Inspection on 04/01/08 for Harker Grange Nursing Home

This inspection was carried out on 4th January 2008.

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

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 24/07/06

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 4th January 2008 10:00 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.V354051.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.V354051.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 kmacfin@aol.com Mrs Wendy McNaughton 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.V354051.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 24th July 2006 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 is difficult in places due to the Victorian nature of the building. 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.V354051.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 star. This means the people who use this service experience good quality outcomes. This was the main or “key” inspection of the service. Jenny Donnelly inspector, made an unannounced visit to the service on 4th January 2008. A second announced visit was made on 8th January to meet with the owner/manager. During the visits we toured the building, spoke with residents, visitors and staff. We looked at care, medication, staffing and maintenance records, and observed how people were spending their day. Prior to this inspection the manager had completed and returned an Annual Quality Assessment Audit (AQAA) that we had requested. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We sent surveys out to half of the people who live in the home and their relatives. The findings of the surveys are included in this report. What the service does well: What has improved since the last inspection? Since the last inspection the service user guide had been updated to provide easy to read, good quality information about the service. A large print newsletter had also been produced. A number of the policies and procedures had been updated, and a formal quality assurance system had been adopted. Catering staff had received update training in food hygiene, and a fire warden had been appointed. A number of new carpets had been purchased, along Harker Grange Nursing Home DS0000010115.V354051.R01.S.doc Version 5.2 Page 6 with new curtains and bedding for some rooms. ‘Doorguard’ closures had been fitted to the lounge and bedroom doors, with the approval of the fire officer. 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. The summary of this inspection report can be made available in other formats on request. Harker Grange Nursing Home DS0000010115.V354051.R01.S.doc Version 5.2 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.V354051.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was good information available about the care home and the admission arrangements were thorough and helped ensure new people’s needs would be well managed. EVIDENCE: A new service user guide had been produced in December 2007 and a copy had been provided in every bedroom. This detailed the services on offer at Harker Grange, and gave information about the staff group and the aims and objectives of the care home. It also included a sample contract, a copy of the complaints procedure and the summary from the last inspection report. There was also a newsletter, which gave information about recent events and activities that would give enquirers a sense of the social life in the home. Records showed that new people admitted to the care home had undergone a thorough assessment of their personal, health and social care needs. This Harker Grange Nursing Home DS0000010115.V354051.R01.S.doc Version 5.2 Page 9 assessment process served to ensure the care home would be suitable for the person’s individual needs. People said they, or their relatives, had been able to come and look around the home and ask questions about the service offered. During this inspection visit some unexpected viewers arrived and were made welcome by staff and shown around. The service does not provide intermediate care. Harker Grange Nursing Home DS0000010115.V354051.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were receiving good quality health and personal care that enhanced their quality of life. EVIDENCE: Each person had an individual plan of care in place and these had been drawn up using the information gathered during assessments. The plans detailed peoples’ personal, health and social care needs, including any particular wishes or requests, and they were written in a person centred way. There was evidence that people received good quality health care and were able to access the doctor, dietician, chiropodist and other specialists as required. Risk assessments for peoples nutritional needs, skin care and safety were all completed and had been updated monthly. Where action was needed to reduce risks in any of these areas, a care plan had been put in place and its effectiveness monitored. No one in the care home had a pressure sore, although a number of people were receiving preventative care. There was evidence that medical conditions were being well managed and staff were Harker Grange Nursing Home DS0000010115.V354051.R01.S.doc Version 5.2 Page 11 knowledgeable about these. People were being treated with dignity and respect and there was a culture of this being the residents’ home, run for their benefit, around their wishes. The care home follows an integrated care pathway for the care of dying people, and through this works in conjunction with the local doctors and other healthcare specialists. People felt they were well looked after at Harker Grange saying; • “I am comfortable and well cared for” • “I feel well looked after”. Relatives told us; • “The nursing home is small and friendly” • “My (relative), now deprived of all her faculties by a cruel disease, receives the best possible care in a home run by, and staffed by caring, loving, dedicated and professional people” • “The care my (relative) has received since living at Harker Grange has been excellent. The staff make every effort to meet her needs”. Inspection of the medicines system showed that medicines were safely managed. There were records of all medicines received into the home, those administered and any returned. The storage of medicines was secure and well managed. There was evidence that periodic medicines and short courses of treatment such as antibiotics were well managed so that people got the medicines they needed at the right time. Harker Grange Nursing Home DS0000010115.V354051.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People said they had a good lifestyle at Harker Grange and could choose to opt in or out of a range of activities, and they enjoyed good home cooking. EVIDENCE: People told us they are able to spend the day as they wished and it was clear that people were able to choose whether to stay in bed late, sit in their own bedrooms or use the communal lounges. The home employed an activity organiser who had drawn up a programme of events. People said they had recently enjoyed a shopping trip into Carlisle where “we went round all the shops in town, and saw the Christmas lights”; there had been a visiting singer and a visit from children at the local school and a trip out for afternoon tea. There were regular fund raising coffee mornings, and other in house events such as quizzes, sing a longs and exercise sessions. The home produces an informative and colourful large print newsletter. This shares any staff and residents news, birthdays and information about outings and events. Outings are funded by the homes fundraising events and are free of cost to residents and their relatives. Daily newspapers are also provided free of charge. Harker Grange Nursing Home DS0000010115.V354051.R01.S.doc Version 5.2 Page 13 The manager has plans to access some local complimentary therapists to undertake massage and reflexology, and is considering providing a computer for people to have Internet access. Meals were home cooked and very popular. People said the “food is always lovely”, “we have a choice of meals”, and “we get plenty to eat”. The cook provided home baking and a homemade soup each day. The menus were quite traditional with roasts, casseroles and hot desserts served at lunchtime and a lighter buffet style tea. People were asked to choose their meals in advance, but there was some flexibility if people changed their mind on the day. We saw people enjoying a lunch of trout fillet or egg with mashed potatoes or chips and peas, or a ploughman’s lunch followed by chocolate sponge and custard or yogurt or cheese and biscuits. The evening meal was lentil soup, sandwiches, sausage rolls and cakes. The kitchen was well organised and staff assisted people to eat as needed. Harker Grange Nursing Home DS0000010115.V354051.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People felt safe at Harker Grange and the staff understood their responsibilities in safeguarding people from abuse. EVIDENCE: Harker Grange had a complaints procedure on display and there was a copy in the service user guide found in each bedroom. There was also clear information on how to access advocacy services, adult social care and the commission for social care inspection. The manager told us she had not received any complaints since the last inspection, and none had been made to the commission. Surveys from residents and relatives told us that people knew how to complain if they needed to. One person had recently expressed a wish to move to another care home and the manager had asked adult social care to meet with the person to discuss their future plans. Since the last inspection, the homes policies and procedures on safeguarding people from abuse had been updated in line with the training staff had received. Since then, the manager had reported one allegation under the safeguarding procedures and this had been investigated and dealt with in a timely and appropriate manner. This demonstrated that the manager and staff took their safeguarding responsibilities seriously, and worked in accordance with the local multi-agency guidance to protect people. The manager has collected information for staff on the new Mental Capacity Act, and is looking into updated codes of practice around restraint and liberty. Harker Grange Nursing Home DS0000010115.V354051.R01.S.doc Version 5.2 Page 15 People told us they felt safe in the care home and thought the staff took good care of them. One relative wrote; • “The care people receive is outstanding. This is due to the dedication of the staff who give 100 and more…residents feel safe, loved and listened to and families feel supported”. Harker Grange Nursing Home DS0000010115.V354051.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Harker Grange provides comfortable and homely accommodation but there is some restricted access for people with infirmities, and some shared bedrooms. EVIDENCE: Harker Grange is an adapted Victorian house with a modern extension that provides accommodation for a maximum of 26 people over two floors. There is a passenger lift in the extension, and a stair chair in the original building. There are some bedrooms that can only be accessed via steps, although the manager is looking to install a wheelchair platform lift to alleviate the problem in one area. Bedrooms are individual in size and shape, with some rooms being quite small; the measurements and outlooks are detailed in the service user guide. People told us they were happy with their bedrooms and had been able to bring in their own belongings. Some bedrooms are for shared use, and people are asked if they would be willing to occupy a shared room. Harker Grange Nursing Home DS0000010115.V354051.R01.S.doc Version 5.2 Page 17 The home has two communal lounges for people to use, and stands in its own large grounds, with pleasant patio areas for sitting out. The home has a number of bathrooms, but only one has a fully assisted bath, and another has a simple bath seat. The home is well equipped with adjustable nursing beds, pressure reducing mattresses and five hoists. The laundry is fitted with an Otex laundry system, which is designed to eradicate infection at lower temperatures without damaging more delicate fabrics. Infection control procedures were sound. The building was clean and fresh throughout, and there was good provision of domestic, maintenance and laundry staff on duty. Since the last inspection a number of new carpets had been provided, as well as some new curtains and bedding. New fixed screens had been provided in the shared bedrooms and ‘doorguard’ automatic closing devices had been fitted to bedroom and lounge doors. The home had received satisfactory reports from the fire service and the environmental heath officer. Harker Grange Nursing Home DS0000010115.V354051.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were being cared for by a competent and committed staff team. EVIDENCE: Staffing levels were consistently satisfactory to meet peoples’ needs and to provide good housekeeping services. The home had a core of long serving staff who knew the residents well and understood the philosophy and culture of the home. Care staff were encouraged and supported to undertake National Vocational Qualifications (NVQ) in care and 68 had achieved this, with a further 25 currently working towards NVQ, which is extremely good. Staff received regular mandatory training in health and safety issues, including fire and safe moving and handling. Kitchen staff had received food handling training and the general manager / maintenance man acted as the homes’ fire warden. Apart for the mandatory training, staff were receiving training about the Mental Capacity Act, two were attending a dementia course, two a palliative care course, and two a tissue viability (skin care) course. Staff had regular meetings and informal discussions to share their learning and to promote good care practices. Inspection of three staff files showed the manager had followed sound recruitment procedures and taken up references and carried out criminal records bureau checks on new staff. People told us they liked the staff, saying, “they are very kind”, and “the staff here are wonderful”. Harker Grange Nursing Home DS0000010115.V354051.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a well managed home that is run in their best interests. EVIDENCE: Mrs McNaughton the owner / manager is a registered nurse, and has been running Harker Grange for over 18 years. People told us they felt well supported by her and staff said she led by example. Her deputy manager and a team of registered nurses support Mrs McNaughton with the daily running of the home. The management structure in the service user guide shows the residents to be at the head of the home, with Mrs McNaughton taking her lead from them. Since the last inspection work has taken place to formalise the homes quality assurance procedures. As well as having daily contact with residents, visitors and staff, Mrs McNaughton had completed a formal audit tool, covering all Harker Grange Nursing Home DS0000010115.V354051.R01.S.doc Version 5.2 Page 20 aspects of the service. In addition to this, questionnaires had been given out to residents and relatives, asking their view of the service. There was only a small response to the latest questionnaire, but these indicated that people were extremely happy with the services and care offered. There was a system of regular staff supervision and appraisal. The manager did not have any dealings with residents’ finances, but referred people to the appropriate authority for help. The home subscribed to the Registered Nursing Homes Association policies and procedures, and had personalised these to Harker Grange. Health and safety was well managed with staff receiving adequate training in a range of subjects, and there were arrangements in place for all equipment and services to be checked regularly. The home demonstrated compliance with the requirements of the fire and environmental health officers. Harker Grange Nursing Home DS0000010115.V354051.R01.S.doc Version 5.2 Page 21 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 3 2 X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Harker Grange Nursing Home DS0000010115.V354051.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Harker Grange Nursing Home DS0000010115.V354051.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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 Harker Grange Nursing Home DS0000010115.V354051.R01.S.doc Version 5.2 Page 24 - 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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