CARE HOMES FOR OLDER PEOPLE
Harker Grange Nursing Home Harker Carlisle Cumbria CA6 4HY Lead Inspector
Lorraine Frost Unannounced 09 May 2005 09:15 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 CS0000010115.V164943.R01.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Harker Grange Nursing Home Address Harker Carlisle Cumbria CA6 4HY 01228 523753 01228 540344 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Wendy McNaughton Care Home 26 Category(ies) of Old age, not falling within any other category, registration, with number Dementia - over 65 years of age of places Physical Disability Harker Grange Nursing Home CS0000010115.V164943.R01.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 1) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 2) 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) 3) 1 named service user in the category of PD (Physical Disabilities under 65 years of age) may be accommodated within the overall number of registered places. Date of last inspection 22/11/04 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 CS0000010115.V164943.R01.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place on 9th May 2005 commencing at 09.15 and concluding at 16.00hrs. The inspection included a tour of the home, meeting and talking with six staff, most of the residents, two visitors and the manager. A number of resident and staff records were checked. These included those of new residents, newly appointed staff and the files for all the registered nurses. What the service does well: Visiting professionals, residents, visitors, and volunteers praise the home and staff for the care, the cleanliness, and for the “family atmosphere.” Good relationships were noted between staff, residents and visitors and appreciation cards were seen. One resident who was so impressed with the way staff looked after her said, “You only have to tell the manager if you have a slight pain and she is off immediately trying to find a cure.” and when asked about the bedrails on her bed she said, “They are only doing it to keep me safe and it works.” The home is well managed and has a good team of staff who demonstrate a sound knowledge of their roles and of the residents as individuals. There is a non-judgemental approach to all service users and the routines are adapted to their specific preferences. Wherever possible all residents are included or invited to participate in all activities. This is possible due to the support and commitment of the staff and the volunteers and the Friends Committee. A recent wine and savoury afternoon was well attended as was a spontaneous VE Day celebration. Harker Grange Nursing Home CS0000010115.V164943.R01.doc Version 1.20 Page 6 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Harker Grange Nursing Home CS0000010115.V164943.R01.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Harker Grange Nursing Home CS0000010115.V164943.R01.doc Version 1.20 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 standard(s) 1, 3, 4, and 5 The Service Users Guide was very informative, and gave information of the services provided so that an informed decision can be made about admission to the home. The pre admission assessment and the opportunity for prospective residents and their families to visit the home reassures them that the home will meet their needs. EVIDENCE: All residents had been given a service user guide explaining the services available and the type of care that they could expect to receive and they had been assessed prior to admission. Those spoken to confirmed that they had looked around the home or a family member had for them. Residents said that they had found the staff friendly, welcoming and the atmosphere and care was described as being “more like a family than a home.” They also said that they felt that their needs were being met. Harker Grange Nursing Home CS0000010115.V164943.R01.doc Version 1.20 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 standard(s) 7, 8, 9, 10 and 11 There is a clear care planning system, which ensures residents health, and social care needs are being met in a way that promotes their privacy and dignity. However, the process of developing care plans and risk assessments soon after admission was not carried out for two service users and this meant that not all of their assessed needs were being met. Residents can be assured that they will be cared for in a sensitive, and dignified way right up to and immediately following their death and their families will be supported throughout. EVIDENCE: All but two residents had a plan of care based on the admission assessment and had agreed risk assessments. The others had been reviewed and they reflected the care being provided. Detailed records were kept of the care being provided, the outcomes of any monitoring, and the results of consultations with other specialists. Prompt referrals were made to GPs and other professionals. Residents were being treated as individuals with the routines of the home paced around them.
Harker Grange Nursing Home CS0000010115.V164943.R01.doc Version 1.20 Page 10 The arrangements for storing and administering medication in the home was safe and well organised, and residents received their medication as prescribed and records kept. The care staff spoke to residents in a courteous yet friendly, and polite way. They knocked before entering bedrooms, and closed bedroom doors when assisting people with personal care tasks. The staff spoke in detail of how they had cared for a resident who had recently passed away and said that the other residents had been kept informed. Those who wished to had been given the opportunity to sit with the resident whilst she was unwell and staff had taken the opportunity to attend the resident’s funeral service. This reinforced the comment made by a resident about the home being a family. Harker Grange Nursing Home CS0000010115.V164943.R01.doc Version 1.20 Page 11 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 standard(s) 12, 13, and 15 Although daily social activities were not planned with the result that some residents said that they were bored there were regular planned activities giving residents the opportunity to mix with local people as well as with volunteers and other residents. An open visiting policy was in place thus providing opportunities for residents to maintain contacts with family and friends. The meals were wholesome and appetising providing a balanced and nutritious diet. EVIDENCE: Residents’ interests and preferences were recorded so that staff could talk with the residents of things that were of interest to them and to enable social interests to be pursued where possible. One resident was looking forward to the better weather so that he could enjoy the gardens and another person loved to go shopping and was looking forward to a visit to the local shops. The menus were about to be reviewed by the manager and the cook. The cook meets new residents and talks to them about their preferences and she likes to help at mealtimes during which she can gain additional feedback. Residents had a choice of dish and they said how much they enjoyed the meals. Special diets were catered for and information was recorded about specific dietary needs and preferences. Meals could be taken in either of the lounges or in the person’s own private room.
Harker Grange Nursing Home CS0000010115.V164943.R01.doc Version 1.20 Page 12 There were numerous visitors in the home throughout the inspection and during their visit they were offered refreshments. Positive comments were made about the home and how comfortable they felt when they visited. Harker Grange Nursing Home CS0000010115.V164943.R01.doc Version 1.20 Page 13 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 standard(s) 16 and 17 A satisfactory complaints system is in place with residents stating that they felt that their views were listened to and would be acted upon. Residents were registered to vote thus enabling their political views to be counted. EVIDENCE: When moving into the home information about how to complain had been given to residents and their families. The information was also clearly displayed in the entrance area of the home. One service user said that she knew how to complain, but had not needed to. Some residents had taken part in the national and local elections through the postal voting system. Assistance had been given where necessary and residents had instigated some lively debates prior to the election. Harker Grange Nursing Home CS0000010115.V164943.R01.doc Version 1.20 Page 14 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 standard(s) 19, 20, 22, 23, 24, 25 and 26 A warm, clean, comfortable and homely environment is provided for residents at Harker Grange. A range of moving and handling equipment is provided to enable residents to be moved safely and to encourage them to be as independent as possible. EVIDENCE: There were no unpleasant smells at Harker Grange due to the care and attention of the care staff to meeting residents’ needs, and to the work of the housekeeping and laundry staff to keeping the home clean and the laundry washed thoroughly and promptly. Repairs would be reported and contractors contacted when necessary thus maintaining a safe environment. Mixer valves had been fitted to all outlets, as required following the last inspection. A ramp at the front door allows easy access for visitors and residents and a range of equipment is provided throughout the home to enable staff to move
Harker Grange Nursing Home CS0000010115.V164943.R01.doc Version 1.20 Page 15 residents according to their risk assessments and in accordance with the moving and handling training. To help people move around the home there was a passenger lift, a new stair lift and grab rails. One resident was very impressed with the new rails as it gave her more independence. The gardens are accessible and very attractive with a pleasant paved area where people could sit. Residents’ bedrooms were comfortable and many were personalised by the resident as they had brought some of their own furniture and other personal possessions with them. Harker Grange Nursing Home CS0000010115.V164943.R01.doc Version 1.20 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Staff morale is high and there is a keen and interested workforce that works positively with residents to maintain their quality of life. There was enough staff on duty to meet the needs of residents and to give individual unrushed care to the residents. EVIDENCE: During the visit staff were also receiving a half-day training session on moving and handling. The staff for the morning training session included the night staff who had been at work throughout the night demonstrating their commitment to keeping up to date and informed. The staffing levels for each shift did not include those taking part in training. None of the residents said that they had found the staff to be slow to respond to the call bells or requests for help. One resident said, “None of the staff are unkind or unpleasant at anytime.” For 23 residents there was one Registered nurse and three care assistants on duty as well as housekeeping, laundry, and kitchen staff. Staff were seen following a routine that was adapted according to the wishes of the residents. Staff had been recruited in accordance with appropriate guidelines. Criminal Record Bureau disclosures and nursing qualifications had been checked, written references had been sought and where there had been difficulty in obtaining written confirmation of a verbal reference then another referee had been sought.
Harker Grange Nursing Home CS0000010115.V164943.R01.doc Version 1.20 Page 17 One member of staff confirmed that there had been an induction to working in the home. Harker Grange Nursing Home CS0000010115.V164943.R01.doc Version 1.20 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, and 38. There was clear leadership, guidance, and direction to staff from a competent manager who is also a registered nurse ensuring that residents receive consistent good quality care. Delegated responsibilities to the deputy manager and the other registered nurses ensures that there is a consistent way of working and ongoing monitoring of the quality of care and service delivered. The manager was said to be resident focussed and her commitment to putting residents first has been clearly demonstrated to the inspector. EVIDENCE: Throughout the day comments made by staff and residents confirmed that the manager was approachable, gave clear instructions to staff and supported the staff giving them clear information on their roles and responsibilities. The manager is a registered nurse who keeps herself up to date with current issues and leads by example. Staff said that they were supported and that they were
Harker Grange Nursing Home CS0000010115.V164943.R01.doc Version 1.20 Page 19 always given a reason for a change or for a way of working. It was clear that staff recognised each other’s skills and abilities and were keen to share them. Staff were aware of their own responsibilities for maintaining standards in the home and supported each other in this. The health and safety of residents, visitors, and staff was not seen being compromised during this visit. The manager was seeking advice with regards to potential moving and handling issues in an effort to minimise potential hazards to staff and residents. Harker Grange Nursing Home CS0000010115.V164943.R01.doc Version 1.20 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 3 x 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x 3 3 x x x x x 3 Harker Grange Nursing Home CS0000010115.V164943.R01.doc Version 1.20 Page 21 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 7 Regulation 15 Requirement Care plans and risk assessments for all newly admitted service users must be completed within a reasonable timescale. Medication must be reviewed to ensure that it is prescribed so as to meet the requirements of the resident. A record must be kept of all medication received and returned in the home. Timescale for action 31.05.05 2. 9 13 31.05.05 3. 9 13 31.05.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 12 Good Practice Recommendations The daily social activities programme should be reinstated. Harker Grange Nursing Home CS0000010115.V164943.R01.doc Version 1.20 Page 22 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
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