Inspection on 14/08/08 for Harley Grange Nursing Home

This inspection was carried out on 14th August 2008.

CSCI found this care home to be providing an Poor 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

Harley Grange Nursing Home 17/08/06

Harley Grange Nursing Home 13/09/05

Harley Grange Nursing Home 20/04/05

Harley Grange Nursing Home 21/02/05

Harley Grange Nursing Home 15/09/04

Harley Grange Nursing Home 23/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Harley Grange Nursing Home 25 Elms Road Leicester Leicestershire LE2 3JD Lead Inspector Louise Bushell Unannounced Inspection 14th August 2008 08:00 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 Harley Grange Nursing Home DS0000001908.V370294.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. Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harley Grange Nursing Home Address 25 Elms Road Leicester Leicestershire LE2 3JD 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) 0116 2709946 0116 2700409 harleygrange@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd Mrs Jeanne Patricia Moitt Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34), Physical disability over 65 years of age of places (34) Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. To admit the named person of Category DE(E) as identified in Correspondence in Application number V13892 dated 09/11/04 To be able to admit the named person of category PD (under 65 years) named in variation application No. V36842 dated 27 November 2006 The maximum number of persons the registered provider can accommodate in Harley Grange is 34. 17th August 2006 Date of last inspection Brief Description of the Service: Harley Grange is a purpose built care home owned by Southern Cross Healthcare and is situated in Stoneygate, a quiet residential area two miles from the city centre of Leicester, which is easily accessible by public and private transport. The home is registered to care for thirty-four residents under categories OP (older persons) and PD (physical disabilities). The premises consist of two floors, which are accessed by use of the stairs and a passenger lift. There are a variety of facilities in the home including dining and lounge space and the residents have a choice of using a bath or a shower. The home has eighteen single bedrooms and eight double bedrooms all with en-suite facilities. A well-maintained garden is located to the rear of the building, which has level access for all the residents. There is information available in the reception area including the Registration certificate from the Commission for Social Care Inspection. The latest copy of the Inspection report from the Commission for Social Care Inspection was available in the managers office The current fee level ranges from £461.00 to £620.00 There are additional costs for individual expenses such as personal toiletries, optician, hairdressing and some recreational activities. Harley Grange Nursing Home DS0000001908.V370294.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 0 star. This means the people who use this service experience poor quality outcomes. This was a key inspection of the home that was concluded with an unannounced visit to the service. Prior to the visit the inspector spent four hours reviewing the previous inspection report and information relating to the home received since the last inspection on the 17th August 2006, including the Annual Quality Assurance Assessment (AQAA) which had been sent to the service for completion. Standards identified as ‘key’ standards and highlighted through the report were inspected. In addition to the key standards a number of other standards were inspected to assess the services ability as part of case tracking people that use the service from the admission stage to placement stage. The key standards are those considered by the Commission to have a particular impact on outcomes for residents. Inspection of the standards was achieved through review of existing evidence, the previous annual quality assurance assessment, pre-inspection planning, an unannounced inspection visit to the home, any information sent to us from the service and other professionals, collating information received in person from relatives and the people who use the service, and drawing together all of the evidence gathered. The inspector also checked other issues relating to the running of the home including health and safety, management and staffing. During the visit the inspector spoke with other residents in the home, staff, visitors and the manager and her administrator. The inspector also observed care practices when the staff assisted the residents. Additionally questionnaires were sent to a random selection of people to ascertain their views. Responses had been received. In addition to this the views of a visitor, staff and people that use the service were obtained on the day of the inspection. The management of residents’ medication was checked through reviewing prescribed medication for a sample of people. A sample of staff files were reviewed to check the adequacy of the recruitment procedures in protecting people who use the service. Communal areas and a sample of bedrooms were viewed and observations were made of people’s general well being, daily routines and interactions between staff and people who use the service. The visit took place on the 14th August 2006 from 08:00 to 16:30. Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 6 Verbal feedback was given to the Manager on the day of the inspection. What the service does well: What has improved since the last inspection? What they could do better: A number of areas have been identified as requiring development. Care plans must be reflective of the needs of the person receiving the care and detail sufficient information in order for the care to be provided. Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 7 The Health and welfare records were not up to date or completed in full, thus not ensuring the health and well being of all people using the service are supported and protected. Staff must be suitably trained to perform podiatry tasks. Medication must be managed effectively. Staff must be trained appropriately to ensure that the skill mix of the team is suitable to meet the needs of the people using the service. Staff must receive National Vocational Qualification (NVQ) to ensure that the people who use the service are in safe hands at all times. A schedule of planned training must be in place to ensure that all staff receive mandatory training as required. Training must be provided in Safeguarding of Vulnerable Adults, Moving and Handling, nutrition and Health and Safety to ensure that people who use the service are protected and that staff are suitably trained to meet individual needs. Staff must receive periodic supervision and appraisal to ensure that they are supported and competent to do their role. 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. Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 8 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 Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 9 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, 3 and 5 Standard 6 is not applicable as intermediate care is not provided, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is provided to help people make decisions about their care and a thorough assessment takes place, which helps to ensure that their needs can be met. EVIDENCE: The service has developed a statement of purpose, which sets out the aims and objectives that the person can expect to receive. This includes a guide, which provides basic information about the service and the specialist care that is available. The guide details what the prospective people using the service can expect and gives an account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. Details of the Commission for Social Care Inspection were incorrect; amendments were made to these immediately by the administrator. Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 10 All people who use the service are given a copy of the guide. One relative stated that “We are very happy, it’s a lovely home, the staff are cheerful, and we have never had any cause to complain”. A person using the service stated, “My husband came to look around the place to see if I would be ok here”. Admissions are not made to the service until a full needs assessment has been undertaken. A senior person always completes the assessment prior to admission to the service. A number of pre assessments were seen. The service then compiles a pre admission draft care plan for the person. The assessment explored areas of diversity including preferences, religious and cultural needs, involvement from family, partners and advocates, race and disability and sexuality. It was evident that the service strives to seek the information and assessment through care management arrangements, prior to admission. The service has the capacity to support people who use the service and respond to diverse needs that may have been identified during the assessment process. The information gathered from the AQAA states “We provide high quality catering, care and activities of a wide variety, based on individual assessment and personal preference. We always recognise our clients have a choice about where they live and receive their care, and they have chosen our home because of what they expect from our service. We therefore ensure we monitor their satisfaction closely and should anything be not to their expectation, we take measures to improve”. Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 11 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 & 11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service’s care planning and medication systems do not ensure that people’s health, safety and well being is maintained. EVIDENCE: A total of two care plans were case tracked fully, it was established that people who use the service receive personal and healthcare support using a person centred approach. Personal healthcare needs including specialist health; nursing and dietary requirements are recorded in each persons care plan. It was evidenced that the care plans detailed the care and support that is to be provided but the documentation relating the activity actually being provided was not completed in full. Examples of this were seen with regards to care plans regarding fluid and food intake, turning charts and personal hygiene charts. Additional examples were evidenced through the Malnutrition Universal Screening Tool (MUST), this had been completed and showed that one person Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 12 was at “very high risk”, however the monthly review had not occurred. The care plans did not consistently provide information on the full details of how to provide care and support to the person, for example a person with Diabetes Mellitus type II did not provide details of who can / should provide nail care within the service, it did state that the person “is to see a chiropodist regularly”. It was observed that an untrained member of staff was cutting the persons nails. The care plan is generated from the pre admission assessment and includes guidelines; risk assessments for the management of falls, manual handling assessments and self-medication risk assessments and care plans. It was evidenced that one person did not have a completed manual handling risk assessment in place in line with the mobility care plan that stated that the person required manual handling. Staff were observed to respect the privacy and dignity of all people. An example of good practice was observed by a member of staff positively engaging with a number of people who use the service, laughing and chatting about daily information and completing activities of hand massage, nail cutting and painting. It was pleasing to see a number of people engaging and being stimulated by the positive engagement. The service listens and responds to individual choices and decisions about who delivers their personal care. The care plan also details personal preferences, this included food types, nighttime preferences, activities, religion, personal appearance, personal time and how the person would like to be addressed. People are supported and helped to be independent and can take responsibility for their personal care needs as detailed in their care plan. People who use the service have access to healthcare and remedial services. The health care needs of residents unable to leave the service are managed by visits from local health care services. The AQAA states “We have comprehensive assessment and care planning protocols that ensure all residents who are admitted to the home do so knowing how they will be cared for and the level of service they can expect”. The AQAA details that the service is aware that improvements can be made to care planning and assessment protocols and sights the following with regards to “What we could do better”. The AQAA states, “More consistant levels of all standards. Sometimes we are let down by poorer standards of work and this is disheartening to those who strive to do their very best. We could improved this by implementing a structured programme for assessing competency and identifying a link nurse with responsibility for assessing competency and coordinating the NVQ training programme. Introduce care plan summary to the care file to provide a pen picture, quick read care plan that outlines the key issues / needs for the client; their preferences around meals, personal care, Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 13 disability and counter measures etc”. The manager of the service discussed a new “Check It” electronic system that the service may be installing to monitor and record accurately all activity that occurs in the service for any named person. The staff would have to in put the care and support that they have provided each time for the person. The service has an efficient medication policy. Medication records are maintained on e Medication Administration Record (MAR). It was evidenced that there were some gaps identified in the administration of insulin to one person. The medication did not stipulate administration instructions, was hand written onto the MAR with out being booked in and double signed by two nurses. Blood sugar records are maintained however no protocols were in place for corrective action to be taken if levels were too high or too low. The care plan did not detail this information either. The insulin pen had not been booked in appropriately and we were unable to establish if the medication had been administered as per the prescription. An immediate requirement was left at the service. The medication trolley was bolted appropriately to a wall, however the size of the room was small and consequently the temperature in the room was very warm. No records of the room temperature were being maintained and therefore it could not be established if medication was being stored within appropriate temperatures. A number of tablet box’s, bottles and tubes did not have the date opening on them. One persons medication stock available did not balance, it was established that this was due to the balance not being carried forward accurately. Staff have completed and passed an appropriate medication course. An assessment has been carried out to ensure each member of staff is competent to handle, record and administer medication properly. The majority of care plans tracked contained suitable and sensitive plans and arrangements for the management of end of life. Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 14 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are encouraged to participate in social activity increasing their stimulation and engagement with others. Menus are nutritionally balanced and varied ensuring peoples preferences and choices are supported. EVIDENCE: People who use the service have the opportunity to develop and maintain important personal and family relationships. Feedback from one relative on the day of the inspection confirmed that relatives / representatives are always welcome into the service. One relative stated that “I am visit my bother and we are always made welcome to the home”. One person using the service commented that “everyone is very friendly and the managers are always kind, the staff are very nice and they come to chat to me which I like”. The service respects the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpinning the care and Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 15 support being provided. This was indirectly observed through the practices of the staff on duty. A number of people who use the service were seen to be very relaxed and calm within their own environment and engaging with staff in an equal manner. Residents are involved in some meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. The care plan details a social assessment for each individual, which supports the service in providing meaningful activities of their choice. There is also reference in the care plan to the preferences of each individual for activities and previous interests. The AQAA states that the service has recently employed an activities coordinator to over see the running and provision of activities at the service. The activities coordinator was seen engaging with a range of people in a respectful dignifying manner. Residents can access and enjoy the opportunities available in their local community, such as a library services, the local pub, and local leisure facilities. Trips were arranged and planning taking place. The manager discussed a number of local trips that were being arranged for the people using the service, including a recent fate. The manager has also identified in the AQAA and in discussion that the service is aiming to further develop the provision and variety of activities being made available to all. The people who use the service stated that they enjoy the activities provided. The AQAA determined that the service over the next twelve months aims “To introduce hairdressing and complimentary therapies as part of our activities programme, so residents can enjoy pamper sessions nail bar and beauty treatments and feel as though they are going to a salon and it is part of the enhanced service provided”. “To enhance the dining experience and enable small groups of residents or families to enjoy a private meal. To further encourage independence by introducing serving dishes on the table for residents to help themselves to vegetables, condiments etc”. The menu is varied with a number of choices including a healthy option. It includes a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. The food provided was appetising and well presented. A varying degree of comments received included; “we get a choice over our man meals and there is always an alternative”. “We would like more fresh fruit available”. Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 16 “The food is only expectable and a bit tasteless”. Food was sampled on the day and was appetising and well presented but bland. This was feed back to the manager of the service. The care staff are sensitive to the needs of those residents who find it difficult to eat and give assistance with feeding. They are aware of the importance of feeding at the pace of the resident, making them feel comfortable and unhurried. Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 17 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a robust complaints procedure in place, good staff awareness and attitude towards safeguarding issues so people who use the service are safe and protected. EVIDENCE: The service has an open culture that allows people who use the service to express their views and concerns in a safe and understanding environment. People who use the service have commented that they are happy with the service provided; feel safe and well cared for. A number of comments received determined that people who use the service and relatives and friends are aware of what to do if they have any concerns. One person using the service commented “the staff always listens to me, if I need anything or unhappy, they are all very kind”. The AQAA states that the service “listens to concerns when they arise and act on them to alleviate the problem, we encourage discussion and train staff to be aware and to address all concerns promptly. The company has a robust complaints procedure and all complaints are investigated and responded to”. “All staff receive training in safeguarding adults and POVA during their Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 18 induction and are aware of all the different types of abuse and what to do if they suspect inappropriate actions are taking place. Any complaints are logged and responded to within the specified time, actions agreed, implemented and monitored to ensure improvement takes place”. The service has a complaints procedure that is clearly written and easy to understand. It is available in a number of formats such as different languages on request. The complaints procedure is supplied to everyone living at the service and is displayed in a number of areas within the service. There is record of all complaints and compliments made and received. The service has not received any written complaints in the last five years. Feedback from a relative determined that if they have any concerns that the staff are always attentive. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff commented that they have received training in safeguarding and felt confident in reporting any issues as they occurred. The service provides in house training in safeguarding of Vulnerable Adults through people that have attended a trained trainer’s course. The service understands the procedures for safeguarding adults and attends meetings or provides information to external agencies when requested. The service has not made any safeguarding referrals. Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 19 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, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the service enables the people who use the service to live safely in a well-maintained homely environment. EVIDENCE: The service provides a physical environment that is appropriate to the specific needs of the people who live there. The environment provides a homely feel with specialist aids and equipment to meet needs as required. The service is a pleasant, safe place to live; the bedrooms and communal room provide a personal and homely feel. The decoration throughout the building is on a rolling programme of redecorating. All rooms have been re painted and are well presented with a number of them being refurbished. The paintwork Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 20 throughout the building is marked and the manager has also ready identified that this requires attention. The AQAA determines that the service receives “Regular comments from visitors who like the feel of the place. There is a happy atmosphere in the home and comments saying the home is calming and relaxing help us to know that we are creating an optimum environment to aid recovery. Monthly home and validation audit scores are always positive and show the home to be clean, well presented and all necessary documentation displayed appropriately”. The layout of the building enables people to move freely where they reside, with several different seating areas throughout to encourage socialising or enabling the person to have privacy. People are encouraged and supported to move amongst different living areas on the same level. The AQAA has identified that the following improvements to the service are planned to take place in the next twelve months; “Main areas to have carpets replaced, dining area to have new tables and flooring. Garden areas to have changes which will incorporate a covered sitting area and raised plot. refurbishment to front entrance and reception area, to provide another seating area with small coffee machine for visitors to help themselves to a drink or make one for a resident etc”. The people who use the service appear to like the environment, were relaxed, comfortable, and settled. The garden areas have flowers and tables and chairs, promoting independence and a homely feel. A new pergola area is in place, which provides a lovely seating area for all people who use the service. The people who use the service are encouraged to personalise their bedrooms. All the home’s fixtures and fittings meet the needs of individuals and can be changed if their needs change. The manager stated that the service has recently had two new washing machines, one new dryer, all new floors and carpets throughout and that the service was due to have a new cooker and kitchen floor replaced. The dining rooms are laid out to encourage communal dining with a calm relaxed atmosphere. The environment promotes the privacy, dignity and autonomy of residents. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. The home has an infection control policy. The service is clean, well lit and smells fresh. One comment received from a person using the service stated, “I like my room, its all cosy, I have pictures of my family around me and my own phone line”. Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 21 There was restricted access to high-risk areas such as the main kitchen and the laundry areas to reduce the risk of cross infection. Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 22 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 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some staff were trained; however a number of staff did not have detailed Safeguarding of vulnerable adults, infection control, nutrition and health and safety training, and were not receiving supervision on a regular basis to ensure that they were able to meet the needs of people living at the service. EVIDENCE: Feedback from the people who use the service shows that they have confidence in the staff that care for them. Staff Rotas were seen and displayed adequate numbers of staff on duty to meet the needs of the people using the service. The manager is in addition to daily staffing numbers; this enables staffing levels to be maintained for the safety of all. One staff member commented, “I feel we work very well as a team. My colleagues and I support each other well; there is good communication between us”. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the service recognising the Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 23 importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Four staff files were audited and were seen to contain all the required documentation. The files were quite disorganised. The administrator stated that she was in the process of sorting through all of the files and transferring to new files. Four individual staff commented on the team culture of the service. A number of staff surveyed stated that they felt that there were not enough staff on duty to meet the needs of the people who use the service. Once recruited staff receive induction and training. The programme is then signed at the end of each stage. Following discussions with a number of staff and the manager it was determined that this process was being reintroduced to the service to ensure that all staff had fully received this and that evidence was held on their file. The AQAA determined that “Most HCAs (Health Care Assistants) have achieved their NVQ2. All staff have undergone an induction programme. We are now implementing the Skills for Care induction programme to all staff. Regional trainer in post, monthly tracker to ensure all staff up to date with training . Staff have taken on roles and are more readily taking on courses as they arise. The culture of the home and the way staff respond to training is much improved”. The training matrix showed that a number of training needs were required. This included health and safety, nutrition, infection control and safeguarding of vulunerable adults. There was not a plan in place for training for the forth coming months. The manager stated that a number courses had been arranged however no evidece was provided to show this. Staff confirmed that staff meetings occur and a number of comments received on the staff surveys determined that the staff feel involved and updated. The mix of staff is suitable to meet the cultural needs and mix of people that use the service. Staff reported that they felt supported in their roles and that they were able to discuss issues with a member of the senior team if required. A comment received from a staff member states that; “my manager is always very helpful and supportive”. Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 24 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, 33, 35, 36, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People benefit from living in a well-managed service but some improvements are needed in relation to supervision, record keeping, in order to ensure that peoples well being is maintained and that they are protected and safe. EVIDENCE: The Registered Manager has the required qualifications and experience and is competent to run the home. The Registered Manager has a clear understanding of the key principles and focus of the service, based on organisational values and priorities. Feedback received on the day of the Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 25 inspection from staff and as part of the feedback questionnaires received determines that the management are effective and approachable. The Registered Manager and deputy managers lead and support a stable staff team who have been recruited and trained to satisfactory levels. The manager is aware of the continued need to ensure that enough staff hold a National Vocational Qualification In Care Level 2. Currently only 45 of the care staff have obtained this qualification with a further 15 currently completing it. The manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. The service has good policies and procedures, which are corporately and internally reviewed and updated, in line with current practice. The manager ensures that staff follow the policies and procedures of the home. This includes the management of finances within the service, where systems were directly observed to be transparent and open, with detailed records being maintained at all times. The AQAA determines that they have identified that they could improve on “regularity of supervision. Planned supervision and appraisals for the year”. Records of supervison for the year were observed and seen to show incomplete schedule not meeting the minumum requiremnts. This was discussed with the manager. One member of staff commeneted that she has had a supervison but it was a very long time ago. There is a need for all staff to be offered guidance about the role of supervision and for periodical one to one sessions to be documented. The manager confirmed that continued development and progress is being made with training and supervision. Discussions occurred with the manager regarding additional steps that she will be taking to ensure full compliance. The manager also identified a need to ensure that all in house training for staff is completed. Staff meetings take place regularly and minutes of the meetings are available. The home works to a clear health and safety policy. Safeguarding is given high priority and the home provides a range of policies and guidance to underpin good practice. In house training is scheduled for safeguarding. Staff showed a working knowledge of action to take in such an event. Internal training is being provided by people trained as trainers. All health and safety records are up to date. Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 26 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 X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 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 3 X 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 2 3 Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 27 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 (1) & (2) Requirement Timescale for action 01/10/08 2 OP8 15 (1) & (2) 3 OP8 18 (1) (c) (i) 13 (1) & (2) 4 OP9 Care plans must be reflective of the needs of the person receiving the care and detail sufficient information in order for the care to be provided. Health and welfare records must 01/10/08 be accurate and completed in full to ensure the health and well being of all people using the service is supported and protected. Staff must receive training 15/11/08 appropriate to their job role in podiatry before carrying out such tasks. All people using the service must 14/08/08 receive medication as prescribed at all times. An Immediate Requirement was issued during the inspection. Compliance was achieved within the time scales set. 5 OP27 18 (1) Staff must be trained appropriately to ensure that the skill mix of the team is suitable to meet the needs of the people DS0000001908.V370294.R01.S.doc 28/11/08 Harley Grange Nursing Home Version 5.2 Page 28 6 OP28 18 (1) 7 OP30 18 (1) 8 OP30 18 (1) 9 OP36 12 (1) (a) & 18 (2) 17 (1) (a) 10 OP37 using the service. Staff must receive National Vocational Qualification (NVQ) to ensure that the people who use the service are in safe hands at all times. A schedule of planned training must be in place to ensure that all staff receive mandatory training as required. Training must be provided in Safeguarding of Vulnerable Adults, Moving and Handling, nutrition and Health and Safety to ensure that people who use the service are protected and that staff are suitably trained to meet individual needs. Staff must receive periodic supervision and appraisal to ensure that they are supported and competent to do their role. Records in the service must be maintained, up to date and accurate to ensure that the care and support needs of the people using the service are met at all times. 28/12/08 30/09/08 28/11/08 30/09/08 30/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard OP30 OP9 Good Practice Recommendations Safeguarding of Vulnerable Adults training should be provided through the county council or externally accredited source. Temperatures should be taken of the room where medication is stored to ensure the correct storage temperature. Date opening should be added to all bottles; boxes and Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 29 tubes of medication. Balances should be carried forward to ensure a correct stock audit balance at any time. Hand written entries should be double signed and booked in. Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Harley Grange Nursing Home DS0000001908.V370294.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!