Inspection on 01/07/08 for Harmony House Care Home

This inspection was carried out on 1st July 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Harmony House Care Home 06/07/07

Harmony House Care Home 22/05/06

Harmony House Care Home 22/02/06

Harmony House Care Home 29/09/05

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Harmony House Care Home The Bull Ring Chilvers Coton Nuneaton Warwickshire CV10 7BG Lead Inspector Sandra Wade Key Unannounced Inspection 1st July 2008 08:25 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 Harmony House Care Home DS0000065174.V371738.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. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harmony House Care Home Address The Bull Ring Chilvers Coton Nuneaton Warwickshire CV10 7BG 02476 320532 02476 320632 harmonyhouse@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited 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) Mandy Anne Moore Care Home 57 Category(ies) of Old age, not falling within any other category registration, with number (57) of places Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th July 2007 Brief Description of the Service: Harmony House is a purpose built care home and is registered to provide residential and nursing care for up to 57 men and women. The home is situated close to junction 3 of the M6, with bus links to Nuneaton town centre and is near by to the George Eliot Hospital. The home is managed by Southern Cross/Ashbourne Ltd. The single room en suite accommodation is situated on two floors. The service provision on the ground floor is for those people who require assistance with personal care. The first floor service provision is for those who require nursing care and qualified nursing staff are available at all times on this unit. Access to the first floor is via passenger lifts/stairs. Garden and patio areas are accessible to all residents including those with limited mobility who require wheelchairs. Information about the home is in a Statement of Purpose and a Service Users Guide which is made available to all residents. The scale of charges at the time of this inspection were for residential care £359.00 to £467.36, nursing care £510 to £568.84 and for continuing care £669.84. These fees are subject to change. Additional charges are made for chiropody, hairdressing and personal items and sundries such as newspapers. The manager confirmed these fees are detailed in the Service User Guide for the home. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection took place between 8.25am and 8.45pm. A completed Annual Quality Assurance Assessment was received from the service prior to the inspection and information contained within this has been included within this report where appropriate. Quality satisfaction surveys were sent out to ten residents and four health professionals prior to this inspection to obtain their views on the service. One health professional survey was returned. Discussions were held with three visitors during the period of the inspection. Three people who were staying at the home were ‘case tracked’ this included one person within the residential area and two within the nursing area of the home. The case tracking process involves establishing an individual’s experience of staying at the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, accident records, financial records, complaint records and medication records. The inspector spent a period of the day in one of the residential lounges to observe residents and ascertain how their care and services are provided. Lunchtime was also observed on the nursing floor. A tour of the home was undertaken to view specific areas and establish the layout and décor of the home. What the service does well: The home is managed by a team of people who well trained to understand the needs of the residents and who ensure that their needs and requirements are Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 6 listened to and acted upon as far as possible to maintain their health and welfare. Over 50 of the care staff have achieved a National Vocational Qualification (NVQ) in Care to help them provide more effective care to the residents. This exceeds our standard of 50 of all care staff to achieve this. There is a comprehensive assessment process is place which enables staff to clearly identify the needs of residents to ensure these can be met by the home. Residents enjoy good home cooked food and are consulted on their likes, dislikes and choices to make sure meals provided are to their liking. The home employs an Activity Organiser who is able to give some one-to-one time to residents and ensure they receive social stimulation each week. There is also an activity board showing weekly activities and outside visits to benefit residents. Both residents and visitors to the home spoke positively about the care and services provided. One visitor said the care is “the care is exemplerary” and “they could not fault it”. Another said staff were “always helpful, always smiling”. Comments from residents included “the staff are very good with me”, “staff pop in to say hello and give me a cup of tea”, “staff are very good”. The staff were observed to interact with residents in a friendly and supportive way. Residents feel at ease to raise any concerns or complaints and it was evident from records in place that these are investigated and resolved as far as possible to the resident’s satisfaction. What has improved since the last inspection? Redecoration of the lounges has been undertaken on both floors to improve the environment for the residents. Some of the bedrooms have also been decorated taking into consideration the choices of residents in regards to décor and soft furnishings so they are to their liking. The garden areas have been improved with a new pagoda as the main structural improvement. Three of the residents have grown all of the plants this year and the garden looks very attractive. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 7 Sixteen new profiling nursing beds have been approved and these are being introduced as part of an ongoing replacement to improve the facilities for those residents who need nursing care. There have been some improvements in the way activities are provided. Staff meet with residents to incorporate their wishes into the activity programme. Requests for outside visits have resulted in barge trips being organised in the Summer and professional entertainers are now incorporated into the activity programme. What they could do better: Some improvements in regard to care planning for end of life need to be made. This in particular applies to non-resuscitation where records need to be very clear how this is to be managed so the resident’s choices and wishes can be respected. Records which show the daily care of residents and how care needs are being met need to be improved. This is to demonstrate that the needs of residents are being met. Some improvements are needed in regard to medication management to ensure all medications are given as prescribed and records reflect this. Staff personal files need to contain all of the required information to demonstrate that appropriate recruitment practices are carried out to safeguard residents. A further review of social activities should be undertaken to allow for increased social interaction between residents as well as social stimulation to maintain their health and wellbeing. Senior staff need to be clear on the reporting process should an allegation of abuse be reported or observed by them. This is to ensure that in the absence of management staff, they are clear on who needs to be told and what their responsibilities are. The plans to implement detailed menus for residents should be carried out so that residents know all choices of meals, snacks and drinks available to them on a daily basis. Duty rotas need to fully reflect the staffing arrangements in place. This includes demonstrating there are sufficient nursing staff available consistently. Also showing the managers hours worked to demonstrate she is working in a supernumerary capacity to support the home. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 8 An annual quality review process needs to be demonstrated which takes in the views of residents, relatives and other interested parties to show that care and services continue to be provided to their satisfaction. 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 House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 9 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 Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 was assessed. Quality in this outcome area is good. Prospective residents receive an assessment of their needs prior to admission to ensure these can be met by staff in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents files were viewed. It was evident that each of the residents had received an assessment of their needs prior to their admission to the home. Assessment records showed key areas of need, including dependency, health and social care needs, specific medical needs, manual handling requirements and as well as potential areas of risk. Records also showed the persons past medical history so that this could be considered when writing plans of care. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 11 Where appropriate, the home also seeks information from a care management assessment undertaken by social services or other health care professionals involved in the residents care. The manager advised that in some cases where a prospective resident may have high needs, an initial care plan is also completed at the assessment stage. This helps staff to gain a full insight into the persons needs before they come into the home which helps with the provision of care. Visitors spoken to said that they were shown around the home and were provided with all the information they needed to help them make a decision about their relative staying. During the inspection prospective service users and their representatives were being shown around the home by the managers. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 were assessed. Quality in this outcome area is good. Although there are some areas for action, all residents have care plans and there is evidence the health care needs of residents are well supported. Residents are treated with dignity and their privacy is respected to maintain their wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans for three residents were read in detail during the inspection. On admission documentation is completed showing a photograph of the resident and relevant information related to the residents GP, next of kin and date of birth. Information obtained at the assessment stage is used to help develop plans of care known as “care plans”. Care plans were found to contain detailed information about the persons care needs and were generally well organised. Care plans identifying clinical needs were well documented and areas of risk were identified as well as the staff Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 13 actions required to minimise and monitor risks. Risk assessments included such areas as falls, developing sores to the skin and dependency. One resident who was asked about their care said that staff were “pretty good all round”. Another resident said “staff are very good with me”. A visitor to the home said “the care is exemplerary” and they “could not fault it”. One persons records showed they had a diabetic leg ulcer and red areas to the skin caused from the pressure of lying or sitting on these areas. These had all been documented on a “body map” indicating the location and size so that staff knew where to locate and treat them. A care plan had been developed giving staff clear instructions on how to manage these and advice had been sought from the Tissue Viability Nurse in regard to the treatment required. There was evidence that the wounds were being regularly assessed to ensure the treatment being given remained appropriate. Dressings to be used had been detailed on the assessment documentation. The resident confirmed that staff regularly came in to check on them and to change the dressings on their leg. They said they were happy with the care they were receiving and would use the call bell if they needed assistance due to their lack of mobility. To promote safety, the care plan stated that bedrails should be used and there were instructions for staff on how to ensure these were made secure when in use. A risk assessment had been developed but it was not clear that the resident had agreed to the use of these which can be considered as a form of restraint. Another resident’s care records showed that they had a pressure sore and again specific instructions on how to manage this were detailed. The care plan was dated March 2008 and it was not evident it had been reviewed since this date. It was therefore not clear if the resident still had the sore or not. A member of staff stated that the resident no longer had this sore. Some care plans seen contained instructions for specific actions to be carried out “regularly” such as “empty night drainage bag regularly”. This was discussed with the manager with a view to ensuring instructions define clearly what is meant by “regularly” so that staff are clear how often these actions need to be done. One resident’s file contained an instruction “do not resuscitate” on the front of their notes. A care plan had been compiled for “if X becomes ill or is dying” which stated that the person did not want to go to hospital in these events. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 14 This matter was discussed with the manager with a view to ensuring the homes procedures for managing this reflects the Department of Health “End of Life Care” guidance. This type of decision must be discussed in a multidisciplinary team involving the GP, the resident, staff from the home and the individual’s next of kin if needed. There should be very clear records in place regarding this and the decision needs to be regularly reviewed. This is to ensure any decisions made regarding resuscitation and care provided are made appropriately. It was evident that the home had acted promptly for a resident who had lost weight over a one-month period. Staff had been recording the weight of the resident and when the loss was noted, informed the Dietician. The Dietician advised a food supplement should be used and it was evident the resident regained the weight they had lost. This same resident had developed a chest infection in June. This was documented on the professional visits sheet in the care plan. This information had not been transferred to a care plan to show how this should be managed. It was however evident that antibiotics had been prescribed for this. One resident within the residential unit was identified to have a catheter. The care plan file for this resident did not contain sufficient instructions for carers in regards to how this should be managed. This is in regards to cleaning it and emptying the bag. Records did advise that any concerns raised by the resident should be reported to the district nurse. Records showed that this was happening. Daily records were being completed for each resident but they did not always give a full picture of the health of the resident and care interventions carried out by staff. Typical entries were “had a settled morning” “toileted as requested” or “settled night”. Significant occurrences were also documented. This was discussed with the manager with a view to information being more specific to care needs. Evidence was available to show that residents are able to access professionals when required such as their GP, tissue viability nurse, optician, dentist and chiropodist. It was also evident that residents are supported to attend hospital appointments when required. The organisation that undertakes the optical care for residents were in the home on the day of inspection and were seeing residents in one of the lounges on the ground floor. A professional survey received by us states “general day to day care is good, communication with our surgery has improved in recent months”. The systems for the safe storage and administration of medication were assessed on both units in the home. It was found that there are some areas where medication management needs to be improved. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 15 Medications are stored in medication trolleys and appropriate cupboards within clinical rooms based on each floor in the home. Cupboards were found to have minimal excess stock which is good practice and demonstrates the ordering of medication is being managed well. A fridge was available within each clinical room for the storage of medications that need to be stored below room temperature. One resident had been prescribed eye drops and these were stored in the fridge. It was found that three bottles were in use two weeks after their expiry date which was 16 June 2008. This was brought to the attention of the manager. One resident had been prescribed an antibiotic for five days use starting 25.6.08, this was indicated on the Medication Administration Record (MAR) and had been given as prescribed. The date on the medication bottle for starting it was indicated as 25.4.08. Staff stated this was an error. Tranodol capsules had been prescribed for one resident and the MAR stated one or two was to be given as prescribed. The nurse said that it was established the resident was actually taking two before they came into the home so this had been written on the MAR. Changes to the MAR should not be made unless this has been authorised by the GP. On checking the MAR it was found that four capsules had been signed for as given but there were five missing from the packet. One MAR chart had been signed both at lunchtime and teatime to state a resident had been given paracetamol. On checking the blister pack these were still in the packet for both these times suggesting they had not been given. Suitable systems for the return of unused medication were in place. Controlled drugs were being stored appropriately. A controlled drugs register was in place and had been completed appropriately to show medications received, given and remaining. Medications available were also checked and found to be correct in accordance with the register. The home has a procedure for ‘homely remedies’ but it was found that one resident who was administering their own inhalers did not have a risk assessment in place showing how they were supported in being able to do this safely. The privacy and dignity of residents was found to be respected throughout the inspection and no concerns were noted. Care plans stated actions staff should take to ensure the privacy and dignity of residents is maintained. This Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 16 included preferences for male/female staff and ensuring staff follow residents preferences when personal care is delivered. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15 were assessed. Quality in this outcome area is good. Residents have a lifestyle in the home that matches their expectations and enjoy the food provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs an Activity Organiser for 30 hours a week who plans social activities on a weekly basis. Activities that are planned are shown on an activities schedule which is displayed on a notice board as well as the door to the dining room so that residents can see what is planned. Activities provided include bingo, hairdresser, foot massage, manicure, video, quizzes, race evening, music evening by outside providers, crafts, board games and jigsaw puzzles. The Activity Organiser said that she sometimes will spend one-to-one time with residents who are less able to join in other activities and she tries to do this at least once a week. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 18 Church services are provided once a month which staff said are well attended and the manager said that arrangements could be made to support any religious needs if residents make specific requests. Records of activities undertaken showed varying participation of residents. One person for example joined in five activities in May and three in June. Residents spoken to were aware of activities taking place but had mixed feelings about joining in. One person said they went to a quiz night and didn’t know the answer to a question so asked the person beside them but they had fallen asleep. Another said that they rarely went into the lounge to socialise because there was not usually anyone they could speak to because they would be asleep. During the inspection residents were noted to sleep during periods of the day but there were also occasions when they were awake. One person chose to sit outside as it was a sunny day, another sat in the lounge and seemed content to watch the television. Many of the residents chose to stay in their rooms. All residents spoken to said there was nothing they would change about their care or the services they receive and seemed content. On the day of inspection the hairdresser was in the home so residents were busy taking their turn to have their hair done as well as see the optician who was in the home. In the evening an organ player had been arranged but they had cancelled so the Activity Organiser said she would be providing some other social entertainment instead. She mentioned that some families were very supportive on social evenings and would join in and help residents. The manager said that resident birthdays and special occasions are celebrated and the cook will make a cake and sometimes a buffet was arranged. The Activity Organiser explained that if social activities organised tended to drop in numbers she would discuss this with the residents at a meeting so they could decide if there was anything they would prefer to do. Care plans were limited in recording specific information about resident hobbies, interests and social activities they would enjoy. The manager said that this had been considered and they were trying to address this through “life story books” although not all residents/relatives were happy to provide some of the information included in these. Outside visits have been restricted as the home currently does not have access to a mini bus. The manager said that the organisation was hoping to replace the bus they used to have which would help when organising trips. A canal trip had been organised and dates were on display on the notice board for any residents interested. Care plans detailed instances when staff should ensure choices are given to residents when delivering care and services. This included times residents would like to get up and go to bed, what drinks they prefer, whether they like Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 19 a bath or shower and being able to choose their own clothes ensuring they can exercise some independence in their personal care. On speaking to residents it was evident that staff were supporting choices indicated. All residents spoken to said they were able to get up and go to bed when they wanted and their choice to stay in their rooms was respected. The manager explained that many residents had been involved in choosing how the lounge should be decorated by viewing carpet and curtain samples. Some had also chosen the soft furnishings for their own rooms. Families were seen to openly visit during the day. The kitchenette in the residential lounge was used by a visitor as their relative had missed the tea trolley due to seeing the Optician. They had to ask staff for teabags, sugar and a teapot as these were not available although a member of staff did promptly collect these. Visitors spoken to were very positive about the home and the care and support provided. They all said that staff were friendly and approachable and one said “staff are always smiling”. One person felt that the residents needed more support to be able to go on outside visits. Most residents were observed to go to the dining rooms for their lunch. Dining tables were laid with a central flower decoration, tablecloths, napkins and appropriate cutlery. Salt and pepper were also available. There was a choice of squashes or water to drink. Residents choose each day what meals they would like the following day. For lunch this is usually a choice of two hot meals or a jacket potato and salad. On the day of inspection the choices were braising steak with swede, peas, green beans, potatoes and gravy or cod fish cakes followed by stewed fruit and custard. The Meal was served from a hot trolley which is taken to each of the two dining rooms. A member of staff asked each resident individually what they would like so that they got exactly what they wanted but this was time consuming due to the number of tables to be served. One member of staff was observed to serve and other staff took the meals to the tables. Meals seen looked appetising and residents seemed to enjoy them. The manager confirmed that some of the residents required assistance to eat and these were supported accordingly. One resident said the food was “the same as anywhere else I enjoy it”, another said they liked the food. One resident said they could have cornflakes, sandwiches or what they wanted for breakfast, another said the food was “pretty good really” but “the teas at night are same menu week in and week out”. The catering manager said that each week she speaks to residents about the food to make sure that meals that are being provided are what they like. One Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 20 resident in particular had made several comments about the food and the catering manager had documented the conversations and the actions she had taken in response to the comments made. It was evident that the catering manager is dedicated to her role and to making good home cooked food for the residents. On the day of inspection there were home cooked scones and cake which were being prepared for later in the day. The catering manager advised that special diets such as diabetic and softened diets are provided and she tries to ensure these are as close to the main menu as possible. She was able to produce a “soft diet menu” detailing the meals provided and said that a sugar alternative is used for the diabetics if needed. The catering manager said she normally meets with new residents in their first week to establish their likes and dislikes. She welcomes suggestions from residents in regards to the food and said that she will always try and accommodate requests. It was not evident that residents see the full choices of meals, snacks and drinks that are available to them on a daily basis. The manager said that the home were in the process of changing over to a new menu system known as “nutmeg” which indicates to staff the nutritional content of the meals. This has impacted on the menu choices and menus were therefore in the process of review. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. Quality in this outcome area is good. Systems are in place to ensure any concerns or complaints are fully investigated and acted upon to ensure residents are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A corporate complaints procedure is in place and this clearly details what will happen if a formal complaint is made. The names and contact details of the manager, operations manager, social services and us are also documented. The complaints procedure is detailed in the Service User Guide for the home which is issued to all residents and is also available within the home. It was evident that the home has taken the positive approach of logging all concerns received so they can demonstrate actions taken to resolve these. The complaints log detailed complaints such as one person not liking how their room was decorated, records showed that the curtains in the room were replaced. There were two complaints about lost property and records showed that these items were found. One person did not like their lampshade and this was replaced. We have not received any complaints about the home. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 22 Three residents were asked if they knew who to speak to if they had any concerns, one of them replied that they would speak to the manager but the other two were not sure who they should speak to. Residents did however say that if they did report something to staff, it was always followed up and acted upon. In regards to issues relating to the safeguarding of resident’s. The home had one issue reported relating to the attitude of a member of staff. This was fully investigated by the home and actions put in place to manage this. The member of staff has since left. No safeguarding issues other than the above matter have been reported directly to us. There is a detailed policy in regards to abuse which details how this is to be managed should it be observed or reported to staff. A member of staff spoken to was able to confirm that they should report this to their manager but was less sure of what actions would then be taken. This was discussed with the manager with a view to ensuring all staff are clear on how to manage any allegations of abuse made. Staff training records showed that Protection of Vulnerable Adults (POVA) training had been completed by almost all staff within the last 12 months. This training includes training on how to recognise abuse and how this should be managed. Staff were aware that there is a whistleblowing policy and all policies and procedures were seen to be in an accessible place for staff should they need to refer to them. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were assessed. Quality in this outcome area is good. Residents live in a clean and wellmaintained environment which is comfortable and supports their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home was undertaken and bedrooms seen were clean, tidy and well presented. All bedrooms have ensuite facilities and lockable pieces of furniture to store personal belongings. The home has been subject to ongoing refurbishment and since the last inspection the lounges on both floors have been redecorated. The manager explained the residents were involved in choosing colour themes and soft furnishings for these areas. Some of the bedrooms had also been redecorated and again residents had been able to choose their own soft furnishings so that their rooms felt homely Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 24 and were to their liking. Residents are able to bring in personal possessions and one resident said they had brought in their own recliner chair because they found it comfortable. The entrance hall to the home is bright, warm and welcoming. The door has a security code and visitors are asked to sign in on arrival so staff know who is in the home at any one time. The foyer area of the home has large information boards with photographs of staff and their role in the home so that residents and visitors can identify who they are. There is also a resident information board and other information such as a copy of last inspection report, the Statement of Purpose, Service Users Guide, and booklets related to the home which visitors can access. One of the lounges on the ground floor has a kitchenette which visitors can use for refreshments. The chairs in the lounges are varied so that residents can choose which seating they would prefer and there are large screen televisions available. On the top floor there is a hairdressing room, which is used by the hairdresser who visits every Tuesday. There is also a wheel chair storage bay and the corridors are wide and spacious which gives the home an airy and open feel. The new dining rooms have a laminated wood floor as opposed to carpet which staff state they find easier to clean. The dining room on the first floor has a serving area where heated trolleys are placed. There is a small domestic fridge in this area which can be used for juice, milk and ice cream or other items needed for meals. There are bathrooms and shower rooms as well as communal toilets on each floor and there are hoists to assist residents into the bath should they prefer a bath to a shower. The garden areas looked well maintained and the Annual Quality Assurance Assessment provided by the home states that there have been three residents in particular who have taken an interest in the garden and have grown all the plants this year. The garden was in full bloom at the time of inspection and looked very attractive. Residents were seen to enjoy sitting out in the sun or sitting in the lounge next to windows looking out onto the garden areas. A tour of the kitchen was undertaken and this was found to be clean and well organised despite limited storage space. The catering manager was using wheeled trolleys to put items on to make up for lack of surface areas when the kitchen is in use. There were various areas where the paint had chipped of the walls which prevents the areas being appropriately sealed and easy to clean. It was Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 25 evident that this matter had been raised with the manager and she advised it was planned this would be attended to within the next 12 weeks. There had been delays in this being done due to the maintenance person working on other areas of the home. Cleaning schedules were in place to show the kitchen is being cleaned. Temperatures of fridges and freezers had been recorded to show that food was being stored appropriately. The laundry was viewed and this had two large driers but only two washing machines. During the last inspection it was planned that three washing machines would be provided to service the needs of the home. The manager said that they manage. This will need to be monitored to ensure there are sufficient washing facilities to support the full needs of the home. Arrangements were in place within the laundry to maintain a dirty to clean flow to ensure infection control could be managed effectively. Gloves and disposable aprons were not in the laundry so that staff could easily access these to maintain hygiene. The manager said these were in another area close by. This should be reviewed. There were no odours within the home apart from in one room, where it was established that this was due to a commode pot not being cleaned after use. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 27,28,29 and 30 were assessed. Quality in this outcome area is adequate. Staff are appropriately trained to meet the needs of residents but records do not demonstrate that policies adopted by the home are always being followed to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a manager and deputy manager for this home and the manager works in a supernumerary capacity. At the time of this inspection there were 57 residents in the home. The manager advised that they aim to have two nurses and four carers on the nursing floor from 7.30 – 2pm and one or two nurses and three or four carers on the floor from 2pm – 9pm. At night they aim to have one nurse and two carers on duty. On the residential floor they aim to have one senior carer and two carers on duty during the day and two carers at night. The manager provided a copy of duty rotas for the home for the last three weeks to confirm staffing arrangements. The review of the duty rotas confirmed that the staffing numbers as stated are being met with the exception that on some days there is only one nurse indicated to be on duty during the mornings. Rotas show this to be the case on 11, 18 and 27 June. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 27 The manager hours were not indicated on rotas seen to demonstrate the times she is available in the home and the supernumerary hours worked. Residents and visitors spoken to were positive in their comments about the staff. One visitor said staff were “always helpful” and there were “always plenty of people about”. Another said “the care is exemplerary at this home” and staff are “very helpful”. They said that they felt their relative enjoyed a “quality of life” at the home. A resident said “the staff have been alright up to now” and another said that staff were “very good”. A member of staff spoken to said that there had been a number of staff who had gone on maternity leave and they felt more staff would be beneficial for the afternoons. They felt that staffing in the mornings was sufficient. Duty rotas show that there is a catering manager or assistant chef who work in the home every day. They are supported by kitchen assistants who work up to 6pm or 7pm each day. The catering manager or chef also provide a meals on wheels service to the private flats next door to the home so the kitchen is very busy throughout the day. The catering manager was observed to be very well organised and had instigated specific routines to ensure the kitchen runs smoothly at all times. There is a housekeeper who works from Monday to Friday and there are laundry and cleaning staff who work seven days a week to ensure an effective service is provided to the residents. Staff within the home are supported to undertake training to enhance their skills. There is an active National Vocational Qualification (NVQ) Training programme for care staff and training records viewed showed that over half of the staff have achieved an NVQ qualification which is good practice. This training helps care staff to provide more effective care to the residents. In addition to this training staff also complete mandatory training which is provided on an ongoing basis. This includes fire safety, food hygiene, moving and handling and health and safety. Training records showed that nearly all staff were up-to-date with this training. Where staff were due to attend the training, the manager had identified this so they could be included on future training planned. Training records showed that staff had also accessed other training which included catheter care, pressure area care, infection control, medication and nutrition. Nursing staff said that they had also recently attended training on syringe drivers which they had found very helpful. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 28 The home is also supporting the NHS End of Life Care Programme and are looking closely at how best they can support people when they are diagnosed with a condition that will result in end of life. Work is ongoing in regards to care plans to ensure these clearly reflect how staff can support residents. New staff to the home do undertake induction training but the full details of this were not available to confirm this complies with the Skills for Care Common Induction Standards. These standards allow care staff to build up their competencies over a number of weeks to ensure they can provide effective and safe care to the residents. A review of three staff files was undertaken to confirm recruitment practices carried out are safe. Of the three files, two had an application form and two written references but one did not. As there was no application form or references it was not possible to check that the home had checked the persons past employment history to ensure there were gaps in their employment and they were suitable for the post. Criminal Records Bureau (CRB) checks had been requested as well as Protection of Vulnerable Adult (POVA) checks. It was not clear for one member of staff that the check returned related to them as there was no other paperwork in the file to cross-reference this. The manager advised that the recruitment of this member of staff was undertaken by the organisation and they therefore would have the information that was missing. It is important that the home is able to demonstrate that appropriate employment practices are being carried out at all times to safeguard residents. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 31,33,35 and 38 were assessed. Quality in this outcome area is good. The home is managed by a person of good character who aims to ensure the service is run in the best interests of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been a Registered Mental Nurse since 1979 and has worked in both NHS and private settings. She has achieved the Registered Managers Award and was registered by us in September 2007 as manager of this home. In addition to the manager there is also a care manager and administrator who both assisted with this inspection and who support the manager in the effective running of the home. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 30 The home has systems in place for monitoring the quality of care and services provided although it was not evident that a quality satisfaction survey has been sent out since the last inspection to the home. The manager advised that they hold meetings with residents and relatives and the last meeting was in December 2008. The notes of these meeting could not be located during this inspection to confirm discussions held. The manager was however able to state changes made as a result of consultation with residents and relatives. These included lounge refurbishments, new fireplaces, new televisions for some residents and new carpets/ curtains in some of the bedrooms. The manager also said that since the last inspection there has been 17 profiling nursing beds approved and they are in the process of obtaining a number of these each month. The manager said that she does a daily walk around the home and speaks to residents on a one to one basis. This allows her to identify any problems or issues that they may have and she said many residents feel more at ease to raise things directly with her rather than at a meeting. During the inspection residents spoken to were positive in their comments about the home. One person explained how staff cared for them during the day, they said “staff respond quickly” when they need assistance and “keep me informed what is going on”. Another said “staff are very good with me” and their was nothing they would change they said “I am alright thank you”. A visitor to the home said the care was “second to none” and their relative “enjoys a quality of life”. They also said they felt they could raise openly any concerns they may have if they needed to. Regulation 26 visits are undertaken, which involve a representative of the organisation undertaking a visit to the home each month to audit care and services provided. A report is then produced and sent to the manager with any actions to be carried out. Reports seen showed positive results. Comments included “All service users looked well cared for and comfortable” and “staff interacting well with service users” and on speaking to visitors, “daughter commented the excellent standard of care her mother has received in the many years she has been at Harmony House”. Formal staff supervision also takes place so that management staff can identify any staff development issues and support staff as required. Supervision schedules were seen to show how this is organised so that each member of staff receives this at least six times per year. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 31 There are suitable arrangements in place for residents to deposit their monies and all transactions managed by staff are clearly documented and receipted. Records checked for several residents confirmed receipts were in place for both deposits made and any money spent by residents such as hairdressing and chiropody. It was identified that the home provide a named receipt for the hairdresser to sign as opposed to the hairdresser providing an independent receipt with their name, address and contact details. This makes it difficult for the home to prove the receipt is actually from the hairdresser. It was advised that this practice is reviewed to ensure that there is clear evidence the receipt provided is from the hairdresser who carried out the service. It was evident that health and safety checks had been carried out as required. This included the monitoring of hot water temperatures in communal areas to ensure they operate within safe levels and prevent scald risks to residents. In addition recent checks had been made on hoists to ensure they are safe to use, gas, fire equipment and a legionella water check. Electrical portable appliances had been checked in October 07 and records confirmed these were due to be done again in September 08. Accidents that had occurred had been recorded with actions taken to manage them or prevent further occurrences. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 3 3 Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12 (2) Requirement Risk assessments for the use of bedrails must show that the resident or their representative have agreed to these being used. This is because they can be considered as a form of restraint. There must be clear records in place in regards to any resident who chooses the option of “do not resuscitate” if they are at end of life. (The National Health Service “End of Life Care” guidance states procedures that should be followed). This type of decision must be discussed in a multi-disciplinary team involving the GP, the resident, staff from the home and the individual’s next of kin as appropriate. There should be very clear records in place regarding this and the decision needs to be regularly reviewed. 3. OP9 13 (2) A review of medication management is required to ensure: DS0000065174.V371738.R01.S.doc Timescale for action 15/08/08 2. OP7 12 15/08/08 31/07/08 Harmony House Care Home Version 5.2 Page 34 Eye drops are not used beyond their expiry date. Start dates of antibiotics written on packets or bottles correspond with prescribing instructions. Dosages are not changed without clear evidence this has been agreed with the GP. Dosages prescribed are not exceeded. Medication Administration Records are not signed to say medication has been given when it has not. 4. OP29 19 Staff recruitment files need to contain all of the required information to demonstrate a robust recruitment system is in place to safeguard residents. 31/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Care records need to show that care is being regularly reviewed. This includes for example regular review of any pressure areas which service users have developed or any short term illness such as chest infections which may only need a short term care plan. 2. OP7 It is advised that instructions to staff are clear in regards DS0000065174.V371738.R01.S.doc Version 5.2 Page 35 Harmony House Care Home to time periods for care to be given (using the word “regularly” could be interpreted differently by each member of staff). 3. OP7 Records need to demonstrate that the care needs detailed are being met consistently. Daily records should be reviewed to ensure they give a consistent clear picture of the resident’s health and staff interventions being carried out. A review of social activities should be undertaken to allow for more opportunities for residents to socially interact. These also need to be more person centred to ensure the social care needs of all residents are met. Records need to demonstrate this. The plans for new menus need to be implemented so that residents know each day what choices of meals, snacks and drinks are available to them. All staff need to be fully aware of the procedures in regards to the management of abuse to ensure residents are sufficiently safeguarded. The duty rotas should have the manager’s hours indicated to demonstrate the supernumerary hours worked. The nursing staff hours planned should be met consistently to ensure the care of residents is not compromised. It is advised that gloves and aprons are made available in the laundry so these are easily accessible to staff. A system should be set up to monitor whether the two washing machines in place are sufficient to manage the volume of laundry effectively. Commode pots should be cleaned after use to maintain effective hygiene practices. The plans to address the chipped paintwork in the kitchen now need to be carried out. This is to ensure all surface areas can be kept clean effectively. Staff files need to show staff induction training completed and demonstrate staff competencies in line with the Skills for Care Common Induction Standards. DS0000065174.V371738.R01.S.doc Version 5.2 Page 36 4. OP12 5. OP15 6. OP18 7. 8. 9. 10. OP27 OP27 OP26 OP26 11. 12. OP26 OP26 13. OP30 Harmony House Care Home 14. OP33 An annual quality monitoring system needs to be demonstrated which takes in consideration the views of residents and their representatives on the care and services being provided. An outcome report should be produced showing how any issues raised have been addressed to support the needs of residents. Harmony House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 House Care Home DS0000065174.V371738.R01.S.doc Version 5.2 Page 38 - 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. 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