Inspection on 27/05/08 for Harewood Park

This inspection was carried out on 27th May 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Harewood Park 27/10/06

Harewood Park 09/01/06

Harewood Park 04/07/05

Harewood Park 08/02/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Harewood Park Leek Road Cheadle Stoke-on-Trent Staffordshire ST10 2EE Lead Inspector Peter Dawson Key Unannounced Inspection 27th May 2008 09:30 Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 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 Park DS0000026951.V364846.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 Adults 18-65. 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 Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harewood Park Address Leek Road Cheadle Stoke-on-Trent Staffordshire ST10 2EE 01538 756942 F/P 01538 756568 moorlands@harewoodpark.wanadoo.co.uk 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) Moorlands Rehabilitation (Staffs) Limited Kathleen Chester Care Home 37 Category(ies) of Learning disability (37), Mental disorder, registration, with number excluding learning disability or dementia (37) of places Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Respite Care & Rehabilitation Nursing Day Assessment Places - 2 The home may accommodate 1 existing named service user over the age of 65 years with MD and LD. 27th October 2006 Date of last inspection Brief Description of the Service: Harewood Park was initially registered in 1986 and is currently registered to provide nursing care for 37 service users, male and female, from the age of 18 years to 55 years who have a past or present mental illness/learning disability. The establishment offers rehabilitation and support and also an individual assessment service. Although the Homes main emphasis is on rehabilitation, individual assessments have identified that some service users may never live independently and as a result the Home is also registered to accommodate some services users over the age of 65 years. Harewood Park is situated in a semi rural location in Cheadle, Stoke on Trent, and is close to all local amenities. The home is set back from the main road and is accessed via a long driveway. There is ample parking space. In the main building, which accommodates 30 people, accommodation is provided to two floors. All bedrooms are single occupancy and six have an ensuite facility. The home has two bathrooms, four shower rooms and eight toilets sited throughout the home. There are four lounges and a separate designated smoking area. The home has a central kitchen but there is also a well-equipped training kitchen for service users to use as part of their rehabilitation programme. There is a laundry facility for main laundry services as well as a small domestic laundry for service users to use. The cottage facility offers semi-independent rehabilitation provision for seven service users and is a stepping stone to future independent community living. Fees charged at Harewood Park are not available in the Statement of Purpose and prospective residents may wish to contact the home direct for this information. Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This unannounced key inspection was carried out on one day by one inspector from 8.45 a.m. to 5.00 pm. The National Minimum Standards for Younger Adults were used to measure the outcomes of the service. An Annual Quality Assurance Assessment (AQAA) – required by Regulation, was completed and sent to us prior to the inspection and forms part of the information contained in this report. Most residents were seen and around 10 spoken with directly. All provided positive comments and information about their life at Harewood Park, no negative comments were made. Many showed pride in the activities they were engaged in and talked about external visits and how important home visits were to them and how staff supported them in all these areas. We, the commission received fourteen surveys from residents prior to the inspection. Comments were very positive supporting the views expressed by residents during the inspection. Comments included: “I think that Harewood Park is a great place, it is ideal for me, there are lovely staff and lots of great mates”, and “The staff are very supportive and help me through the days when I’m not comfortable, they are very understanding and always there for you”. Staff on duty were spoken with and gave useful information about the service. A staff handover at 2 pm was witnessed and provided useful information about the operation of the home, residents’ needs and staff attitudes. This was very positive and there were sensitive exchanges of information demonstrating the care and commitment to residents. The home provides care to 30 people in the main building and 7 people in the adapted Cottages in the grounds. All have been involved in rehabilitation programmes. A nucleus of 10 people remain unable to live more independently in the community. The remainder are all involved in rehabilitation programmes of varying intensity. The 7 people in the Cottages have early prospects of living in the community and are supported in an intense skill enhancement programme which is evaluated daily with the particular resident. There was a positive and relaxed atmosphere in the home allowing residents to openly state their views about the home. Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Part redecoration of the kitchen area has taken place to comply with the requirements of the Environmental Health Officers report. A count of PRN (as required) medication is now completed with a decreasing total of tablets so that the numbers can be checked at any time. Checks are now carried out to ensure the MAR sheets mirror the prescribers instructions on the bottle. This further improves the safety of the medication system for the residents. There were some shortfalls in the last inspection in risk assessments for all daily living situations. Risk assessments seen on this visit were comprehensive for example they covered risks relating to residents going on leave, self harm, use of kitchen and substance abuse. Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 7 The activities programme has been further extended to include the new garden project – initiated by residents involving them in all aspects of the project, allowing them to take ownership of the scheme. The home has purchased a 7- seater mini-bus to transport residents. This allows greater flexibility in allowing small groups to access community activities. The use of two additional colleges at Bentilee and Burslem has doubled the number of colleges used and therefore access to courses for a greater number of residents. What they could do better: Risk assessments must always be reviewed following falls or incidents where there is personal injury. Apart from reducing the risk of a repeat of the injury, it is a requirement under Health and Safety legislation. A review of the procedures for handling residents, finances are vital. This is important to protect residents and also to protect staff who are responsible for handling these monies. It is important that at least monthly bills are completed for residents so that they are aware of their financial liabilities prior to receiving their weekly/monthly allowances and can budget accordingly. Residents should have the opportunity of preparing drinks/snacks as a basic part of their rehabilitation programme. The dining arrangements must be reviewed to address the issues of lack of space and poor presentation of the dining area. There should be greater opportunity for residents to be more involved in food provision to promote the development of practical and social skills and to meet their needs. It is important and good practice that all residents should sign care plans as proof of their knowledge of their content and to take responsibility for decisions made. The home were unable to give a satisfactory reason for bathroom/toilet areas being locked. This practice should be changed to allow residents access to all communal areas to demonstrate ownership, trust and normality. Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 8 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 Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 9 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 Outcomes Statutory Requirements Identified During the Inspection Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1-4 were inspected on this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. With the exception of fees payable, residents are provided with adequate written information and invited to spend time in the home prior to admission. Pre admission assessments ensure peoples diverse needs are identified and planned for before they move into the home. EVIDENCE: There is a statement of purpose/service users guide in the home available for current and prospective residents. Weekly fees are not included in the statement of purpose and must be added. The documents were not seen on this inspection and the home are aware of the need to regularly review them. Pre-admission procedures include securing all assessments and information about the person. In the case of a recent admission a comprehensive assessment had been provided from the previous placement (hospital). The Manager had carried out an assessment in the hospital setting and the social worker provided a Care Management Assessment. The person had made two pre-admission visits to Harewood Park prior to actual admission. Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 11 The pre admission assessments were seen to provide the basis of the care plan established. In written feedback residents said that they had not been asked if they wished to move into the home and no information about the service was given. It was not possible to identify those providing that written feedback. A recently admitted resident said that she had been provided with adequate information and made two visits to the home prior to admission. Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6 –10 were inspected on this visit. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Care plans ensure that the needs and aspirations of residents are known and met by staff wherever possible. Reviews of risk assessments would ensure the ongoing safety of residents. EVIDENCE: A sample of care plans were seen including recently admitted and long-term residents. Care plans generally covered all aspects of personal care, social support and health care needs. Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 13 Information for a new resident was based upon good pre-admission procedures including comprehensive assessment from the former placement (hospital) a Care Management Assessment and the homes own assessment. There was adequate detail of the mental health diagnosis with a care plan to support the person in the daily living situation. A named Consultant Psychiatrist continues to see the person on a regular outpatient basis. Physical needs were identified including weight, continence care, diagnosed physical conditions and regular planned input on a weekly basis by the homes GP. There was a risk assessment in place based upon aspects of behaviour previously identified and risk assessments relating to daily living included: being on leave, use of kitchen and any mental health difficulties. The absence of risk assessments for daily living identified in the last inspection report has been addressed. The plan had not been signed by the resident although it was stated she was fully aware of the information in the care plan. A recommendation to ensure residents sign care plans was made at the last key inspection and this should always been done. Care plans seen are reviewed regularly on a monthly basis, additionally statutory reviews including Section 117 Aftercare, Guardianship and Section 37 reviews are carried out as required. Rehabilitation records show ongoing scoring of achievement and skills, residents are involved and aware of the progress being made. The majority of residents are on rehabilitation programmes, those considered unable to ultimately live independently still have ongoing assessments but without the scoring process. The care plan of a long-term resident was seen as a result of a significant injury received 4 days prior to the inspection. She had fallen in her bedroom sustaining a facial injury on the bedside cabinet whilst going to the toilet during the night. In fact she had two falls within the preceding 4 days. The falls were recorded in the daily notes and also in the accident book. It was mentioned that the GP would be asked to see her on his weekly visit. There was no review of the moving & handling falls risk assessment – the person uses a tripod for mobility and was seen moving hazardously in the dining room during the inspection. Risk assessments must be reviewed following all falls or incidents resulting in personal injury, to ensure that people are supported safely. The Independent Advocacy Service is used as required. At this time two residents have the use of this service in ensuring protection of their interests. Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 14 Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11 – 17 were inspected on this visit. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents enjoy a wide choice of meaningful activities and are encouraged to maintain relationships with their families. Some opportunities for personal development are restricted by rules of the home. Mealtimes do not provide a positive enjoyable experience for residents. EVIDENCE: The home has a good programme of internal and external activities led by 2 very enthusiastic members of staff who work several days, including weekends in the home. Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 16 All activities are planned and recorded and aim to provide a range of interests for a very diverse group. Many have the propensity to enjoy group activities but the few unable to do so receive specific 1:1 input. All are provided and are documented. There is a wide range of internal activities, many are craft based and residents spoken with clearly enjoy the creative aspects of these activities. On the day of the inspection a group were making garden figures with Salt Dough, some residents have their own store of craft activities and engage without any prompts or presence of staff in their chosen activity. The two staff involved have a proven skill in motivating residents. The interest of some residents fluctuates with their mental health status but all respond in different ways to the opportunities presented. Over the past year and following suggestion from residents a gardening project has been established in the extensive grounds. The services of a horticulturist/trainer have been secured who works closely with 10/12 residents per session. Residents have taken ownership of the project, there is a wildlife garden, vegetable garden and currently residents are engaged in landscaping work and the development of a “remembrance” garden in memory of a resident who passed away in 2007. External activities are numerous and include access to drop-in centres in Cheadle and Burslem, historic walks around Cheadle, Tittesworth Craft Fair, theatre visit to see “Godspell”, visit to craft sessions at shop in Cheadle. Some residents are still involved in a gardening project with the Re-Think organisation. There have been regular visits to the home by the E-Bus (from Leek College), which visits Harewood Park providing literacy/computer skills. This comes for a day per week and provides 2 sessions. College courses previously accessed at Leek and Cheadle Colleges continue and have now been extended to include courses at Burslem and Bentilee. Transport is readily available in the form of a 7-seater mini-bus and staff car owned by the home. . Residents are charged a pro-rata mileage rate for the mini-bus/car. In addition taxis are used and 7 bicycles were seen and said to be often used by residents. The range of activities and commitment to them by residents and staff is impressive. This was highlighted in written feedback from a resident who said, “I go out during the week, we go to the gardening project, cinema, swimming and I make decisions about activities. Usually they make arrangements for us but I don’t have to go to places that I don’t want to go to”. Residents spoke positively about family links being maintained and said that staff support and promote family contacts. Many residents are not local but visit their families in areas such as Cheshire, Kent and Merseyside. Many relatives visit from the local area and also from similar distances. These Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 17 contacts are vital and key requirements of support for residents and part of the homes philosophy. Outcomes relating to Education and Occupation, Community Links and Social Inclusion, Leisure and Relationships are good. Outcomes relating to Personal Development, Daily Routines and Meals and Mealtimes are not: A recommendation of the last report (18 months ago) was made to “Consider opportunities for residents to prepare drinks/snacks as part of their rehabilitation process”. This has not been addressed although the AQAA (Annual Quality Assurance Assessment) completed by the home states that the introduction of tea/coffee making facilities in some bedrooms will be provided in the next 12 months. The current situation does not promote independence and is disabling. The majority of residents are on rehabilitation programmes the objective being to maximise potential and develop social and independent living skills. The preparation drinks/snacks is a basic and vital part of social skill development. Comments were made in the last report about the unsatisfactory and inadequate dining facilities. - Tables for 4 people are formica-topped without table linen in a canteen style and regimented presentation. Space in this area is restrictive and inadequate in both style and layout to provide dining facilities for 30 people in the main building. This has not been reviewed as expected and we urge the service to urgently review the dining arrangements to ensure that the facilities meet the needs of residents. It is clear that residents play a minimal role at mealtimes; meals are mainly served to them at tables and cutlery/crockery removed upon completion. This again is not conducive with maximising independent and social living skills. Dining facilities should resemble domestic style living with residents participating in the provision of food in a “congenial setting”. This is not the case. All 3 bathroom/toilet areas in the main building were locked. This included one that had a walk-in shower/toilet. The reasons for this were not clear. When discussed with the provider it was stated that this was a restriction made by the insurers to avoid drowning. It was agreed with the provider that a recommendation would be made in this report for residents to have open access to bathroom/toilets areas and the provider would review this matter with the insurers. Standard 16 states that, “Daily routines should promote independence, individual choice and freedom of movement, subject to restrictions agreed in the individual plan or contract”. Many areas of the home have to be locked for safety reasons and these include the training kitchen, store rooms, treatment Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 18 room and several offices, adding bathrooms to those numbers mean a large part of the home is not accessible to residents. Communal areas should not be locked. In contrast it was pleasing to see that all bedrooms are lockable, residents having keys. Most actually locked their bedrooms demonstrating evidence of choice. Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18 – 20 were inspected on this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good recording of health care needs and actions taken ensure residents health care needs are met. Improvements to the recording of medication ensure safety for residents. EVIDENCE: The home has a retained GP service from a practice in Cheadle and a good service is reported. Regular reviews of health and medication are carried out. Whilst the GP visits the home residents are also encouraged to use the open surgery. In written feedback at the time of the last inspection the GP expressed satisfaction with the care provided at Harewood Park. In records seen there was evidence of at least annual health care checks for those residents. Residents have needs relating to enduring mental health needs. It was stated that all had been assessed as needing nursing care to meet those needs. Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 20 Health care specialists are involved where necessary. All residents have allocated Consultant Psychiatrist with immediate access if there are concerns about mental health needs. The Hospital Psychology service is also used. Diabetic Nurse Specialists provide support/advice on diabetes and oversees residents who use insulin. The District Nursing service has provided training and support in catheter care. Continence assessments have been carried out by the Continence Nurse. A recent visit from the Continence Advisor has provided advice/assessments for continence care to be carried out in the home. There was some concern that residents may pay for continence aids, although they are all assessed as needing nursing care. We pursued this and found it not to be the case – there is one instance where a resident chooses to use an aid exceeding the amount allowed in the Free Nursing Care Assessment but is credited with an amount from the assessment, towards the cost. Residents do not pay for continence aids. The medication system was inspected. All records had been completed accurately. There were procedures for the ordering, checking, storage, administration and disposal of medication in place that had been followed. Some self-medication is in place, residents in the Cottages (7) all selfmedicate. Two requirements made at the last inspection relating to medication have been satisfactorily addressed. There is a safe system of medication in the home. Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23 were inspected on this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to a clear complaints procedure and confidence they will be listened to. Arrangements for handling residents’ finances must be reviewed to protect them and staff involved in the transactions. EVIDENCE: There is a clear and accessible complaints procedure in the home for residents and visitors. There is a copy of the procedure in the Service Users Guide. No complaints have been received directly by the service since the last inspection. A complaint received by us about the care of a resident was forwarded to Social Services under the Safeguarding procedures last year. Nothing has been heard further about the referral. A further complaint from a professional organisastion, concerning professional practice and disclosure of information by Harewood Park was received by us. The provider was asked to provide a report and reply directly to the organisation. This was done and some of the issues clarified. The home have purchased some training DVD’s - one relates to the Protection of Vulnerable Adults. The procedures have been re-named Safeguarding Procedures, the home were unaware of this. It was recommended that the Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 22 home obtain a copy of the new Safeguarding Procedures from the Local Authority. Some staff have had training in Protection by attending courses, others had training in-house by DVD, the Manager will need to ensure that all staff have adequate knowledge and training in relation to the revised procedures for Safeguarding. Physical restraint is not used in this home. Staff have received training in diversionary techniques/de-escalation which is the method used in dealing with difficult behaviours. One resident was transferred to another setting when his needs could not be met in this area. Residents’ finances were inspected on this visit. Payments payable to residents were clearly documented when received. Payments for fees or weekly allowances (including DLA payments) were recorded and allowances given in cash to residents, being passed to the care office (nurse in charge responsible) from where they are distributed to residents on a daily, weekly or other basis. These payments follow deductions for expenditure such as mileage, outings etc. In fact the deductions had not been computed for the previous month, meaning that residents were given monies that may need to be repaid and they were unaware of their financial liability. Payments to the care office are recorded only in envelopes with a date and no amount. The number of envelopes are recorded and then signed for by the resident when given e.g. 2 x envelopes etc. Nurses responsible for the payments were unaware of the amounts in the envelopes or even the total of cash held. This exposes them and all staff to challenge for monies held/given to residents, the value of which is not known. The home must review the arrangements for handling resident finances. Balances of monies held must be known and easily identified to all. It is also important that monthly “bills” to residents for other payments should be up to date to ensure they are aware of their financial liabilities. All residents have Building Society/Bank accounts in their own names and monies can be paid in directly. Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30 were inspected on this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a safe, clean, well-maintained environment. Improvements to the dining facilities and free access to all communal areas would provide a more homely environment for residents. EVIDENCE: Harewood Park is a well established home which has been extended over the years. There is a separate area called The Cottages providing accommodation for 7 residents who are involved in a rehabilitation scheme to enable them ultimately to live in the community. The Cottages have 7 en-suite bedrooms with showers, a kitchen and dining area and communal lounge. It provides comfortable accommodation with good facilities and run separately from the main building which accommodates 30 people. Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 24 The main building has been extended and provides comfortable, wellmaintained accommodation. Plans have been submitted to further extend the building but are subject to the stringent rules of the National Park and have had to be re-submitted. Maintenance of the building is good and is ongoing. It is summarised in the AQAA, which states, “Over the past year there has been a complete facelift of the external structure. Several bedrooms have been redecorated and recarpeted. Armchairs in the bedrooms have been re-upholstered. We have commenced a programme of landscaping overlooking the patio area (with residents taking ownership and being involved in all aspects). We have refurbished the residents’ training kitchen”. The external grounds are extensive, well maintained and provide a range of seating with uninterrupted views of the surrounding countryside. This area is much used by residents and there is a “smoking shack” where they can smoke (a large proportion do). The kitchen area has been redecorated in part to comply with the requirements of the Environmental Health Officer as required in their last report. There has been considerable re-investment into the home over the years and this continues. Aspects of the environment that are not satisfactory are the dining facilities and locked communal areas – both mentioned earlier in this report in Standards 11 – 17. All areas of the home inspected were clean and hygienic with evidence of good infection control. A sample of bedrooms seen were comfortably furnished, all for single use only, some with showers. Bedrooms were personalised to reflect the individuality of residents. Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 25 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31 - 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from competent, well trained staff who demonstrate commitment to resident care and able to meet their needs. EVIDENCE: The home employs 11 Nurses (RMN/RMNH), 26 care staff and 7 ancillary staff. There is a nurse on duty throughout the 24-hour period. Additionally a nurse who is the care manager works 4 days 8.00 – 4.30. The Registered Manager is nurse qualified and works supernumerary. Additionally there are 3 Care Aides per shift. – In summary in the main building there are 3 aides and 2 nurses for most of the day. The Cottages are staffed separately with a Senior Aide. There is a nurse and 2 Aides on nights. Additionally the Activities Co-ordinator and Senior Aide provide activities over a 7-day period. Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 26 The staffing is adequate for the perceived needs of the current resident group. The percentage of non-nursing care staff qualified to NVQ level is 70 exceeding the required minimum. Staff training records seen showed that all required statutory training had been completed or in process for new staff. Professional updated training for nursing staff is completed for the work needed to update their nursing registration. Two staff will complete phlebotomy training in order to enable Clozaril blood testing to be carried out in-house, prior to being sent to the Clozaril Monitoring Service (CPMS). Some training for non-nursing staff is carried out internally by a nurse who has experience and expertise in training. This includes mental health awareness and care practice training. Staff meetings are held separately for domestic/catering staff. There are separate staff meetings for nursing and also for non-nursing staff and a separate meeting for night staff. Nursing and non-nursing care staff do not have a joint staff meeting. The home was re-awarded the Investors in People Award for a further 3 years from February 2008. A sample of staff files were seen and contained all required checks; references and documents legally required. POVA/CRB checks had been obtained prior to employment, assuring the residents that they are supported safely by the right people. Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 27 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37 – 39 & 41- 43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management arrangements are robust and protect the interests and safety of residents. EVIDENCE: The Registered Manager has worked at the home for 6 years, is a registered nurse and has considerable experience in providing care in relevant settings. She does not wish to pursue the NVQ4 in Management. Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 28 She provides a positive lead in the home and carries out quarterly audits of the home, including care delivery; records and the environment to ensure the required standards are met. The 2 Owners/Providers have a daily presence in the home and support the Manager and staff. Since the last inspection an experienced nurse (RMN) has been appointed to the role of Care Manager (November 2006). This has provided support for the Registered Manager and the Owners/Providers. There are regular weekly meetings for residents, able to express their views about the service. Fire records were not inspected on this visit and records relating to the maintenance of equipment were not inspected. Records seen in the home during the inspection were to a good professional standard – the only exception being the records of residents’ finances, which should be urgently reviewed as stated earlier in this report. Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 Standard No Score 1 2 2 3 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 2 12 3 13 4 14 3 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X 3 2 X Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 30 No Are there any outstanding requirements from the last inspection? 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 YA23 Regulation 16(2)(l) Requirement Timescale for action 30/06/08 2 YA42 13(4) (c ) Review arrangements for handling resident finances. Amounts of monies being held must be readily available and up to date. This will ensure that the residents can account for their monies and budget accordingly. Risk assessments must be 30/05/08 reviewed following falls/incidents resulting in personal injury. This will ensure that residents are supported safely according to their current condition. 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 YA1 YA 6 Good Practice Recommendations Information provided to the residents must include the fees payable and what is and is not included. Ensure all care plans are signed by residents to provide evidence that they are involved in planning their care. DS0000026951.V364846.R01.S.doc Version 5.2 Page 31 Harewood Park 3 YA11 4 5 6 YA 16 YA17 YA24 Provide opportunities for residents to prepare drinks, snacks as part of their rehabilitation process and development of individual living skills to promote and encourage their independence. Previous recommendation. Review the practice of locking bathroom/toilet areas. Residents should have freedom of movement in communal areas. Review dining arrangements to ensure that the facilities meet the needs of residents. The residents should be enabled to freely enjoy their environment in a homely manner, unless it is assessed as being unsafe. Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 33 Harewood Park DS0000026951.V364846.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!