Inspection on 22/11/05 for Harker House

This inspection was carried out on 22nd 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 House 22/11/07

Harker House 25/01/07

Harker House 13/01/05

Harker House 21/06/04

Harker House 03/02/04

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

CARE HOMES FOR OLDER PEOPLE Harker House Flowerpot Lane Long Stratton Norwich Norfolk NR15 2TS Lead Inspector Mrs Dorothy Binns Announced Inspection 22nd 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 House DS0000034340.V257297.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 House DS0000034340.V257297.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Harker House Address Flowerpot Lane Long Stratton Norwich Norfolk NR15 2TS 01508 530777 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) Norfolk County Council-Community Care Mrs Dorothy Evelyn Nisbett Care Home 35 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (27) of places Harker House DS0000034340.V257297.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users who need wheelchairs to assist with independent mobility at the point of admission can only be accommodated in room numbers 7, 24, 39, 86, 99, 111 and 113. At least one person who has received training in dementia awareness is on duty at all times in the unit for Older People who have dementia. One (1) Service User who has dementia and is named in the Commission`s records may be accommodated in the main home. 1st June 2005 2. 3. Date of last inspection Brief Description of the Service: Harker House is a care home providing personal care and accommodation for 28 older people and 7 older people with dementia.It is owned by Norfolk County Council.The home is located in the busy village of Long Stratton, close to the local GP/Health Centre and close to shops, pubs, post office and other amenities.There are 28 single bedrooms on the ground and first floors and communal lounges are available in different areas of the home. There is a large dining room. A separate unit for those people being cared for with dementia has 7 bedrooms with lounge/dining room and bathroom. The home has a passenger lift. There are gardens to the front and side of the property with car parking to the rear. Harker House DS0000034340.V257297.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine announced inspection of the home lasting about 7 hours. The requirements of the last inspection were discussed with the manager and some records and policies were examined. Five service users were each seen in private and three staff were interviewed. Throughout the inspection, the building was viewed and certain parts were looked at in detail. In addition survey forms were provided by the Commission for the service users and eight returned them with their views about the home. What the service does well: What has improved since the last inspection? The main improvement has been the building up of a stable staff group. After a rocky time with vacancies and the use of agency staff, the home now has more permanent staff and only uses agency staff on occasions. Staff are feeling less stressed and feel things are looking up. The support to staff where they can talk to their seniors on a one to one has improved and the manager is looking more closely at training needs. The building is having some improvement work done though there is still some way to go. There are more covered radiators to prevent burning. The medication records are much better but the amount of stock in the home should be reduced. Harker House DS0000034340.V257297.R01.S.doc Version 5.0 Page 6 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 House DS0000034340.V257297.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 House DS0000034340.V257297.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): None of these standards were inspected. EVIDENCE: None of these standards were inspected. Harker House DS0000034340.V257297.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 and 9 Each service user has an individual plan of care outlining their particular needs and routines. These assist staff to look after them properly. Service users’ health care needs are well met with staff monitoring and responding to the service users. Most service users have assistance with their medication and are protected by the policies and procedures in the home and by trained staff. Stock control however needs to be improved. Harker House DS0000034340.V257297.R01.S.doc Version 5.0 Page 10 EVIDENCE: Four care records were examined. Each had a plan of care based on the information collected at the assessment. There was a summary of the assistance required and the usual routines of the service users. A senior member of staff reviewed the plans every 2 months to ensure they were still appropriate. The service users sign the initial care plan. Each also had a moving and handling assessment so that staff worked safely. Other individual risk assessments were also seen for instance for the use of a hot water bottle and another for the use of a scooter. In addition staff wrote daily notes commenting on the wellbeing, health and progress of each service user and whether they had enjoyed a visitor, increased their mobility or participated in an activity. The quality of the daily reports was much improved from the last inspection. Care plans were also well organised into sections and had a photo of each service user. The care plans also showed that the staff were monitoring the health of the service users. There were references to seeing the doctor, to the chiropodist calling, to seeing the optician. Medical appointments at hospital were mentioned and liaison with a continence advisor. Annual flu jabs were also recorded. Staff also monitored sleep and whether someone was off their food or unwell. Falls and accidents were clearly noted and could be cross referenced to the accident book. One service user told of how she was helped with her hearing aid and described a quick response when she fell and hurt her head. Overall health needs were monitored well. The medication systems in the home were checked. The home operates a monitored dosage system where the pharmacist pre packs the tablets. There were a lot of medicines not on this system however and were still in their boxes. However the daily administration record for three service users was checked against the tablets and was correctly completed. The home also cares for two people who require diabetic injections which staff have to oversee. The record showed that the community nurse checked this on a regular basis. There were some controlled drugs but these were appropriately locked and two staff signed when they were given out. The stock was carefully counted each day. The general stock control appeared to be faulty with too many boxes of tablets in the cupboard. More oversight of the stock is needed. Harker House DS0000034340.V257297.R01.S.doc Version 5.0 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 the following standard(s): 12,13 and 15 Service users are very enthusiastic about the home and feel it exceeds their expectations. They would however like more activities. Service users are free to see their family and friends at any time and see them in private. Service users enjoy the food offered in the home. EVIDENCE: Four service users seen in private all raved about the home and said how nice it was to live there. Their comments ranged from “100 ”, staff are willing to do anything to help you” to “staff are absolutely brilliant – you have no need to worry when the staff are about” to “this place is lovely – I enjoy it”. They felt the routines were flexible getting up when they liked (one person liked to get up at 5am and had a cup of tea from staff at 6am,another said it varied when she got up as sometimes she went to bed later on some nights). They felt they could have a bath when they liked and staff were “very obliging”. One person said she liked hers in the evenings so she could go straight to bed and this was arranged. They could also spend time in their rooms as they liked or mix in the lounges. One person liked to sit in the porch of the home watching the comings and goings. Meals were mainly taken in the dining room but the times of meals suited the service users. Harker House DS0000034340.V257297.R01.S.doc Version 5.0 Page 12 Overall the routines and flexibility to move around the home suited the service users well and gave them a sense of freedom. Service users were less sure about the activities and felt there was little on offer. Two gave the impression that they would probably not join in but the two others thought they would if they were offered. One mentioned a quiz newly organised which she enjoyed. The manager said that they are busy organising a reminiscence room which will be used for small groups of service users, and themed teas are going down well, for instance Bonfire night and VE day. Staff said that activities are organised every day in the special unit as these service users need some stimulation. More stimulation in the main house needs to be encouraged however. Five out of seven replies to the Commission from service users said there were not enough activities and staff also felt they should do more. Service users are able to see their visitors at any time and confirmed they saw their families privately in their rooms. They also go out with their families. Service users felt they were well fed and comments ranged from “lovely”, to “alright”, to “pretty good”. Six out of seven replies to the survey felt the food was good. One service user said you could have all you wanted. A choice is offered at each meal. Harker House DS0000034340.V257297.R01.S.doc Version 5.0 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 the following standard(s): 16 Service users will be listened to if they express a concern and there is a procedure for more formal complaints. EVIDENCE: A complaints procedure is given out to all service users with the guide to the Home. A complaints record is kept showing the actions taken by the home to deal with the complaint. No complaints reached the Commission showing that the Home is dealing at an early stage with concerns from service users and relatives. Service users spoken to said they felt they could speak up to staff if they had a concern and that they would be listened to. Harker House DS0000034340.V257297.R01.S.doc Version 5.0 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 the following standard(s): 19 and 21 The service users are comfortable and live in a home that is undergoing some renovation in order to improve the facilities. The bathroom facilities are not sufficient to cater for the needs of the service users and need to be improved. Work has started. EVIDENCE: Harker House is an older type purpose built home that is now ageing and in need of some renovation. Maintenance and renewal of the building is being implemented but there are many areas to be done. Equipment in the home like bathrooms and radiators need attention and this is slowly being carried out. Some rooms had covered radiators to prevent burning and others had none and were very hot. Risk assessments have been carried out in the meantime to ensure safety. All the rooms are single and there is a variety of communal space. The manager has had a visit from the fire officer and is expecting to comply with his requirements. The home is well located not far from shops and doctors surgery. Harker House DS0000034340.V257297.R01.S.doc Version 5.0 Page 15 A recommendation was made at the last inspection for improvements in the bath facilities as service users had all to come downstairs for a bath. Currently work is being carried out on the downstairs bathroom to install an adapted shower and a new bath. There are plans for the upstairs bathrooms but currently one is not used and the other is only used by more mobile service users. Nine service users upstairs are therefore poorly served. The special unit has its own adapted bath. All baths now have valves to control the water temperature. The facilities will be reviewed again at the next inspection. Harker House DS0000034340.V257297.R01.S.doc Version 5.0 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 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, 29 and 30 The service users needs are being met by the numbers of staff on duty now that there are fewer agency staff, though the numbers of staff in the afternoon need to be monitored. Recruitment procedures are rigorous protecting the service users though record keeping in the home could be improved. Training is provided to ensure staff are competent at their jobs. EVIDENCE: The rota for the week of the inspection showed that staff hours were satisfactory with six or seven staff on in the morning and evening with slightly less in the afternoon. This assumes that the care coordinators and seniors are able to support care staff in service user care and are not consumed by administrative tasks. Staff confirmed that there were usually two staff on duty in the special care unit. There has been a problem in this home with staff vacancies and the use of agency staff. Although these are a good stop gap, there is more stability in the home if permanent staff are in place. Fewer agency staff are now being used with the recruitment of new staff. There were some worries expressed about the low numbers of staff in the afternoons and the manager will need to monitor this especially if the rota shown is not reflecting the true number of staff on duty. Harker House DS0000034340.V257297.R01.S.doc Version 5.0 Page 17 Recruitment files showed that the process for getting a job at Harker House was rigorous with application forms, identity checks, interview notes and references seen in the files. One file did not have evidence of a criminal record check though this was thought to be still at County Hall where they have a centralised system. The Home needs to ensure that evidence is on the files held by the home. Evidence of staff having undergone criminal records checks was later sent by the manager to the Commission. Staff interviewed at the inspection confirmed that they had undergone induction training when they came to the job. Moving and Handling training is offered from time to time and some reminiscence training has been provided. Two staff had no dementia training and the manager is trying to arrange this. She confirmed all except the new staff have received dementia training. It is a condition of the registration that there is always someone on duty in the special unit who is trained in this area. All staff receive free training and have an evidence of learning file showing what they have covered and where the gaps in training are. Harker House DS0000034340.V257297.R01.S.doc Version 5.0 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 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): 35,36 and 38 The finances of service users who need assistance to look after them are safeguarded by procedures and accurate record keeping. Staff are appropriately supervised by a senior worker on a regular basis and this helps to ensure their practice is satisfactory. Health and safety matters are being taken seriously and service users are being protected. EVIDENCE: A number of service users have assistance with their finances and records of the transactions were examined. No benefits are collected but money is received from relatives for the service users. Two records were checked against the cash held and were found to be correct. Receipts were kept and the record is signed by two staff. Harker House DS0000034340.V257297.R01.S.doc Version 5.0 Page 19 Care staff confirmed that they were receiving formal supervision every two months and they were able to discuss aspects of their work and their training needs. Evidence of such supervision sessions were also seen on the staff files. Not all the health and safety policies were examined but some checks were made. More work has been carried out to cover hot radiators and this work is ongoing. An assessment for Legionnella was documented with a recommended course of action to keep the home safe. A fire service has been carried out and the extinguishers checked. Drills to ensure staff know how to react in the event of a fire are carried out though the next drill (two a year) is due. Fire alarms are tested weekly. An up to date lift certificate was seen and hoists have been serviced this year. Electrical testing of appliances was also up to date. Staff are trained in moving and handling and on health and safety and fire matters. It was not clear whether the temperature of water was checked on a regular basis but there are valves fitted to the baths ensuring that service users will not be scalded. Harker House DS0000034340.V257297.R01.S.doc Version 5.0 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. 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 2 x 2 x x x x x STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x 3 3 x 3 Harker House DS0000034340.V257297.R01.S.doc Version 5.0 Page 21 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 OP9 Regulation 13(2) Requirement The registered person must make arrangements for the disposal of medicines received into the home. Timescale for action 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP12 OP21 OP29 Good Practice Recommendations It is recommended that the provision of activities and stimulation continues and increases. It is recommended that more speed is given to the revamping of the bathrooms to ensure all service users have good access. It is recommended that the recruitment files of staff have all the relevant documentation as outlined in schedule 2 Harker House DS0000034340.V257297.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 House DS0000034340.V257297.R01.S.doc Version 5.0 Page 23 - 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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