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 Unannounced Inspection 26th January 2006 09:40 Harmony Care Home DS0000056459.V280786.R01.S.doc Version 5.1 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.V280786.R01.S.doc Version 5.1 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.V280786.R01.S.doc Version 5.1 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 Ms Carolyn Swinton Care Home 6 Category(ies) of Learning disability (7), Physical disability (7), registration, with number Sensory impairment (7) of places Harmony Care Home DS0000056459.V280786.R01.S.doc Version 5.1 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. 11 August 2005. 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.V280786.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector arrived unannounced at 9.40am and stayed until 5.30pm. Due to the communication difficulties of people living at the home the inspector was unable to talk to them to find out their views and opinions regarding care provision. However time was spent formally interviewing staff, looking at records, indirectly observing care practices and touring the building before giving feedback to the registered manager. As this is the second inspection to take place in the last twelve months both this report and the one published in August 2005 should be read to find out how the home is meeting national minimum standards. As in previous inspections by the end of the visit the inspector was satisfied that generally the home provides a very good service and would like to thank everyone for the co-operation and assistance shown. These observations are further reinforced by the parents of 2 service users living at the home both of who sent comment cards to the inspector stating, ‘this is the best place my son has been in for being looked after’ and ‘staff and management alike have a good caring attitude’. What the service does well:
Throughout the inspection staff demonstrated excellent knowledge in relation to service users rights and responsibilities and providing personal support. As one member of staff explained when discussing rights and personal care, “we all have rights regardless of our abilities, so for example we always ask service users their permission even thought they can’t answer verbally, this shows respect. We ask if they are happy with the way we offer support and look for facial gestures and body language as responses to questions. Its also important to communicate to other members of the team, so that everyone is aware of important information”. Practices observed throughout the visit reinforced comments made by staff, where service users were seen being treated with respect whilst at the same time being offered support in a personal and dignified way. Staff also demonstrated excellent understanding of their role as advocates for service users with communication difficulties and other complex needs to raise issues and complaints. For example one member of staff stated, “the only way they can complain is through us, it’s our duty to monitor situations and do something if we feel someone is unhappy. We have to look for expressions, changes in mood, hand gestures. Any concerns we report to the senior or manager”. Harmony Care Home DS0000056459.V280786.R01.S.doc Version 5.1 Page 6 The manager should also be congratulated for monitoring systems in place for healthcare, medication and general health and safety all of which are robust and ensure the protection and wellbeing of everyone living at the home. 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. Harmony Care Home DS0000056459.V280786.R01.S.doc Version 5.1 Page 7 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.V280786.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards assessed at previous inspection. EVIDENCE: Harmony Care Home DS0000056459.V280786.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards assessed at previous inspection. EVIDENCE: It was noted by the inspector that a previous requirement to ensure staff are aware of aims and goals contained within service user plans of care is now met. Evidence was supplied that demonstrates these are discussed at induction, staff meetings and supervisions. Harmony Care Home DS0000056459.V280786.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. The rights and responsibilities of service users are well managed in this home, creating an inclusive atmosphere for those living here. EVIDENCE: Harmony Care Home DS0000056459.V280786.R01.S.doc Version 5.1 Page 11 A previous requirement to ensure the nutritional needs of service users are assessed is now met and the regular weighing of service users partly met. The manager states that the home is having some difficulty accessing appropriate weighing equipment suitable for some service users but that the proprietor is looking at purchasing this in the future. The inspector witnessed staff knocking on service users bedroom doors before entering and asking their permission before giving assistance to ensure individuals rights and responsibilities are respected. Presently no service user has a key to their bedroom (risk assessments were found to be in place for these practices) and a security coded keypad system is in place at the entrance of the building that no service user is capable of using. The inspector recognises that this is in place to safeguard people living at the home but recommends this restriction on freedom of movement be included in the service user guide so that people are aware when deciding on the suitability of the home. The inspector saw that staff communicate in a very friendly manner, interacting with service users on a one to one basis. Due to the complex needs of service users living at the home they are unable to open their own mail however parental consent for this to be undertaken by the home was found in all files that the inspector sampled. When looking at the homes policies for service users to keep pets conflicting information was identified (see standard 40 – policies and procedures). For example 2 policies are in place one that states they are allowed after assessment and the other that says ‘no pets allowed’. Despite this 2 service users presently have fish with risk assessments that support this facility. Also when assessing service users rights and responsibilities the inspector instructed that rules on smoking, alcohol and drugs must be clearly stated in their contract/terms and conditions of residency. When assessing staffs understanding of service users rights and responsibilities everyone that was spoken to demonstrated knowledge in this area. For example one person stated, “They have the same rights and responsibilities as us, because they have communication difficulties that should not make a difference. Its our job to support them and reinforce these things”. Harmony Care Home DS0000056459.V280786.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. 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: Harmony Care Home DS0000056459.V280786.R01.S.doc Version 5.1 Page 13 Due to communication difficulties families of service users contribute information regarding preferences about how service users are guided, moved and supported with care. Staff explained that despite communication barriers they look to service users for consent with personal care. As one member of staff stated, “being vigilant, looking for facial expressions, hand gestures and body language. All of these let us know if someone is happy with the support we give”. The inspector does however recommend that views relating to personal care given by someone of a different gender be sought and relevant consent gained. All personal support is given in service users bedrooms. Records seen by the inspector demonstrated that times for getting up, bathing, meals and other activities are flexible, depending on each service users needs. All service user files sampled detailed what support staff had given with regards to personal hygiene. On the day of inspection all service users appearances were individual to their personalities. The inspector found an abundance of documentary evidence indicating specialist support given to the home to ensure service users needs are met. The home attempts to employ staff from a variety of backgrounds in order to meet the needs of service users. Comprehensive records are maintained by the home that demonstrates service users healthcare needs are being met. All service users at Harmony have been assessed as requiring full assistance from staff to undertake all healthcare issues. Individual records are maintained of GP, Dentist, Chiropodist and other healthcare appointments. A monitoring sheet is used by the home to ensure that service users receive annual health checks including those for vision, medication and dentistry with only hearing tests requiring action. A monitored dosage system is in place for the administration of medication and on the day of inspection all records and medication were found to be in order. The inspector recommends that the home arrange for the supplying pharmacist to complete 3 monthly audits as per contract agreement. No service users living at the home are able to self medicate, with risk assessments in place that demonstrate this along with consent to administer medication. No one living at the home presently takes controlled drugs however systems are in place should such an event occur. All staff that administer medication are in the process of completing accredited medication training. Also in addition to this the manager completes competency assessments for all staff that administer medication. The inspector observed a senior member of staff administering medication and found this task to be completed competently. The home has a condition of registration to ensure invasive practices carried out in the home are done so in line with department of health and CSCI guidance. All records and practices observed during the inspection demonstrate that this condition is being complied with in full. Harmony Care Home DS0000056459.V280786.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22. The home has a satisfactory complaints system with some evidence that service users views are listened to and acted upon. EVIDENCE: The inspector found 2 complaints policies in place, containing differing information (see standard 40 – policies and procedures). Records and discussions with the manager confirm that there have been no complaints since the home opened. 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 knowledge and understanding of their responsibilities in this area. For example one person stated, “The only way they can complain is through us. It’s our duty to monitor things like moods and behaviour and do something about it. We look at changes in moods as communication” and another said, “Behaviour can change, facial expressions. It’s this sort of thing that we take to mean something is wrong and they are not happy. We take concerns to the senior on duty but if it was really serious I would go straight to the manager”. When asking staff where situations such as they had explained are recorded some staff were unsure whilst others said, “in the daily care notes”. The inspector discussed this practice with the manager strongly recommending that a formalised recording system be implemented for issues raised by staff on behalf of service users to further enhance the quality monitoring systems in place at the home. The inspector also feels that if implemented this would demonstrate the open and inclusive atmosphere within the home where complaints regardless of how informal are construed as constructive.
Harmony Care Home DS0000056459.V280786.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24. The standard of furnishings in this home is very good, providing service users with a homely and comfortable place to live. Further improvements to the building must be made to ensure the health, safety and wellbeing of service users and staff. EVIDENCE: All 4 requirements relating to the environment that were identified in the previous inspection have been met. Records of temperature for the rear corridor and for both freezers are maintained, the freezer and kitchen flooring have been repaired and items have been removed from the tops of wardrobes. A good practice recommendation has also been actioned, resulting in a shower facility being provided in the bathroom in order that service users now have a ready supply of water to wash their hair. In addition to this the main bathroom has also been decorated resulting in a very welcoming and homely facility and the previously unused service user kitchen has been converted into a music therapy room containing an abundance of musical instruments. When examining temperature records for the rear corridor the inspector found that over a thirty-one day period temperatures had not been maintained to legal minimum requirements on twenty-one occasions. The inspector is concerned about this situation as it has been raised in several inspections and as yet is still unresolved. Not only must the temperature be maintained to at least 16
Harmony Care Home DS0000056459.V280786.R01.S.doc Version 5.1 Page 16 degrees Celsius for staff but more importantly for service users who firstly have mobility problems that restrict movement and impact on them maintaining body temperature but also have to use the corridor to access the shower room, bedrooms and sensory room. When inspecting the premises the inspector found that the window frame in the front left lounge to be rotting. The frame is crumbling and gaps between the frame and windowpane are evident. At the rear of the premises part of the fascia board is crumbling and the inspector is concerned that if both of these areas are not repaired and/or replaced they could pose risk to visitors, staff and service users. The internal building was found to be decorated and maintained to a high standard and fitted with furnishings of a high standard. Harmony Care Home DS0000056459.V280786.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards assessed at previous inspection. EVIDENCE: Although the above standards were not assessed at this visit it was noted by the inspector that ten of the eleven requirements identified in the last inspection have been met and one partly met. The inspector congratulated the manager for the efforts undertaken to address these requirements. Harmony Care Home DS0000056459.V280786.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 40 and 42. Improvements must be made to policies and procedures to ensure they comply with legislation and offer protection to service users. Management practices within this home promote health and safety for service users. EVIDENCE: Harmony Care Home DS0000056459.V280786.R01.S.doc Version 5.1 Page 19 It was noted by the inspector that a previous requirement to implement a quality assurance system is now partly met. The home has an abundance of policies and procedures to inform and support people however upon closer inspection of many of these the inspector found that many require reviewing and amending to reflect practices within the home and to comply with legislation. For example a policy is in place for shared rooms when the home is not registered for this facility and another policy describes intermediate care services, again another facility that the home is not registered for. Also many policies including that for pets, complaints and smoking are duplicated and contain conflicting information. All records relating to fire equipment, gas, electrical testing, lighting and water temperatures were found to be up to date and in order. The manager explained that all staff receive fire training as part of the induction process and then every six months. Records viewed by the inspector demonstrate that almost every member of staff holds first aid, food hygiene, health and safety, infection control and moving and handling certificates. A detailed and comprehensive risk assessment has been completed by the manager for all safe working practice topics including fire along with individual assessments for service users. COSHH data sheets and risk assessments were viewed. In the main these were found to be acceptable, however the inspector strongly recommends that the make of each product be included on the risk assessment and that these be maintained in close proximity to where products are used and/or stored for ease of reference. Harmony Care Home DS0000056459.V280786.R01.S.doc Version 5.1 Page 20 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 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 X ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 2 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 2 4 X X X 2 2 X 3 X Harmony Care Home DS0000056459.V280786.R01.S.doc Version 5.1 Page 21 YES 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 YA16 Regulation 12(4) Requirement Rules on smoking, alcohol and drugs must be clearly stated in service user contract/terms and conditions of residency. All service users nutritional needs must be assessed and regularly reviewed. All service users who have specific dietary requirements must be weighed on a regular basis – Part met. Requirement originally made August 2005. Arrangements must be made to offer all service users hearing tests. The temperature in the rear corridor must be maintained to a minimum of 16 degrees Celsius at all times. The rotting window frame in the left lounge must be replaced. The crumbling fascia board at the rear of the building must be repaired. The home must be able to demonstrate that all senior staff are suitably qualified – Part met. Requirement originally
DS0000056459.V280786.R01.S.doc Timescale for action 30/04/06 2 YA17 16(2) 30/04/06 3 4 YA19 YA24 12(1) 16(1) 30/04/06 26/01/06 5 YA24 16(1) 30/04/06 6 YA32 18(1) 30/04/06 Harmony Care Home Version 5.1 Page 22 made August 2005. 7 YA39 24 The home must implement a quality assurance system that meets all of Standard 39 of the National Minimum Standards – Part met. Requirement originally made February 2005. All policies and procedures must be reviewed, amended to reflect practices within the home and comply with legislation. However particular attention must be given to policies for: * * * * * Pets Complaints Smoking Shared rooms Intermediate care 30/04/06 8 YA40 17 Schedules 1,4 30/04/06 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 YA16 Good Practice Recommendations It is recommended that information regarding the security coded keypad system be included in the service user guide in order that people are aware of this restriction on freedom of movement It is recommended that views relating to personal care given by someone of a different gender be sought and consent gained. It is recommended that the home arrange for the supplying pharmacy to carry out 3 monthly audits. It is very strongly recommended that a formalised recording system be implemented for issues raised by staff on behalf of service users. This should include details of issue raised, action taken and outcome. It is strongly recommended that the product name be included on COSHH risk assessments and that assessments be maintained in close proximity to where products are used and/or stored.
DS0000056459.V280786.R01.S.doc Version 5.1 Page 23 2 3 4 YA18 YA20 YA22 5 YA42 Harmony Care Home 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: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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