Inspection on 10/11/05 for Harker Grange Nursing Home

This inspection was carried out on 10th November 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Harker Grange Nursing Home 04/01/08

Harker Grange Nursing Home 24/07/06

Harker Grange Nursing Home 09/05/05

Harker Grange Nursing Home 22/11/04

Harker Grange Nursing Home 19/04/04

Harker Grange Nursing Home 08/09/03

Harker Grange Nursing Home 20/05/03

Harker Grange Nursing Home 09/12/02

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

CARE HOMES FOR OLDER PEOPLE Harker Grange Nursing Home Harker Carlisle Cumbria CA6 4HY Lead Inspector Colette Hibbert Unannounced Inspection 10th November 2005 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 Harker Grange Nursing Home DS0000010115.V254725.R01.S.doc Version 5.0 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. Harker Grange Nursing Home DS0000010115.V254725.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Harker Grange Nursing Home Address Harker Carlisle Cumbria CA6 4HY 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) 01228 523753 01228 540344 wmacfin@aol.com Mrs Wendy McNaughton Care Home 26 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (26) of places Harker Grange Nursing Home DS0000010115.V254725.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 26 service users to include: up to 26 service users in the category of OP (Older people not falling within any other category) up to 2 service users in the category of DE(E) (Dementia over 65 years of age) Date of last inspection 9th May 2005 Brief Description of the Service: Harker Grange is an adapted Victorian House set in extensive grounds close to the M6 and Carlisle. Care is provided for up to 26 service users within the category of older Persons. There are two well used sitting rooms and for those who wished to smoke there is a conservatory. Rooms may be single or the option to share may be given, subject to availability. There was access to the first floor via stairs, a passenger lift or a new stair lift. Access to some parts of the first floor was difficult for those with poor or reduced mobility and advice was being sought on other ways to manage this. The Committee of Friends continues to support the home and holds regular fund raising activities as well as volunteering to escort residents when going on trips. Harker Grange Nursing Home DS0000010115.V254725.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 10th November 2005 from 08.50 to 15.00hrs conducted by Colette Hibbert. Time was spent with the Deputy Manager, touring the home, talking to residents, relatives, visitors and staff. The inspector looked at several care plans and medication administration and procedures. What the service does well: What has improved since the last inspection? What they could do better: Harker Grange Nursing Home DS0000010115.V254725.R01.S.doc Version 5.0 Page 6 Each resident has a written care plan, but this must be regularly updated and used as an ongoing assessment tool for providing appropriate care. The manager should make sure that the staff read through the Adult protection policy of the home and be aware of action that should be taken if this situation arose. Staff must have regular sessions for fire training to promote practises that will keep residents safe. Due to the long term absents of the general manager the home should look at ways of improving the daily maintenance, repairing and replacing broken equipment within the home for the greater comfort of its residents. There was no information available to the inspector regarding written contracts between the residents and the home. The manager should make sure that senior staff have access to all documentation. 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. Harker Grange Nursing Home DS0000010115.V254725.R01.S.doc Version 5.0 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 Harker Grange Nursing Home DS0000010115.V254725.R01.S.doc Version 5.0 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): 1,3 Prospective residents and families are encouraged to visit the home prior to admission. This enables care needs to be discussed and informed decisions can be made about the home. EVIDENCE: The inspector spoke with residents, relatives and visitors during the visit and they all said they had visited the home prior to admission and they felt that the care needs were being met. One resident had been admitted since the last inspection and there was a comprehensive assessment made including assessments by social services and the hospital. The care plan had been developed from these assessments to provide staff with the information required to carry out appropriate care. Harker Grange Nursing Home DS0000010115.V254725.R01.S.doc Version 5.0 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 and 10 Each resident had a care plan but not all had been updated. The short falls in the staffing levels have a potential to reduce the levels of care so placing residents at risk. Residents were treated with dignity and respect. EVIDENCE: Individual care plans are available, but some risk assessments had not been updated to reflect changes in care needs. One resident had a pressure sore which was being treated with dressings, the documentation was not clear as to the treatment and entries in the care plan were not dated so it was difficult to monitor the progress. Visits by other health care agencies were noted within the care plan and referrals to specialists where appropriate had been made. The residents were spoken to in a friendly manner by the staff and treated with dignity. Medications were given in an appropriate and safe manner. The home had introduced a system to keep a record of medication received and returned. Medication was also reviewed to meet the resident’s needs. The staff knocked on the residents’ bedroom doors before entering, and their privacy was maintained at all times. Personal support at times was limited due to lack of staff, but staff seemed to be aware that this affected the level of care, and did their best for the residents. Harker Grange Nursing Home DS0000010115.V254725.R01.S.doc Version 5.0 Page 10 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): 13, 14,and 15 Residents within the home can choose how they spend there time and are helped to live as full a life as possible. EVIDENCE: One relative said that ‘ nothing was too much bother for the staff, they are 100 dedicated to giving the residents an excellent life’. Visitors said that they could arrive at any time and were always made welcome. The visitor’s book showed a high volume of visitors on a daily basis to the home. There was a notice up for a forthcoming trip for the residents who wanted to go to the Metro shopping centre to do their Christmas shopping. Residents were looking forward to this, they also told me about the trip to Maryport last month. A committee who hold a coffee morning every month within the home, which people from the local community attend, supports the home. The activities organiser worked two mornings a week. She spent part of the morning in the lounge with the residents. Some enjoyed a game of dominoes then had a music session. The residents were actively encouraged to choose what type of music they wanted to listen to. There was a weekly planned activities program in place. Two residents were reading newspapers, which are delivered for them every morning, they both said they were regularly asked if they were happy with the paper they had delivered. Harker Grange Nursing Home DS0000010115.V254725.R01.S.doc Version 5.0 Page 11 Some residents who were able were assisted to fill out the next day’s meal menu cards and they were given choices for each meal. Residents said that the meals were good, one said ‘they were the best bit of his day’ Meals were served on individual trays with doyleys and salt and pepper, either in the resident’s own room or in the lounges. They always had home made scones mid morning, cakes and biscuits mid afternoon and suppertime. The weekly menu appeared be well balanced, and a wide variation of dishes. There was plenty of fresh produce in the kitchen, which was very clean, tidy and well organised. Harker Grange Nursing Home DS0000010115.V254725.R01.S.doc Version 5.0 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): 16,18 Residents stated that their views were listened to and relatives were confident that any concerns or complaints they had would be acted upon. The lack of knowledge on vulnerable adult procedures by the staff does not ensure that the people living in the home are protected from abuse. EVIDENCE: Residents, relatives and visitors spoken to said that they were aware of how to make a complaint. The staff where aware of the complaints procedure and said they could help residents to access the complaints process. The staff spoken to about their understanding of abuse were not too sure what they would do in these circumstance, one said she would tackle the problem herself. They confirmed they were not sure about the homes POVA procedures. Harker Grange Nursing Home DS0000010115.V254725.R01.S.doc Version 5.0 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): 19,21,24,26 Harker Grange is a large Victorian property set in its own grounds. It is homely and clean but there are several issues regarding maintenance, which need to be addressed to improve the living standards for the residents. EVIDENCE: Fire doors were propped open with door wedges and I asked for them to be removed as this was not safe practice, due to this a requirement was made. The door to the downstairs linen cupboard was bare wood and needed attention. Several of the windows throughout the building were in need of having panes replaced. One bedroom had secondary glazing units that were broken; staff were unable to close these units. A lot of the furniture within the bedroom was in need of replacing or new coats of varnish, as they looked very shabby. The main lounge had lampshades missing with bare light bulbs exposed and generally appeared very cluttered. In the upstairs bathroom tiles were hanging off the wall over the bath. Staff said that the bath was not used. Residents were taken downstairs to be Harker Grange Nursing Home DS0000010115.V254725.R01.S.doc Version 5.0 Page 14 hoisted into the bath. A commode used by one of the residents was in need of replacing as the seat was cracked and would be a source of infection. The bedrooms were personalised with pictures and ornaments and screens were used in double rooms to provide privacy as required. Storage space was a problem and wheelchairs had to be stored in the corridors which limited the space for passing residents. The home was clean with no unpleasant odours. The cleaner was busy on the morning of the inspection and felt she had no problems with her work. Harker Grange Nursing Home DS0000010115.V254725.R01.S.doc Version 5.0 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): 27,28,30. Staff moral was high, but it did not appear that there was adequate provision of staff to provide individualised unrushed and safe care for the residents. EVIDENCE: On the morning of the visit the home was staffed by the deputy matron, two care assistants and a qualified nurse, who was in to replace a care assistant who was off sick. The rota showed that most morning there were four members of staff on duty. Staff were extremely busy and it was obvious from the care plans that several residents had been washed and dressed by the night staff. During the lunch time period the activities organiser and the kitchen assistant helped out by feeding residents and helping to serve the meals. Staff said mornings were rushed due to having to ‘get the baths done’ and that they had more time for each individual resident on the days when there was more staff on duty. Staff said it was sometimes necessary to work extra hours to get the paper work done at the end of the shifts. When all the four morning staff went for there lunch the two staff that came on after lunch took a resident upstairs to bed. This left the majority of residents unsupervised by staff for approximately 20 minutes in the lounge. Harker Grange Nursing Home DS0000010115.V254725.R01.S.doc Version 5.0 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): 33, 34, 35, 36, and 37. There is clear leadership, guidance and direction from the Manager who is also the owner. A deputy has been newly appointed to strengthen the team. The Manager and staff were very committed to the well being of the residents. EVIDENCE: Residents, relatives and staff all felt that the home was well run. The staff said they were well supported by the Manager and that they had clear information on their roles and responsibilities. A new member of staff had a full induction program in place and was undergoing a shadowing process until an updated CRB check arrived. The home did not have responsibilities for any residents’ finances. Most residents had family members to help look after their finances and two residents were supported by social services, in which case the home purchased items required by the residents and submitted receipts. Health and safety needs to be addressed regarding fire doors and training for the staff. Harker Grange Nursing Home DS0000010115.V254725.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 2 X X 2 X 3 STAFFING Standard No Score 27 2 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 3 3 3 2 X Harker Grange Nursing Home DS0000010115.V254725.R01.S.doc Version 5.0 Page 18 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. 2. 3. Standard OP7 OP18 OP19 Regulation 15 13(6) 23(2b,c) Requirement Care plans and risk assessments must be updated on a regular basis. All nursing and care staff must be made aware of the POVA policy within the home. The registered manager must review systems in place for repair and renewal of broken equipment also improving daily maintenance to the building. The registered manager must review procedure for staff fire safety training within the home. The registered manager must ensure adequate numbers of care staff on duty to provide appropriate care to meet the resident’s needs. Timescale for action 10/12/05 10/12/05 10/01/06 4 5 OP19 OP27 23(4a) 18 (1a) 10/11/05 10/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000010115.V254725.R01.S.doc Version 5.0 Page 19 Harker Grange Nursing Home Standard Harker Grange Nursing Home DS0000010115.V254725.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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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