: The home is a Victorian property with an accessible front garden. There are two main entrances to the house one of which is a flight of steps and it was noted that these were due to have remedial work in order to make them safer. The other entrance will be having a ramp to improve access for one resident with mobility problems. There was a welcoming first impression and all areas of the home seen were clean, comfortably furnished and free from unpleasant odour. In order to maintain the property to a good standard and improve facilities the conservatory area is to have a new floor and roof in order to make it more comfortable to use in the winter. One resident complained about the smell of the flooring in their bathroom, and this is due to be replaced. Harewood House D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 34 The staff have a very good understanding of the residents support needs, this is evident from the positive relationships which have been formed between staff and residents. EVIDENCE: The home has a clear job description format and all staff have terms and conditions of employment. Staff consulted had a clear understanding of their role and duties. There are usually two care staff on duty together including the manager; additional staff hours are used to cover activities for residents outside the home. Since the last inspection there has been one new member of staff employed at the home, the practice followed meets the necessary standard. Appropriate checks are carried out, for ensuring the safety of the residents. Staff records inspected were found to be well maintained. Harewood House D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 18 Staff have recently undertaken training in first aid, food hygiene, medication management and fire safety. Staff consulted indicated that other training is accessed to meet the specific needs of clients accommodated. NVQ training is ongoing with three members of staff working toward level two. A programme of staff supervision sessions will be introduced and will consist of formal and informal sessions. The staff feel able to approach the manager and have their comments and suggestions regarding service provision listened to. Harewood House D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 42 Residents’ views are sought and influence the day-to-day running of the home. The manager provides clear leadership throughout the home in order to provide a safe and supportive environment for residents. EVIDENCE: The manager for the home is well qualified, and is remaining as the registered manager for Harewood House. Regular staff meetings are not held but staff commented that there was good communication and use of a communication book. Service users views are sought individually by their key workers and also via the residents meetings. One resident also completed a service users comments card for this inspection. The fire log book was inspected and evidenced regular checks and drills. At the time of the inspection there are no areas of health and safety implementation that are of concern to the inspector.
Harewood House D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 20 There appears to be team cohesion and willingness to work together to benefit the residents. This may be attributed to the leadership of the management and the continuity of care. The quality assurance currently in use is a yearly visitor/relative questionnaire that has been distributed and the results collated. There is a daily visual health and safety audit of the home. The quality audits of specific areas of the home will be introduced. Harewood House D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x x x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score 3 3 x 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Harewood House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x 3 x D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 22 Are there any outstanding requirements from the last inspection? NO 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 Regulation Requirement Timescale for action 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 23 29 Good Practice Recommendations Staff awareness in Adult Protection procedures could be updated. An assessment of the premises by the Woodspring association for Blind People could be undertaken to help identify any aids and adaptations to improve accessibility for all residents. Harewood House D53- D02 S8116 Harewood House V223032 26.05.05 stage4.doc Version 1.30 Page 23 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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