Inspection on 22/02/06 for Harmony House Care Home

This inspection was carried out on 22nd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Harmony House Care Home 01/07/08

Harmony House Care Home 06/07/07

Harmony House Care Home 22/05/06

Harmony House Care Home 29/09/05

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

CARE HOMES FOR OLDER PEOPLE Harmony House Care Home The Bull Ring Chilvers Coton Nuneaton Warwickshire CV10 7BG Lead Inspector Jackie Howe Unannounced Inspection 22nd February 2006 09:30 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.V279047.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 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.V279047.R01.S.doc Version 5.1 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 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) Ashbourne (Eton) Limited Mrs Barbara Moir-Bussy 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.V279047.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th and 30th September 2005 Brief Description of the Service: Harmony House is situated close to Nuneaton town centre and the George Eliot Hospital. The home is owned by Ashbourne Ltd. Harmony House is a purpose built care home and is registered to provide care for 57 elderly residents. The home is not currently registered for the provision of specialist services. The single room en suite accommodation is situated on two floors. The service provision on the ground floor is for those people who may require assistance with personal care. Whilst the first floor service provision is for those who may require nursing care, qualified nursing staff are available at all times on this unit. Access to the first floor is via passenger lifts/stairs. Garden/patio areas are accessible to all residents including those with limited mobility who require wheelchairs. Harmony House Care Home DS0000065174.V279047.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 7 hours and was unannounced. This was the second inspection of the year 2005/06. The inspection was undertaken with the care manager in the manager’s absence. The inspection included a tour of the home, discussions with staff residents and relatives, accessing records, policies and procedures and reading care plans. During the inspection six staff, five residents and two relatives were spoken with. What the service does well: What has improved since the last inspection? The manager and her staff have worked hard at improving the accuracy of the care plans and recording of relevant health care treatments. Harmony House Care Home DS0000065174.V279047.R01.S.doc Version 5.1 Page 6 Procedures for the storage and safe administration of medication have significantly improved but there are still some omissions noticed in recording. Surveys have recently been conducted to gather opinions of residents and their relatives, of the services provided, but the results of these are yet to be formulated and made available. 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 House Care Home DS0000065174.V279047.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Harmony House Care Home DS0000065174.V279047.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 There is a clear, consistent needs assessment in place that adequately provides staff with the information they need to satisfactorily meet service user needs. EVIDENCE: Three completed needs assessments of residents admitted to the home were read. The care manager generally completes the assessments, and these are thorough and meet the required standards. Care management assessments for those residents referred by social services are obtained, but the care manager always undertakes her own assessment, in order to supplement the information. The needs assessment of a new resident of a minority ethnic group and with limited English, showed that staff had identified alternative communication methods, and had reviewed her needs in a very individual way. Information gained from the assessment is used to formulate a care plan, which is then used to guide staff in the best ways to care for each individual. Harmony House Care Home DS0000065174.V279047.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 The care needs of the residents are met, with personal care being delivered in the way they prefer, and needs are accurately recorded in the care plans. Considerable improvements have been made in the management, administration and recording of medication, since the last inspection; but the home does not always adhere to its own medication policies and procedures resulting in poor practice that has the potential to place residents at risk. EVIDENCE: Since the last inspection staff have worked hard to introduce care plans for each individual person, which identifies their own individual, needs. Areas identified for improvement have been achieved and accurate records are now kept of wound care. Advice on wound care is available from visiting district nurses, and the care manager is booked to attend a tissue viability course in March. Harmony House Care Home DS0000065174.V279047.R01.S.doc Version 5.1 Page 10 Care plans currently in use are generated by the initial assessment based on assessed needs and risk assessments. The care plan documentation, which is pre written, is then put in place. Previously, this had not been reviewed to identify care for each individual resident. Reviews and assessments have now taken place, and additional, more personal needs have been identified. New care plans due to a change of ownership, will be introduced slowly into the home over the next year. Procedures for the safe administration, storage and disposal of medication have improved, but omissions were still noted on the medication administration record (MAR) sheet. Medication stocks checked, indicated that medication had been administered, but a lack of recording puts residents at risk. The requirement made at the previous inspection has not been fully met and the care manager is aware that this needs immediate action. The medication policy is accessible to staff, as a copy is kept in the clinical room. One member of staff was unaware of the policy for disposal of deceased residents’ medication. Residents who choose to do so are able to take responsibility for their own medication. Lockable facilities are provided and a risk assessment is undertaken and reviewed. Disposal of medication is undertaken safely following correct procedure, but oxygen no longer in use by the home is currently still stored. It is recommended that this be returned. The manager and care manager audit the medications weekly. Controlled drugs are administered on both of the units, and stocks are held separately and within correct guidelines. Both units use a bound register and stocks checked on both units were found to be correct. All staff administering medication have received appropriate training from an external training source. Harmony House Care Home DS0000065174.V279047.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 The residents’ lifestyle experience in the home matches their recreational, social, cultural and religious interests and needs. The also home ensures that residents’ maintain contact with their family and friends and have choice and control over their life. Consequently they have a good quality of life. EVIDENCE: The home employs an activities organiser, and residents spoke positively about the activities they were able to attend. A display board informs residents and their relatives, about forthcoming events. These included monthly summer canal boat trips; sing a longs, pub visits, dominoes, quizzes and a forthcoming spring fair. Regular church services are also held in the home. Local clubs and the Bedworth Civic Hall are used for social nights. Resident’s birthdays are celebrated with handmade cakes and a teatime party There was a constant flow of visitors to the home, bringing dogs and babies, and friends to visit, bringing a buzz of activity to the home. A private lounge is available for relatives to visit in comfort apart from their bedroom. Harmony House Care Home DS0000065174.V279047.R01.S.doc Version 5.1 Page 12 Staff greeted relatives positively. Resident’s confirmed that their relatives and friends were made to feel welcome. A gentleman visiting said that he was able to visit his wife and spend all day with her if he chose to do so, and that the home was hospitable to him. Residents spoken with confirmed that they were able to exercise a level of choice over their lives, in regard to their routine, attendance at activities, where they spent the day, and what they had to eat. One lady said to me that she was able to eat anything she wanted. ‘I’m a bit choosy, but there is always something for me.’ The cook confirmed that residents have input into the menu, and it is often revised to include a requested meal. Residents are free to bring in to the home any personal possessions with them. One resident spoken with said he was really happy with his room, which contained his own television, video player and a large selection of films he enjoys. Harmony House Care Home DS0000065174.V279047.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Complaints are taken seriously and acted upon, but a lack of concise recording and monitoring, makes it difficult for interested people to assess how complaints are investigated and if they are upheld. Staff have an understanding of the prevention of abuse, which has the effect of providing a suitable protective environment for residents. EVIDENCE: The complaints procedure is thorough and is displayed in the service users guide, which is held centrally in the reception of the home. The complaints procedure is explained to residents on admission, but residents do not receive an individual copy of the procedure, and as some residents are not able to freely get around the home, some may not be able to access the procedure. Complaints have been received and responded to, but not all complaints had been recorded on the complaints record, and no information was kept to show if complaints had been upheld or not, or how investigations into complaints had been conducted. The manager should keep an accurate record of all complaints received in order to monitor where there is dissatisfaction with the service, and to be able to identify where improvements can be made. All complaints received are currently sent to the organisation to monitor and offer guidance to the staff in the home. Harmony House Care Home DS0000065174.V279047.R01.S.doc Version 5.1 Page 14 Residents and relatives spoken with confirmed that they did not feel a need to complain, but if they did felt confident their complaint would be listened to. Staff are aware of adult protection issues and have received training in recognising and responding to abuse. The care manager said she had not had to refer anyone under the Prevention of Vulnerable Adult (POVA) regulations. A thorough in house training pack is used to induct staff, and this is reviewed with staff if required. Some staff have also been able to access external training courses. The home has procedures for staff to follow and offers a free confidential phone line for staff to report allegations or raise concerns. The home currently does not have a copy of the Department of Health ‘No Secrets’ document. Residents spoken with, said they felt safe at the home. Harmony House Care Home DS0000065174.V279047.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: Whilst these standards were not fully assessed, a tour of the home showed that the home is well maintained and provides a homely environment for its residents to live in. Rooms including communal rooms, bedrooms, and toilet / bathrooms, are clean and odour free. Garden areas are well maintained and accessible by all. Harmony House Care Home DS0000065174.V279047.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 Staff are provided with good training opportunities and generally this training is put into practice to enable staff to competently meet the needs of residents. EVIDENCE: The home has a very good training record with a considerable amount of the training being given by the care manager using training packs devised by the company. Staffing records indicate that staff are inducted according to the required standards and receive training in the required mandatory areas of Health and Safety, Fire safety, Manual handling, Basic Food Hygiene and recognising and responding to signs of abuse. A significant number of staff have received training in Health and Safety, Manual Handling and Fire safety in the last year, and a number of other courses are advertised and free for staff to attend, including dementia care. The home is within the required standards of staff attaining an NVQ award in care. Harmony House Care Home DS0000065174.V279047.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35, 36, 38 Systems for the management of residents’ finances ensure that their interests are safeguarded. Staff have not received formal supervision addressing the necessary specifications and at the required intervals. Systems for the management of health and safety are satisfactory. EVIDENCE: Very few residents choose to keep their own money, but those who do so are given lockable facilities. Harmony House Care Home DS0000065174.V279047.R01.S.doc Version 5.1 Page 18 Most of the residents make use of the homes safe. Money is held individually, and individual written records are kept. Records are kept of all possessions held for safekeeping, A recommendation was made at the last inspection that a programme of staff supervision be implemented. Discussion with the care manager and records accessed showed that this had not developed in the way the manager had anticipated, and there were no records of supervision available for inspection. Meetings with staff are held regularly, and the ‘handover’ is used by the care manager, to guide and support staff in their care practices. A lack of recorded supervision does not allow the manager to demonstrate that her staff are appropriately supervised, and that staff are confident to care for residents appropriately. The home holds a Health and Safety policy for maintaining safe working practices, and as previously mentioned staff receive regular training on safe working practices. The home employs someone to maintain the home, so that the health and safety of the residents and staff in the home, as far as reasonably practicable, is ensured. A monthly health and safety audit is undertaken by the manager, targeting areas of the home, and a regular health and safety committee meeting is held with all department heads including a representative from night duty. Minutes of the last meeting were read, and items for discussion included safety during floor cleaning, fire alarms and evacuation, the use of bed rails, and safety of wheel chairs. Health and safety is also discussed as part of the weekly management meeting. Harmony House Care Home DS0000065174.V279047.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 2 X 3 Harmony House Care Home DS0000065174.V279047.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 13 Requirement Timescale for action 22/02/06 2. OP33 24 3. OP36 18 The registered manager must make arrangements for the safe recording and administration of medicines in the care home. (Previous timescale not fully met) The registered manager must 01/04/06 forward a copy of the results of resident surveys to the commission and make these available to current/prospective residents. (Previous time scale not met) The registered manager must 01/06/06 ensure and be able to demonstrate that all staff receive supervision six times a year. These records must be maintained and available for inspection. Harmony House Care Home DS0000065174.V279047.R01.S.doc Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP9 OP14 OP16 OP18 Good Practice Recommendations The inspector recommends that oxygen cylinders stored in the home but no longer in use are returned. The inspector recommends that information on how residents or their family or friends, can access advocacy services, should be displayed. The inspector recommends that the home develops a system to show how complaints received have been investigated and if they have been upheld. The inspector recommends that the home obtains a copy of the DoH ‘No Secrets’ document. Harmony House Care Home DS0000065174.V279047.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Harmony House Care Home DS0000065174.V279047.R01.S.doc Version 5.1 Page 23 - 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. 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