Inspection on 24/07/06 for Harker Grange Nursing Home

This inspection was carried out on 24th July 2006.

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

The inspector 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 10/11/05

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 Jenny Donnelly Unannounced Inspection 24th July 2006 11:00 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.V291295.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Harker Grange Nursing Home DS0000010115.V291295.R01.S.doc Version 5.2 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.V291295.R01.S.doc Version 5.2 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 10th November 2005 Brief Description of the Service: Harker Grange is an adapted Victorian House set in extensive grounds close to the M6 and Carlisle. Nursing care is provided for up to 26 service users within the category of Older Persons. The home has a large and a small lounge for residents’ communal use. Bedrooms 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 chair lift. Movement and access around the home was difficult in places due to the Victorian nature of the building. As Harker Grange was in existence prior to the development of the National Minimum Standards, the building does not have to conform to the same environmental standards as newer care homes. 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. The weekly fees at the time of this inspection ranged from £385.00 to £542.00 plus any registered nursing care contribution entitlement from the primary care trust. Information for prospective residents and their families could be gained from the home, in the form of a service users handbook. Harker Grange Nursing Home DS0000010115.V291295.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place in July 2006 and included an unannounced visit to the home on 24th July at 11am. Written information had been collected, in the form of satisfaction questionnaires from residents and relatives, and management information from the homeowner. At the visit to the home, a tour of the building was undertaken, records relating to staff recruitment and training, and residents care and medication records were examined. Residents, visitors and staff were spoken to in private, as well as in small groups. What the service does well: What has improved since the last inspection? 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. Harker Grange Nursing Home DS0000010115.V291295.R01.S.doc Version 5.2 Page 6 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.V291295.R01.S.doc Version 5.2 Page 7 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): 3 Quality in this outcome area is good. The home had fully assessed new residents care needs before offering them a place. This ensured that residents knew the home would be able to meet their assessed needs before they chose to move in. This judgement has been made using the available evidence including a visit to the service. EVIDENCE: There was evidence that residents care needs had been assessed prior to them being offered a place at Harker Grange. Assessments were carried out by the manager/owner, and where possible information was also gained from the persons’ social worker and the hospital. On the day of admission to the home, a profile of the persons’ care needs was drawn up, to assess if any changes had occurred in the interim. The residents and visitors spoken to confirm they had been able to look around the home before they moved in. Residents and visitors felt their care needs were being well met, and that the home was right for them. There was evidence that when a residents’ care needs changed after admission such that Harker Grange was no longer suitable for the person, the home assisted them to find a more appropriate placement. Harker Grange Nursing Home DS0000010115.V291295.R01.S.doc Version 5.2 Page 8 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 Quality in this outcome area is good. Residents’ health and social care needs were being met to their satisfaction. The management of medicines in the home was safe. Residents felt they were treated with respect, and that staff maintained their privacy and dignity. This judgement has been made using the available evidence including a visit to the service. EVIDENCE: Further to previous requirement, individual care plans were available and up to date for each resident. The care planning system was not very user friendly, and consisted of a lot of loose sheets. However the information contained was pertinent and staff were familiar with the system. The plans detailed residents’ individual health and social care needs and any particular preferences or wishes they had expressed. There was evidence that residents’ health care needs were being met, and there was good access to external healthcare professionals, such as the doctor, chiropodist and optician. Residents and visitors confirmed that they felt well cared for, and that “nothing was too much trouble for the staff”. The manager had received a thank you letter from the family of a former resident saying their relative had been “loved and cherished, and treated with respect” at Harker Grange. It was clear that residents’ Harker Grange Nursing Home DS0000010115.V291295.R01.S.doc Version 5.2 Page 9 privacy and dignity was being upheld by staff, who always knocked before entering bedrooms and called residents by their preferred name or title. A brief examination of the medicines storage and records showed that safe systems were in place, and staff were working in accordance with these. Harker Grange Nursing Home DS0000010115.V291295.R01.S.doc Version 5.2 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): 12, 13, 14 and 15 Quality in this outcome area is good. Harker Grange provided a real home from home, with residents enjoying many visitors and support from the friends association. There were regular in house and outside activities for residents who wished to join in. The provision of meals was very good, and much enjoyed by residents. This judgement has been made using the available evidence including a visit to the service. EVIDENCE: The home employed an activities organiser for two days a week. This person also assisted residents with meals, and had worked as a carer and received appropriate training on feeding and swallowing difficulties. On other days, care staff organised the activity. There was a weekly programme showing armchair exercises, ball games, discussion around the days newspapers, quizzes and sing a longs. The home used a local wheelchair mini bus for quarterly outings for theatre trips, Christmas shopping and afternoon teas. There were also visiting entertainers every couple of months. The home was well supported by “The Friends of Harker Grange” who held fundraising coffee mornings and strawberry teas. Visitors commented that they were made very welcome in the home, offered refreshments and could phone at any time if they were worried about their relative. Harker Grange Nursing Home DS0000010115.V291295.R01.S.doc Version 5.2 Page 11 The meals were a real highlight of the day with residents saying “there is always a choice”, “the menu is variable and well cooked” and, “if I don’t like something, I always get a substitute”. One visitor commented, “Lunch always looks so lovely I want to eat it myself”. The kitchen was clean and tidy, with plentiful stocks of fresh fruit and vegetables. The cook bakes daily, so there was a selection of fresh scones and cakes. Soups were all homemade, and special medical diets were managed well. Lunch on the day was beef casserole with vegetables or pork salad, followed by stewed fruit and custard or artic roll. Tea was homemade leek and potato soup with various sandwiches, cheese and biscuits and custard trifle. Harker Grange Nursing Home DS0000010115.V291295.R01.S.doc Version 5.2 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): Quality in this outcome area is adequate. The home had a system through which people could complain about the service if they wished. Staff had received training on the protection of vulnerable adults (abuse), but the homes policies and procedures on abuse need improving. This judgement has been made using the available evidence including a visit to the service. EVIDENCE: The home had not received any complaints since the last inspection, and none had been directly to the inspector. Information on how to make a complaint was on display in the home, and a copy was provided to every resident/family in the service users handbook. The residents and visitors spoken to knew how to complain, but said they had never needed to do so. A previous requirement had been made of the home to provide adult protection training (abuse) for staff. On the day of this visit, an external trainer was in the home, delivering this training. Seven staff attended the morning session, and nine attended in the afternoon. The manager had been at the morning session, and said the trainer was very good indeed. As a result of this session the manager intended to review the homes’ policies and procedures in relation to adult protection. This is needed, as the homes’ procedures do not make the referral process, and the role of social services clear to staff. Harker Grange Nursing Home DS0000010115.V291295.R01.S.doc Version 5.2 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, 22 and 26 Quality in this outcome area is adequate. Harker Grange has some access difficulties due to being a Victorian property. The home however is well equipped with good nursing beds and various mobility aids. The upkeep of the fabric and decoration of the building is a continuous job, but the home is clean and fresh throughout. This judgement has been made using the available evidence including a visit to the service. EVIDENCE: Harker Grange is an adapted Victorian house, and as such has some difficulties with access and movement around the building. No recommendations are made about this, as the home is not subject to the environmental standards required in new care homes. There is a passenger lift to the upper floor on one side of the home, and a chair lift to access the upper rooms on the other side of the building. There are ramps in place over corridor steps. Bedrooms are individual in size and shape, some of them quite small, and have varied Harker Grange Nursing Home DS0000010115.V291295.R01.S.doc Version 5.2 Page 14 outlooks depending on their situation. The home stands in its own large grounds, and there are pleasant patio seating areas with sunshades. Since the last inspection a number of running repairs and general redecoration had taken place. In the laundry a new disinfection system had been installed to the washing machine, and there was a new tumble drier. The home had three mobile hoists, including one new one. Although there were a number of inaccessible ordinary baths around the home, there was one specialist bath and a bath with a rising seat. The home had 20 electric profiling beds, with the remainder having hydraulic adjustability. All beds had good pressure reducing mattresses, and there were 10 specialist airflow mattresses. In the week prior to the visit, the cleaner had been on holiday, and there had been limited cover in her absence. Despite this, the home was essentially clean and fresh, with no unpleasant smells in any areas. The corridor carpets were quite stained, but the home had loaned a carpet shampooer for use later in the week, so no recommendation is made. Some of the paintwork around the home was worn and damaged, and the homes repairman was said to be continually redecorating these. Harker Grange Nursing Home DS0000010115.V291295.R01.S.doc Version 5.2 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, 29 and 30 Quality in this outcome area is good. Residents were cared for by a committed and competent staff team, who benefited from good access to training in a variety of relevant subjects. The recruitment procedures protected residents from having unsuitable people working in the home. This judgement has been made using the available evidence including a visit to the service. EVIDENCE: Staffing levels were not as normal on the day of the visit because of the staff training events. Additional staff had been available earlier in the morning to assist residents, prior to the training, and less staff were available during the session. The homes’ usual staffing arrangements had increased since the last inspection in line with the increase in resident numbers. There were generally five staff during the day, reducing to four at 5.30pm and 3 at night. Included in these numbers was a registered nurse at all times. The residents and visitors spoken to said, “all the staff, from kitchen to nursing are brilliant”, and “staff are always available and often take time to have a laugh with us, and a smile is always on their face”. Staff recruitment procedures were sound and ensured no unsuitable persons worked in the home. The manager found recruitment difficult in the area, and had one care staff vacancy. The home had 61.5 of care staff with an NVQ in care, which is very good. There was plenty of training provided in the home and records showed that since the last inspection in November 2005 the following had taken place; brain tumours and communication, control of infection (10 week course), Harker Grange Nursing Home DS0000010115.V291295.R01.S.doc Version 5.2 Page 16 mental health programme on depression and dementia (20 week course), safe handling of medicines (10 week course), a further dementia course, care of the dying, safe moving and handling and protection of vulnerable adults. Further training on other subjects was also planned for the remainder of the year. Harker Grange Nursing Home DS0000010115.V291295.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. Residents benefited from the home having clear and effective leadership. The health, safety and welfare of residents and staff were being promoted. The casual approach to quality assurance needs to be formalised, and the home should have a fire warden and update staff food hygiene certificates. This judgement has been made using the available evidence including a visit to the service. EVIDENCE: Mrs McNaughton the owner/manager is a registered nurse, and has been running Harker Grange for over 17 years. Residents, visitors and staff said they felt well supported by the owner/manager and had great confidence in her. A deputy and a team of registered nurses supported the manager. The home did not have much in the way of a formal quality assurance system, although in the past they have done satisfaction surveys of residents. The manager said she concentrated on speaking to people individually and put every effort in making sure the care provided was to a high standard for each Harker Grange Nursing Home DS0000010115.V291295.R01.S.doc Version 5.2 Page 18 individual, and that no pressure sores developed in the home. The home will need to develop a quality assurance system based on residents’ views, as this is a legal requirement. The home did not have any dealings with residents’ finances. The health and safety arrangements in the home were adequate, with staff having received regular instruction on fire safety and the safe moving and handling of residents. However changes in staff meant there was no longer a fire warden in the home, and the food hygiene certificates for staff were out of date, the manager was aware of the need to address these. Harker Grange Nursing Home DS0000010115.V291295.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Harker Grange Nursing Home DS0000010115.V291295.R01.S.doc Version 5.2 Page 20 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 OP18 Regulation 13(6) Requirement The home must update the adult protection policies and procedures to reflect the local multi-agency guidance. The home must have a quality assurance system based on the views of service users and stakeholders. Timescale for action 01/01/07 2. OP33 24 01/01/07 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 OP38 OP38 Good Practice Recommendations The home is recommended to appoint a suitably person to act as fire warden / appointed person for fire safety. Staff handling food should have evidence of current food hygiene training. Harker Grange Nursing Home DS0000010115.V291295.R01.S.doc Version 5.2 Page 21 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. Extracts may not be used or reproduced without the express permission of CSCI Harker Grange Nursing Home DS0000010115.V291295.R01.S.doc Version 5.2 Page 22 - 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. 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