Inspection on 25/01/07 for Harker House

This inspection was carried out on 25th January 2007.

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 22/11/05

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 Mr Pearson Clarke Key Unannounced 25th January 2007 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.V330038.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 House DS0000034340.V330038.R01.S.doc Version 5.2 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) www.norfolk.gov.uk 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.V330038.R01.S.doc Version 5.2 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. 22nd November 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. . At the time of this inspection the services maximum fee was £368.72 with each service users fee individually assessed according to individual circumstance. Harker House DS0000034340.V330038.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out by using information from previous inspections, information from the providers ,the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home and this report gives a brief overview of the service and current judgements for each outcome. During the site visit the inspector spent time with service users both in a group and on an individual basis and views expressed have helped shape the judgements made. In addition time was spent observing life in the home and staff on duty were spoken to as was the service manager. A tour of the premises was undertaken and relevant records were inspected. What the service does well: What has improved since the last inspection? The manager has worked hard to ensure improvements to the building with redecoration of bedrooms and new furnishings. Staff training has continued to develop there is on going recruitment of staff to reduce reliance on agency staff. Harker House DS0000034340.V330038.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Harker House DS0000034340.V330038.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 House DS0000034340.V330038.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service makes admissions based on an assessment of need and service users receive the necessary information to allow them to make an informed choice of home. EVIDENCE: As a result of the site visit it was possible to track recent admissions to the home and to speak to service users about their experience of the admission process. The service manager confirmed that admissions are based upon an assessment of need and examples were seen of completed assessments. There was an awareness of what needs the home could appropriately meet and the manager talked of occasions where admissions had not proceeded after the assessment. Service users spoken to felt that their admission to the home had been properly managed and that they had been provided with the necessary information at the time. Harker House DS0000034340.V330038.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9and10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service needs to produce more effective and consistent care plans to ensure best care practice. The home manages service users medication in a satisfactory manner. EVIDENCE: During the site visit the inspector looked at six care plans. Although plans seen contained much information they were not always consistently organised and in the inspectors opinion were not as accessible as they should be. This was acknowledged by the homes manager who expressed the view that instability in the service management team had led to some slippage in the updating of plans. Consistent, easily accessible and appropriately updated plans are an important part of effective care delivery and whilst the services plans contained many positives, there remains work to be done and as such a requirement is made. Harker House DS0000034340.V330038.R01.S.doc Version 5.2 Page 10 During the visit the inspector spoke to a selection of service users and their views and the views of service users expressed in writing painted a positive picture of the home. People said that they felt well cared for, that their privacy and dignity was protected and most people could not think of any improvements they would make to the home. From care records seen it was possible to track how peoples health care needs are being met in a satisfactory manner. The services medicine management arrangements were inspected. Sample medication administration records were seen and the recording seen was accurate and appropriate. Medicines are securely stored although it was noted that temperatures recorded at some times in the last summer did on occasions exceed the maximum expected readings. The manager confirmed that they are seeking solutions to this and expect to resolve the issue before this years hot weather. Staff administering medication have received training and the service has policy and procedure in place. Harker House DS0000034340.V330038.R01.S.doc Version 5.2 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. 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. Service users enjoy a relaxed atmosphere, where they feel in control of their own lifestyle. The levels of activity are reasonable and most service users enjoy the food served. EVIDENCE: Service users were generally positive about their home, valuing the kindness of staff and feeling they lived in a relaxed and homely environment. People spoken to felt able to choose their own routine and felt in control of their lives. The services activity provision had suffered a little, however recent efforts have been made to improve this. During the visit the inspector spoke to a member of staff who has taken a particular interest and is developing a number of new activities. Service users were generally satisfied with the levels of social stimulation. The home has open visiting and the inspector spoke to one visitor, who was very happy with the service and said she was kept up to date by staff and able to arrive at any time and be welcomed. Those spoken to were nearly all satisfied with the food served and this reflected the written feedback received. Harker House DS0000034340.V330038.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. 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. Service users are protected by the homes approach to complaints and adult protection. EVIDENCE: During the site visit the inspector looked at the complaints record which clearly detailed complaints received and action taken in response. The services complaints process is appropriately publicised and service users talked to by the inspector, were confident that if they raised concerns they would be listened to and action would be taken. The provider has a sound adult protection process and training records confirmed that this is supported by staff training. Harker House DS0000034340.V330038.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is kept clean and fresh and offers homely and comfortable accommodation. There is a need for a structured plan of improvement to the environment to offer better outcomes to service users. Harker House DS0000034340.V330038.R01.S.doc Version 5.2 Page 14 EVIDENCE: During the site visit the inspector toured the premises looking at communal areas and a selection of bedrooms. The service was built in the 1970’s and although homely, suffers somewhat in comparison to modern provision. As such most bedrooms are on the small side and bathroom provision is limited. In respect of bathrooms the home has a recently refurbished ground floor bathroom with assisted bath, however the first floor bathroom is very stark with an old style bath hoist and an absence of non slip flooring. All areas seen were clean and the home is generally comfortable, however in many areas the decoration is looking tired. From discussion with the manager it was apparent that she has worked hard to get improvements to the building, including redecoration of some bedrooms and provision of new furnishing, however there is still much to be done and those improvements made and still to happen do not appear to be part of a planned and timed approach to refurbishment and improvement. As such a requirement is made to develop a structured plan with timescales to address redecoration and improvements to bathing facilities. During the inspection it was noted that a cleaning cupboard was left open with a key in the door and as such was a potential health and safety hazard, as was the use of unlocked disused kitchen areas to store a variety of things. This was discussed with the service manager at the time and she undertook to ensure that these issues are addressed and therefore no formal requirement is made. All areas seen were clean and there was no unwanted odour.. Harker House DS0000034340.V330038.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. 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. Service users benefit from well a trained and motivated staff team. Staffing levels need to be kept under review to ensure that need can be met at all times. EVIDENCE: Service users consulted by the inspector were keen to stress how highly they value staff and that they get good quality care. Inspection of records and discussion with the service management indicated that staff are well trained and that a thorough and robust recruitment system is in place. A number of service users felt that on occasions there could be more staff although this was not a universal view. Staff spoken to confirmed that they able to deliver effective care if there were no staff shortages. At the time of this inspection dependency was not high and providing the basic rota pattern is adhered to the inspector would judge staffing levels to be adequate, however this needs to be kept under review and the management needs to ensure that where ever possible shifts are covered. In this respect it is noted that the use of agency staff has increased again and this can lead to a lack of consistency in care given. This was discussed with the management who are addressing the issue through the recruitment of more relief staff. Harker House DS0000034340.V330038.R01.S.doc Version 5.2 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from a management approach which seeks to place them at the centre of the homes operation, however the failure to maintain a settled management team has affected performance. Harker House DS0000034340.V330038.R01.S.doc Version 5.2 Page 17 EVIDENCE: Service users and staff told the inspector that they found the manager to be approachable and to be working hard to improve the home. However there has been a lack of consistency in the management team as a whole over the last year and this has had negative effects, such as failure to ensure regular staff supervision and proper maintenance of the care planning system. This has arisen from sickness and changes in personnel and was discussed with the manager at the site visit. As such it was confirmed that recruitment is currently taking place and it is expected to have a settled team again in the near future. The service has a quality system based on survey and the manager has developed an annual plan for the home which is good practice. Service users finances are where needed properly managed with good clear records maintained and samples of these were inspected. The service has a generally sound approach to health and safety with satisfactory policies, procedures and records seen. Harker House DS0000034340.V330038.R01.S.doc Version 5.2 Page 18 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 2 8 3 9 3 10 3 11 x 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 2 x 2 x x x x 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 2 3 x 3 x x 3 Harker House DS0000034340.V330038.R01.S.doc Version 5.2 Page 19 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 OP7 Regulation 15 Requirement That the service management review the structure and format of the homes service user plans to ensure that all plans are structured in a consistent way which makes them easily accessible to those needing to refer to them. That the provider submit a structured plan for improvements to the environment which addresses general redecoration and improvement to bathrooms. Timescale for action 30/04/07 2 OP19 23 31/05/07 Harker House DS0000034340.V330038.R01.S.doc Version 5.2 Page 20 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 OP27 Good Practice Recommendations That the service management keep under review the staffing levels in the home to ensure that service users needs can be effectively met at all times That efforts are maintained to build a consistent and effective management team. 2 OP32 Harker House DS0000034340.V330038.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 House DS0000034340.V330038.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. 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