Inspection on 17/08/06 for Harley Grange Nursing Home

This inspection was carried out on 17th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Harley Grange Nursing Home 14/08/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Harley Grange Nursing Home 25 Elms Road Leicester Leicestershire LE2 3JD Lead Inspector Thea Richards Unannounced Inspection 16th August 2006 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.V306932.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.V306932.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 Limited 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.V306932.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To admit the named person of Category PD as identified in Correspondence in Application number V10761 dated 02/08/04 To admit the named person of Category DE(E) as identified in Correspondence in Application number V13892 dated 09/11/04 13th September 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 £490.00pwto £ 530.00 p.w. There are additional costs for individual expenses such as personal toiletries, optician, hairdressing and some recreational activities Harley Grange Nursing Home DS0000001908.V306932.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection of the home that was concluded with an unannounced visit to the home. Prior to the visit the inspector spent five hours reviewing the previous inspection report and information relating to the home received since the last inspection on the thirteenth of September 2005 including the pre-inspection questionnaire, which had been sent to the home for completion. The visit took place on the 17th August 2006 from 0845 and lasted five hours. During the course of the visit the inspector checked all the ‘key’ standards as identified in the National Minimum Standards. This was achieved through a method called ‘case tracking’. Case tracking means that the inspector looked at the care provided to two residents living at the home, by speaking with the residents themselves; talking with staff supporting their care; checking records relating to their health and welfare and viewing their personal accommodation (with their consent) as well as communal living areas. 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. What the service does well: This was a positive inspection with the home having achieved all the requirements from the last inspection having been met. All the residents, visitors and staff spoken with were happy and positive about the home, the food, activities and the care given. The staff spoken with were enthusiastic in their care of the residents and appeared to be committed to them and aware of their needs. Staffing levels are good and the staff were found to be knowledgeable about the safeguarding of adults, the medication policy and the care needs of the residents. This ensures that the residents receive the appropriate care delivered safely by knowledgeable staff. There is a good range of appropriate activities in the home for the residents. The residents receive a good variety and choice of meals by a staff that are aware of their needs. Harley Grange Nursing Home DS0000001908.V306932.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Harley Grange Nursing Home DS0000001908.V306932.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 Harley Grange Nursing Home DS0000001908.V306932.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 is not applicable in this home Quality in this outcome area is good. This judgement has been made using the available evidence. Residents’ needs are well assessed prior to moving into the home by the completion of a pre-admission assessment by a trained member of staff or by Social Services. EVIDENCE: The inspector checked the care records of two residents who were case tracked. All residents have a contract and a statement of terms present in in their files. Completed pre-admission assessments are present in the residents files, identifying their needs, prior to their admission to the home. Care plans reflected the needs of the resident which had been identified in the preadmission assessment. The residents and the visitors spoken with told the inspector that they had had a visit from the Home Manager before their admission to the home and had the opportunity to visit the home. Staff spoken with said that they were aware of the residents needs prior to them moving into the home. Harley Grange Nursing Home DS0000001908.V306932.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome group is good. This judgement is made using the available evidence including a visit to the service. The staff fully meet the care needs of the residents. EVIDENCE: Care plans for two residents were ‘case tracked and they were found to contain good individual evidence of care which reflects the care being given to the residents. There is evidence of the involvement of G.P.s, chiropodist, optician, speech therapist and dentist, which is clearly documented, enabling the staff to monitor that the residents are seen by these professional staff as often as they need to be. The daily record of care is up to date which enables the staff caring for the residents to be aware of their current care needs and recent occurrences and it contains entries for the resident’s involvement in activities. Care plans identified care needs for the residents and had been regularly updated ensuring that the staff were aware of changes in the treatment for the residents enabling them to give the most apprpriate care. Staff spoken with were aware of the care needs of the residents and the changes that had been Harley Grange Nursing Home DS0000001908.V306932.R01.S.doc Version 5.2 Page 10 made to their care. The residents and the visitors spoken with were happy that their care needs were being met. The home has good links with the tissue viability service who advises on and provides training for the best care for any residents who have skin problems such as ulcers or pressure sores. A good range of risk assessments were in place in the care plans and had been updated however, a risk assessment and a consent form for the use of a lap belt in a wheelcahair were missing. These areas should be discussed with the resident and/or the family to ensure that they are aware of the need for the restraint and the risks of putting it in place or not. Medication records for the case tracked residents were in order. Staff were knowledgeable about the medicines and where to obtain information. They were also aware of the requirements for the receipt, storage and disposal of medicines. The home manager or her deputy complete monthly audits of the medication records,which were satisfactory. There are no residents currently administering their own medication. The inspector observed residents being treated with dignity and respect when staff spoke with them, assisted them at lunchtime and provided care. Residents spoken with were happy with the way staff treated them and said that they were very kind. Two visitors spoken with on the day of the visit were very happy with the level of care being given, one the visitors spoken with said ‘ wouldn’t still be alive if hadn’t come here’ The home is taking part in the Gold Standard Framework initiative for the care of terminally ill residents, whereby all the professional staff, together with the resident and their family agree a course of treatment which they all work together on to provide the best care for the terminally ill person. Harley Grange Nursing Home DS0000001908.V306932.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome group is excellent. This judgement is made using available evidence including a visit to the service. Residents have their social, religious and nutritional needs met very well by a dedicated staff. EVIDENCE: There was documentation available in a separate file confirming that residents were taking part in varied activities in the home. There is an activities organiser employed for twenty hours a week who is dedicated to the planning and undertaking of appropriate activities. Whilst there is a planned programme of activities this is made very flexible to allow the residents to do whichever they would like to on a particular day. Outings are arranged by the home and the residents said that they particularly enjoyed the boat trip. These are arranged for half days as the residents in this home cannot cope with longer trips. On the day of the visit the residents were enjoying music in the lounge together with some exercises, with the very enthusiastic activities organiser. The residents were also being given the opportunity to try different types fruit together, with the more familiar ones which were all cut up into manageable pieces which they appeared to be enjoying. There was good individual interaction observed between the residents and the staff with individual activities such as a manicure taking place. The residents and the visitors spoken with said that they enjoyed the variety of the activities Harley Grange Nursing Home DS0000001908.V306932.R01.S.doc Version 5.2 Page 12 and that they had improved a great deal. Both the residents and the visitors spoken with had attended and enjoyed the fete that the home had held the week-end prior to the visit. The hairdresser was visiting the home which she does on a weekly basis and the residents were enjoying having their hair done, A resident spoken with said ‘ that it really made her feel better having her hair done’. The hairdresser was using an empty bedroom to work in but the manager has got plans to convert a bathroom, which will still leave adequate bathing facilities for the numbers of residents in the home and will provide a more appropriate space for the hairdresser to work in. There is a choice of meals available and diabetic meals are provided, if there was a need for any other diets the kitchen staff told the inspector that they would be able to provide them. Two cooks spoken with were very knowledgeable about the residents individual needs and were extremely enthusiatic in their roles. Both have undertaken a National vocational award at level two in cooking and one hopes to be able to undertake level three. The National Vocational Qualification is a qualification for care staff to ensure that they receive appropriate training in the needs of the resident group whom they are caring for. Residents spoken with all said that they enjoyed the food and were happy with the choices and were able to have something else if they did not like the choices on offer. Visitors are made welcome in the home and this was confirmed by visitors spoken with who told the inspector that they were made very welcome at any time. Families and friends are invited to social functions and to resident meetings to express their views. A lay reader from the local church visits once a month to hold a service which many of the residents attend and enjoy. The Priest from the local Roman Catholic visits those residents of that faith. Harley Grange Nursing Home DS0000001908.V306932.R01.S.doc Version 5.2 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, 18 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the service. There systems in place to support and protect residents and staff are knowlegeable about the processes EVIDENCE: There is a complaints policy in place and no complaints or concerns have been recorded in the home since the last inspection. Residents spoken with were happy that they would speak to the manager or a member of staff, if they had a problem. Visitors spoken with on the day of the visit said that they were aware of the procedure to complain and would have no concerns about doing so. The Commission for Social Care Inspection has received no complaints or concerns since the last inspection. There is evidence of training in safeguarding adults having been received by staff and staff spoken with had good knowledge about safeguarding adults, the process of dealing with an incident and would be prepared to ‘whistle blow’ if they thought there was a problem. Harley Grange Nursing Home DS0000001908.V306932.R01.S.doc Version 5.2 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, 20, 21, 23, 24, 25, 26 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the service. The residents live in a generally good and safe environment. EVIDENCE: The registration certificate from the Commission for Social care Inspection was displayed in the reception area. The latest inspection report from the Commission of Social Care Inspection was available in the managers’ office. The communal areas of the lounge and dining room provide a homely and comfortable environment for the residents to live in. There was an odour of urine in the lounge/dining room area and in an upstairs corridor. With their permission, the bedrooms of the ‘case tracked’ residents were looked at. The bedrooms provided good accommodation and had been personalised with the resident’s belongings. They were clean and safe and had en-suite facilities of a Harley Grange Nursing Home DS0000001908.V306932.R01.S.doc Version 5.2 Page 15 W.C. and wash hand basin. The room that was shared had adequate provision for the privacy of the residents. The staff were observed using a hoist to move a resident which was undertaken safely with consideration for the residents modesty. There is level access to well kept grounds which enables the residents to spend time outdoors if they wish, with chairs and a gazebo for protection from the sun in the hot weather. The staff spoken with had received training in the control of substances hazardous to health (COSHH) and had new chemicals in place which had the data sheets to enable the staff to be aware of precautions that are necessary when using these cleaning products. One bathroom inspected was found to be being used as a storage area. The manager was proposing to change its use to use it as a hairdressing salon. This room should be locked whilst it is being used for storage as it could present a hazard to any of the residents if they went into the room. A further bathroom was found to contain hoists and a chair which left no room to access the bath. This should be cleared to provide safe access for the residents and the staff. The remaining bathrooms were in good order. There were no further outstanding safety or maintenance issues noted on the tour of the premises. Records for the maintenance of fire equipment, fire-drills and testing of water temperatures were found to be in order. Harley Grange Nursing Home DS0000001908.V306932.R01.S.doc Version 5.2 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, 28, 29, 30 Quality in this outcome group is good. This judgement is made using the available evidence including a visit to the service. The residents’ needs are met and their safety protected by the staff EVIDENCE: There is evidence of a good skill mix of staff to give the care identified for the residents needs and the number of staff on duty reflected the duty rota. Residents, staff and visitors spoken with felt that there were always sufficient numbers of staff on duty to cater for their needs. Two staff files were viewed by the inspector and the required documentation was complete in both files. There was evidence of a robust recruitment policy in place which ensures the safety of the residents. There was evidence of staff training in a separate file and staff spoken with confirmed that they received regular training in both the mandatory and other training such as tissue viability and diabetes. There are 50.5 of the care staff who have a National Vocational Qualification at level two or above and several more were about to commence it. Ancillary staff had also undertaken the award in cooking and in housekeeping. The manager has not yet completed the registered managers award, however she is a nurse and has undertaken many varied courses to support her role. The National Vocational Qualification is a qualification for care staff to ensure that they receive appropriate training in the needs of the resident group whom they are caring for. Harley Grange Nursing Home DS0000001908.V306932.R01.S.doc Version 5.2 Page 17 There was documentary evidence that staff supervision was in place which gives staff time with their line manager to discuss their work and training needs. There were no visiting professional staff in the home on the day of the visit to enable the inspector to dicuss their views of the home with them. Harley Grange Nursing Home DS0000001908.V306932.R01.S.doc Version 5.2 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): 31, 33, 35, 38 Quality in this outcome group is good. This judgement has been made using the available evidence including a visit to the service. Residents live in a home, which provides for their needs, with basic safety and protection in place. EVIDENCE: The manager or the administrator were available throughout the visit to the home. The manager is an experienced manager who has worked in this home for three years. Whilst she has not completed the Registered managers award, she has undertaken many varied courses to gain a wide experience in managing the home and caring for the residents. The manager holds regular meetings with the residents and has one to one discussions with them and their families to ensure that the home is providing the service that they need and require. There is a new deputy manager in post to assist the manager and spend time with the staff and residents ensuring the correct and appropriate delivery of Harley Grange Nursing Home DS0000001908.V306932.R01.S.doc Version 5.2 Page 19 care needs. She will deputise in her absence in a supernumary role which will enable her to undertake all the duties needed. Residents are protected by the recruitment policy, with the obtaining of relevant documentation such as references, identification and criminal records bureau checks. Staff were being given appropriate training to look after the residents both in care needs and health and safety issues. This was confirmed by available documentation, the manager and by staff spoken with. Residents finances are handled by their families with the home holding some monies on their behalf for incidental expenses. This is handled by the manager and the administrator with good records in place. There are records of expenditure available in the home and the records for the case tracked residents were found to be in order. Residents needs are met with a well trained staff and a good working relationship with the professional staff who visit the home. Southern Cross Healthcare who own the home supplies necessary equipment when needed. There are appropriate records in place confirming that all health and safety requirements are being met to maintain a safe environment for residents and staff. Harley Grange Nursing Home DS0000001908.V306932.R01.S.doc Version 5.2 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 3 X X N/A 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 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 X 3 3 3 2 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 X 3 X 3 X X 3 Harley Grange Nursing Home DS0000001908.V306932.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? None STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP7 Good Practice Recommendations The registered person should ensure that documentation for the risk assessment and consent for using a lap belt in a wheelchair is present in the care plan. The registered person should ensure that there is documentary evidence in the care plan about the views of a resident sharing a bedroom and that it is regularly updated. The registered person should ensure that bathrooms are cleared of equipment and that if they are to be used as a storage area that they should be kept locked. The registered person should ensure that the home is kept free of unpleasant odour. 3 4 OP19 OP26 Harley Grange Nursing Home DS0000001908.V306932.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX 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 Harley Grange Nursing Home DS0000001908.V306932.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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