Inspection on 19/02/07 for Harmony Care Home

This inspection was carried out on 19th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Harmony Care Home 26/01/06

Harmony Care Home 11/08/05

Harmony Care Home 09/02/05

Harmony Care Home 27/09/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Harmony Care Home Harmony Care Homes (2003) Ltd 91 Highgate Road Walsall West Midlands WS1 3JA Lead Inspector Lesley Webb Key Unannounced Inspection 19th February 2007 08:00 Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 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 Harmony Care Home DS0000056459.V326505.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 Adults 18-65. 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. Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harmony Care Home Address Harmony Care Homes (2003) Ltd 91 Highgate Road Walsall West Midlands WS1 3JA 01922 474336 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) Harmony Care Home (2003) Ltd Mrs Denise Elizabeth Thompson Care Home 6 Category(ies) of Learning disability (7), Physical disability (7), registration, with number Sensory impairment (7) of places Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home is registered to accommodate people with complex needs and/or challenging behaviour. That any invasive practices required to meet service users needs are carried out in line with CSCI and Department of Health guidance. That the Registered Manager of the home will monitor any invasive practices. This person must also be a registered nurse with experience of working with service users with complex needs. 26th January 2006 Date of last inspection Brief Description of the Service: Harmony Care Home is a privately owned six-bedded residential home that provides care for service users with learning and/or physical disabilities and/or sensory impairment. Facilities within the home consist of six en-suite bedrooms (including three which have been adapted for wheelchair users), two large lounge/dining rooms, separate laundry, kitchen, sensory room, ball pit, service user visitors room and kitchen and adapted bathing rooms. There are parking facilities to the front and rear of the building along with a smallenclosed patio area. The home is located in a residential area of Walsall, close to shops, public transport and other amenities including the local park. Harmony Care Home strives to provide care, comfort and security for those in need of long term care, with emphasis on the individuality of each service user. Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken by one inspector with the home being given no prior notice. During the visit time was spent formally interviewing staff, examining records and observing care practices before giving feedback about the inspection to the registered manager. The people who live at this home have a variety of needs. This was taken into consideration by the inspector when case tracking three individuals care provided at the home. For example the people chosen have differing communication and care needs and have various cultural heritages. No relatives of service users were present during the inspection. However six comment cards were completed by relatives all of whom praised the home and service provided. Compliments include “This home is the best ever. The level of care my son has is of the highest standard. I cannot praise the staff and management enough”. The home is registered to provide care for adults with learning and physical disabilities, and other complex needs. Fees charged for living at the home range from £1008.00 to £2400.40. The inspection was conducted with the full co-operation of the registered manager and staff. The discussions and atmosphere throughout the inspection were positive and constructive. What the service does well: Prospective people to use this service and representatives have the information needed to choose a home, which will meet their needs. As in previous inspections all service user files sampled contained the appropriate pre-admissions documentation, including assessments of need completed by the relevant placing authority. When discussing admission processes the registered manager demonstrated understanding of her responsibilities in relation to assessing prospective service users and compatibility of those already living at the home. Care plans are excellent within this home, providing staff with the information they need to satisfactorily meet service users needs, within a risk managed framework. Practices observed and discussions with staff demonstrate that the principles of person centred planning are put into practice within the home. All staff that were interviewed demonstrated knowledge and understanding of care plans and their importance. For example one person explained, “Gives us what each individual needs, the way their care should be provided, risk assessments, special needs they have”. The home takes responsibility to support service users with communication difficulties to become involved in decision-making processes. As one member of staff explained, “You get to know what they like, still let them make that Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 6 choice even if cant tell you verbally, for example when shopping, give different objects, look for responses like smiling when touching different textures, eye contact. Its all about body language”. As in previous inspections the atmosphere within the home is very relaxed and welcoming with an abundance of evidence that indicates relatives and friends of service users are embraced by the home, with service users supported to maintain contact as per their wishes. Also as in previous inspections an abundance of evidence was found that people living at this home lead full and active lives, based on their individual needs and capabilities. During the visit the inspector observed service users going to purchase shopping, visiting family members and participating in intensive interaction with a member of staff. Service users appeared happy with the choice of activities undertaken during the day. The health needs of service users are well met with evidence of good multi disciplinary working taking place. Procedures and practices with the home in relation to medicines and controlled drugs were found to be good with no requirements identified. Medication in the custody of the home is handled according to the requirements of legislation and records are available, of medicines received, administered and leaving the home. Staff working at this home support people to express their concerns. All staff demonstrated good knowledge and understanding of their responsibilities in this area. As one person explained, “Not all can complain directly, but as staff we should know if up set for example if they seem withdrawn, we have to investigate, find out what wrong, then report to manager. We must keep eye on them and if thought something not right keep looking until got to bottom of it”. At this unannounced inspection Harmony Care Home was again found to be comfortable, well maintained and clean. There were no offensive odours and the premises offer adequate light and ventilation. The home continues to offer a good standard of furnishings and fittings and is well decorated. Observations of interactions between service users and staff, discussions with staff confirm that excellent relationships have been developed. When asking staff what they thought the best thing about working at the home is everyone made reference to the service users. For example one person stated, “the relationships between the guys who live here and staff. I have worked lots of places and the people who live here do more than anywhere else, are given opportunities all the time. Staff are willing and want the people who live here to have the best life possible”. Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 3. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective people to use this service and representatives have the information needed to choose a home, which will meet their needs. They have their needs assessed fully in order that they can be confident about the service they will receive. EVIDENCE: The homes Statement of purpose and Service User Guide are available in CD/computer format. Further attempts have been made to make this information accessible by the use of photographs and pictures. Further work is required to ensure these documents reflect amendments to the Care Home Regulations 2001. There have been no new admissions since the last inspection. The preadmissions policy and documentation were examined in order to ascertain of the homes policies and practices would ensure prospective service users needs will be appropriately assessed and managed, all were found to be in order. There were no outstanding requirements from the previous inspection. Due to the complex communication difficulties of service users living at the home assessments and care plans are discussed with their next of kin and social workers. In addition to this information about the home such as the Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 10 Statement of Purpose and Service User Guide give comprehensive information about services and facilities on offer. As in previous inspections all service user files sampled contained the appropriate pre-admissions documentation, including assessments of need completed by the relevant placing authority. When discussing admission processes the registered manager demonstrated understanding of her responsibilities in relation to assessing prospective service users and compatibility of those already living at the home. Through observations of care practices, interviews with staff and a review of documentation it can be confirmed that as in previous inspections, the home is meeting the assessed needs of service users accommodated there. Harmony Care Home offers a specialised service for people with complex care needs. Conditions of registration are being adhered to and services offered reflect current good practice and clinical guidance. Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Care plans are excellent within this home, providing staff with the information they need to satisfactorily meet service users needs, within a risk managed framework. The home takes responsibility to support service users with communication difficulties to become involved in decision-making processes. EVIDENCE: As in previous inspections care plans are excellent; contain specific aims and goals including a break down of tasks in order that staff have sufficient information in order to meet the needs of service users. Plans in place include those for communication, personal care, community access, nutrition, health and personal care. In addition to these specific plans have been implemented for additional needs for named service users such as diabetes, epilepsy, religion and behaviours. All files sampled contained evidence that plans are reviewed on a regular basis and that risk assessments are in place that support the contents of each plan of care. Detailed and comprehensive daily Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 12 records are also completed. It is recommended that monthly key worker meetings be introduced as a forum where the daily records are examined, with all key information extracted that can then be used to further evidence the review and amendment of care plans. All staff that were interviewed demonstrated knowledge and understanding of care plans and their importance. For example one person explained, “Gives us what each individual needs, the way their care should be provided, risk assessments, special needs they have”. Practices observed and discussions with staff demonstrate that the principles of person centred planning are put into practice within the home. It is recommended that further guidance regarding person centred planning be given to some staff. When interviewing staff about this approach to care planning one person was not able to explain in sufficient detail what is was. For example one person said, “I hadn’t really had a look at these plans yet, but think they say everything that they like to do, activities. I’m quite new and have not had training in this yet”. Others however demonstrated very good understanding in this area, for example saying, “its about basing the care on the specific service user and their wishes and needs, building around their likes/dislikes, things that are important to them, its better than basic old style care planning”. Despite the majority of people who live at this home having potential communication needs that could impact on them being able to express choices all staff demonstrated understanding of promoting good practice in this area. As one member of staff explained, “You get to know what they like, still let them make that choice even if cant tell you verbally, for example when shopping, give different objects, look for responses like smiling when touching different textures, eye contact. Its all about body language”. All people living at Harmony have person centred plans in place that aid communication. All are detailed and include the use of photographs and pictures. It is recommended that the home continues the development of these documents with the aim that these will be the main document used by care staff to understand and deliver care and support to individuals living at the home. Risk management is good, ensuring those receiving a service are protected but not restricted. As already mentioned assessments are completed that work in conjunction with care plans for all identified needs. It is recommended that numbers of staff having signed to say they have read these documents continue to increase. Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social, educational, cultural and recreational activities meet individual’s expectations. Further work must be undertaken to ensure detailed and comprehensive records are maintained of all meals taken by service users in order that the home can be confident specialist needs are being catered for. EVIDENCE: All three requirements identified in the previous inspection are now met. Rules on smoking, alcohol and drugs are now included in the service user guide, nutritional needs are now being regularly assessed and all service users living at the home are now being weighed on a regular basis. As in previous inspections the atmosphere within the home is very relaxed and welcoming with an abundance of evidence that indicates relatives and friends of service users are embraced by the home, with service users supported to maintain contact as per their wishes. The home actively supports individuals Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 14 to maintain contact with friends and relatives. The Registered Manager keeps relatives regularly updated with any changes/incidents. There are two lounge areas available where visitors can meet their relatives; service users can also access their own rooms with relatives if desired. All staff that were interviewed demonstrated understanding of supporting service users to maintain relationships. Also as in previous inspections an abundance of evidence was found that people living at this home lead full and active lives, based on their individual needs and capabilities. Information supplied to the Commission for Social Care Inspection before the visit details community access and activities that include music therapy, snoozelem, ball pool, intensive interaction, life skills, inhouse disco, karaoke, swimming, cinema, pub, bowling, shopping, theatre and visits to the library. During the visit the inspector observed service users going to purchase shopping, visiting family members and participating in intensive interaction with a member of staff. Service users appeared happy with the choice of activities undertaken during the day. The home has its own sensory room, music therapy room and separate ball pit, all of which are accessible to those living there. Information supplied to the Commission For Social Care Inspection prior to the visit states ‘times of meals are suited to each individual on each day. Service users have a choice of menu, special and cultural dietary needs are catered for and that there are facilities for service users to make drinks and snacks’. When visiting the home the inspector found that a 4-week menu is in operation but that this does not detail choices or alternatives. It is recommended that further work to evidence choices and alternatives is undertaken as individual records of meals taken by service users show the majority of times that everyone has had the same meal, despite staff stating this is not the case. It was also found that in several instances meals taken have not been recorded. During day service users were indirectly observed having meals, with assistance from staff. The atmosphere was very relaxed and informal. Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18.19 and 20. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff’s excellent knowledge ensures personal support in this home is offered in such a way as to promote and protect service users privacy and dignity. The health needs of service users are well met with evidence of good multi disciplinary working taking place. Medication practices are excellent in this home, ensuring protection and good health for service users. EVIDENCE: As in previous inspections staff have excellent knowledge of the personal care needs of service users and observation of practices confirm the principles of respect, dignity and privacy are put into practice. Staff were observed knocking on doors before entering bathrooms and bedrooms and talking to people in a friendly yet respectful way. Service users have access to a telephone, are spoken to using a preferred term of address, (which is documented) and arrangements are in place to ensure personal clothing and laundry is returned to its owner. Due to communication difficulties families of service users contribute information regarding preferences about how service users are guided, moved and supported with care. A policy has now been Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 16 introduced for care given to individuals by someone of a different gender and the registered manager confirmed that family involvement is going to be sought regarding this. Also as in previous inspections health care management and documentation is excellent. Information supplied to CSCI prior to the inspection states that support services such as general practitioners; district nurses, occupational therapists and dieticians are obtained via a referral system as required. Also that home visits by the dentist and optician takes place and that chiropody treatment takes place every month. Records maintained on the three service users files sampled confirm this information to be true. The home should also be commended for other health care documentation in place. These include health action plans and records relating to specific health needs such as diabetes and epilepsy. A form is used by staff to sign to say they have read the content of health plans and other associated documentation. It is recommended action be taken to ensure this is implemented in full. Procedures and practices with the home in relation to medicines and controlled drugs were found to be good with no requirements identified. There are no residents who self administered at the time of inspection and medication in the custody of the home is handled according to the requirements of legislation and records are available, of medicines received, administered and leaving the home. Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff working at this home support people to express their concerns, and have access to a robust, effective complaints procedure. People living at this home are protected from abuse and have their rights protected. EVIDENCE: The inspector is aware that the majority of service users living at the home have either no or very little verbal communication and therefore explored how they are able to raise issues or make complaints in detail when interviewing staff. All staff demonstrated good knowledge and understanding of their responsibilities in this area. As one person explained, “Not all can complain directly, but as staff we should know if up set for example if they seem withdrawn, we have to investigate, find out what wrong, then report to manager. We must keep eye on them and if thought something not right keep looking until got to bottom of it” and another “we act as advocates on their behalf, we know if unhappy, and we must act on this, take action and pass information on”. Complaints policies and procedures are appropriate, including being provided in alternative formats. All comment cards received from relatives of people living at the home state they have been made aware of the homes complaints procedure and would be happy to raise any concerns. Since the last inspection a book titled ‘service user complaints’ has been introduced where staff can raise issues on behalf of people living at the home who have limited communication. It was pleasing to find that two issues relating to a Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 18 service user not being shaved have been raised along with evidence of action taken to address this (meeting a previous good practice recommendation). The inspector examined a sample of protection policies and procedures (physical intervention, adult protection and whistle blowing), finding all to be appropriate. Also records and systems for the management of service users finances are good, offering protection to those living at the home. Individual allowance sheets are maintained along with receipts for all transactions. In addition to this checks are undertaken on every change of shift. As with complaints staff have good understanding of protecting service users from abuse. When asked how they can protect service users responses include, “Think everyone must be aware, observing what’s going on around, knowing if service users not happy, for example if they are uneasy around certain staff. If staff concerned they should be confident to raise concerns and all allegations must be taken seriously. If not happy with how concerns are being dealt with, must always take higher”. Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally the physical design and layout of the building enables people to live in a safe, well-maintained and comfortable environment. EVIDENCE: At this unannounced inspection Harmony Care Home was again found to be comfortable, well maintained and clean. There were no offensive odours and the premises offer adequate light and ventilation. The home continues to offer a good standard of furnishings and fittings and is well decorated. A maintenance and renewal programme has been formulated and regular environmental audits are being conducted. The premises are in keeping with the local community, and offers access to local amenities and transport. Since the last inspection the rear corridor has been insulated in order that temperatures are maintained to a minimum of 16 degrees Celsius, a rotting window frame has been replace and fascia board at the rear of the building repaired (however this requires further attention as it appears to have come Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 20 loose and poses a health and safety risk). Specialised equipment is in place as required to meet service users needs. Bedrooms are decorated and furnished to a high standard and reflect individuals tastes and preferences. Information supplied to the Commission for Social Care Inspection prior to the visit states that the downstairs shower room is no longer in use. This was investigated during the visit. This facility was found to be de-commissioned due to concerns regarding access via a ramped area and the risk to both service users and staff. The home was instructed that this must be investigated and a resolution found with findings forwarded to CSCI. Bedrooms have en-suite facilities but the shower room is the only separate bathing facility located on the ground floor resulting in service users having to use the first floor facility whilst this is not in use. It is also recommended that door guards be fitted as many appear chipped from contact with wheelchairs and that advice be sought regarding the Disability Discrimination Act and access to the home (for example steps and signage). Laundry facilities are appropriate and are sited in a separate area designated for the purpose. Equipment provided ensures foul laundry is washed at appropriate temperatures, and the washing machine has a sluicing facility. Laundry facilities do not intrude on resident’s routines, and walls and floors are readily cleanable. Infection control policies appear appropriate, however it is recommended that the procedure for sanitizing mop heads be expanded as in its current form it does not give clear and detailed information. Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who live there. Further improvements to some recruitment documentation will offer further protection to those living at the home EVIDENCE: Observations of interactions between service users and staff, discussions with staff confirm that excellent relationships have been developed. When asking staff what they thought the best thing about working at the home is everyone made reference to the service users. For example one person stated, “the relationships between the guys who live here and staff. I have worked lots of places and the people who live here do more than anywhere else, are given opportunities all the time. Staff are willing and want the people who live here to have the best life possible” and another, “The people who live here get quality care, everyone is friendly and we all talk to each other which is good. We work as a team”. The home operates at staffing levels of between five and six support workers during wakeful hours and two support worker during the night time. In Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 22 addition to this the manager is allocated supernumerary hours. A kitchen person is employed of a weekend and for an hour each day in the week. Observation of practices and examination of records indicate that staffing levels are appropriate to meet the needs of those living at the home. Staff meetings take place on a regular basis (above those recommended in the National Minimum Standards). Information supplied to CSCI before the inspection states that four staff have a national vocation qualification (with all others in progress), twelve have undertaken LDAF (all others in progress) and that staff have undertaken specialist training in eating and swallowing, epilepsy, intensive interaction, autism, record keeping, PEG management, disability awareness, quality assurance and equality and diversity. A training plan and individual training needs analysis are in place, however the inspector has some difficulty assessing if suitable numbers of staff hold up to date certificates as training documentation is currently stored in three locations. It is recommended that this is reviewed and records collated in one place for ease of reference. Improvements to some recruitment documentation are required. Four staff personnel files were examined and found to contain documents required by regulation, however it was noted that the homes application for only asks for the previous three years employment history (The Care Home Regulations 2001 states that a full employment history should be obtained) and that the enhanced CRB disclosures on two files were from previous employers despite these people commencing employment at the home in 2005. Supervision and support offered to staff is good, with all staff files sampled containing evidence that they receive formal one to one supervision on a regular basis, in addition to an annual appraisal. Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39 and 42. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect. Quality assurance systems are based on the views of people. EVIDENCE: Discussions and observation of practices confirm that the home is being managed appropriately. The manager is aware of areas that require improving, with evidence that action is taken within appropriate timescales to address deficits. Mrs Thompson registered since the 8th January 2007. She has nearly five years experience in a nursing and social care setting, working with adults who have a profound learning and physical disability, autistic spectrum disorders and associated challenging behaviours. Mrs Thompson qualified as a Registered Nurse in Mental Handicap (Leve1) 28 May 1989, Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 24 updating dating her practice 20 June 2006. Training completed relevant to her current and past experience included, BSL Sign Language Stage 2, NasoGastric & Peg Tubes, Tissue Viability Assessment and Management, Epilepsy Awareness, Supra Pubic Catheterisation, Palliative Matters, Buccal Miadozolam/Epistatus Awareness. Mrs Thompson has also completed a number of training courses relating to managing budgets, disciplinary and grievance and recruitment and appraisals. Since last being inspected the home has commissioned an external quality assurance consultant. Audits for physical environment, communications, care, staff and management are undertaken, with the last external audit completed December 2006 (referenced to National Minimum Standards). This audit identifies some areas for improvement (some of which have been acted upon). It is recommended that work continues to address all areas identified. The views of families and professionals have also been obtained, all of which are very positive, with no negative comments made. Comments include ‘in my opinion harmony care have a staff team who sincerely care about the service users; I feel that this is vital and fundamental to this good service. The ethos at harmony is client centred and I believe that through rigorous selection harmony have a focused staff group’ and ‘harmony take excellent care of our nephew, he seems happy and is always commenting on how nice the staff are’. It is now recommended that an analysis of all information be undertaken (including the views of people) and the findings incorporated into a development plan for the home. The management of health and safety at this home is excellent, with no requirements identified. Information supplied to the CSCI prior to the inspection states that fire equipment was checked on 14/09/06, the last fire drill occurred 12/12/06, fire training took place 31/01/06, the fire alarm is tested weekly, the gas was serviced 22/01/07, a legionella assessment was undertaken 03/02/07, emergency lighting tested 16/01/07, the bath hoist serviced 27/12/06 and wheelchairs serviced 10th and 11th Jan 07. Safe working risk assessments were viewed and appear appropriate for the setting. It is recommended that the moving and handling policy be reviewed and amended as currently this is generic and not based on the needs or practices undertaken within the home. Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 4 3 4 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 X 15 3 16 4 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 X 4 3 3 X X 4 X Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 26 No. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4,5,6 Requirement Timescale for action 2 YA17 16(2)(I) 3 YA24 23 The statement of purpose and 30/05/07 service user guide must be reviewed and amended to reflect amendments to the Care Home Regulations 2001. Full and detailed records must 30/04/07 be maintained of all meals taken by service users. When service users decline a meal this must also be recorded in every instance. The facia board at the rear of 30/06/07 the property must be made safe. Arrangement must be made to ensure the downstairs shower room is accessible to everyone. The home must amend its application form in order that a full employment history is obtained. The home must ensure a new enhanced CRB disclosure has been obtained for anyone employed after 26th July 2004. 4 YA34 19 30/05/07 Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 27 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 YA6 Good Practice Recommendations That monthly key worker meetings be introduced. That key information from daily records is extracted and incorporated into monthly key worker meetings. That staff receive further guidance on person centred planning. That person centred plans continue to be developed for all service users. That all staff sign to say they have read to contents of risk assessments. That further work is undertaken to evidence service users are offered choices and alternatives at meal times. It is recommended that views relating to personal care given by someone of a different gender be sought and consent gained. That all staff sign to say they have read the contents of health plans. That door guards be fitted to stop paintwork from becoming chipped. That advice is sought regarding the Disability Discrimination Act and access to the home. That the procedure for sanitizing mop heads be expanded. That systems for storing training documentation be reviewed. That the home continues to address all areas the external quality assurance audit. That an analysis of all information is undertaken and the findings incorporated into a development plan for the home. That the moving and handling policy be reviewed and amended to reflect practices undertaken within the home. 2 3 4 YA9 YA17 YA18 5 6 YA19 YA24 7 8 9 YA30 YA33 YA39 10 YA42 Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Harmony Care Home DS0000056459.V326505.R01.S.doc Version 5.2 Page 29 - 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!