Inspection on 29/09/05 for Harmony House Care Home

This inspection was carried out on 29th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

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 22/02/06

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 Louise Thompson Unannounced Inspection 29th/30th September 2005 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.V255933.R01.S.doc Version 5.0 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.V255933.R01.S.doc Version 5.0 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.V255933.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 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 Care Homes. 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.V255933.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection and took place over two visits. Staff co-operated fully with the inspection. The manager was present throughout the inspection. The inspection process involved the following: a tour of the home, talking with the manager and her deputy, examining records and care plans and other information provided by the manager prior to the inspection. Observation of care practices along with discussions with residents, staff and relatives who were visiting on the day of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Some care plans need further review to ensure that they are up to date so that the staff are able to know what to do for each resident and ensure that individuals care needs are met. Harmony House Care Home DS0000065174.V255933.R01.S.doc Version 5.0 Page 6 The recording of medicines needs improvement to minimise the risk of errors in the administration of medicines. An immediate requirement was made with regards to this at the time of inspection. 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.V255933.R01.S.doc Version 5.0 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.V255933.R01.S.doc Version 5.0 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): These standards were not assessed at this inspection. EVIDENCE: Harmony House Care Home DS0000065174.V255933.R01.S.doc Version 5.0 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): Standards 7, 8 9 and 10 Minor changes to care plans are needed to provide the staff with the necessary information to meet individual residents needs. Health needs of residents are met with evidence of liaison with health and social care professionals on a regular basis. The shortfalls in the medication administration records potentially leave the residents at risk. Personal support is offered in such a way as to maintain residents’ privacy and dignity. EVIDENCE: The home has recently introduced new care documentation and staff have worked hard to implement this for all residents. The records of four residents were observed during this inspection. The quality of the assessment and care plans was generally satisfactory. Harmony House Care Home DS0000065174.V255933.R01.S.doc Version 5.0 Page 10 Records for one resident with difficult and challenging behaviours contained minimal evidence of the behaviours being exhibited and the care plan recording how staff should deal with this was limited. Advice was being sought from the psychologist. One file observed contained a core care plan for nutrition due to an assessment, which indicated a high risk. This care plan was unsuitable to meet the resident’s needs as the resident was being fed via a PEG and was nil by mouth. The care plan recorded the need to encourage snacks and drinks between meals, menu choices and portion sizes etc. Good risk assessments were observed on each of the files with ongoing review. Access is available to health professionals outside of the home, which includes the Chiropodist, GP, Psychologist, Tissue Viability Nurse and the Dentist. Care files viewed showed involvement of members of the multidisciplinary team in assessing and meeting residents’ care needs. Wound care charts for one resident were incomplete and it was not possible from the information available to determine the grade, size and location of wound and to track treatments. However there was evidence on file of liaison with the Tissue Viability Nurse Specialist with regards to the management of this wound. Systems for the management and administration of medications were observed and the following issues were discussed with the manager. • Errors in medications transcribed by hand. Dosage and frequency of administration was omitted. Some medications indication for prn usage is incorrect. E.g. indicated that an antidepressant should be administered for stomach upset. Not all medications prescribed as required (prn) clearly specified the reason for administration. Controlled medication of one resident was not administered in accordance with prescription. Errors with administration records of resident who was in hospital. Medications crossed off on MAR sheet. No date given for discontinuation of medication. Unable to audit changes in care records. • • • • An immediate requirement was made during the inspection with regards to medications. The manager has provided the commission with a suitable action plan to address these issues prior to the completion of this report. Throughout the inspection it was observed that staff knock on residents’ doors, offer choices and ensure that all personal care and consultations are conducted in private, this assists in maintaining the residents privacy and dignity. Residents told the inspector that they were very well cared for and that staff were very kind and helpful. Harmony House Care Home DS0000065174.V255933.R01.S.doc Version 5.0 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): Standard 13 and 15 People living in this home are supported to maintain family links and friendships and continue to be part of the local community in which they live. Dietary needs of residents are well catered for with a balanced and varied selection of food available that meets residents’ tastes and choices. EVIDENCE: There are no restrictions placed on visiting unless requested by residents. Four of the residents said that visitors are welcome at any time and that family and friends can arrange to take meals with them when visiting should they wish. Relatives of one newly admitted resident said that they were made to feel welcome by the staff and were given information about visiting. Several of the current residents continue to access the local town and its facilities. Staff were supporting one resident to obtain a motorised scooter to enable him to continue to be part of the local community. The inspector ate lunch with the residents. The meal was tasty and nicely presented. The dining room tables were attractively laid and staff were readily available to assist residents where necessary. Harmony House Care Home DS0000065174.V255933.R01.S.doc Version 5.0 Page 12 Residents said that they enjoyed the meals and that choices were available. The manager said that menus and catering services have recently been reviewed and improvements made. The catering staff visited residents during the meal to obtain their opinion of the meal that lunchtime. Harmony House Care Home DS0000065174.V255933.R01.S.doc Version 5.0 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): These standards were not assessed at this inspection visit. EVIDENCE: Harmony House Care Home DS0000065174.V255933.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 19 and 26. The standard of décor and furnishings is good with evidence of ongoing planned improvement and maintenance. The home presents as comfortable and homely for residents. EVIDENCE: The home is a purpose built care home providing single en suite accommodation for residents. There are lounge and dining areas on each floor. A garden is provided to the rear of the home and some residents said that they like to spend time in the garden in the summer months. The standard of the décor, fittings and furnishings are good .The manager said that there is a planned programme of redecoration and ongoing refurbishment. During the inspection the home was clean and free from offensive odours. The laundry was not observed at this visit but was assessed as satisfactory at a previous inspection. Harmony House Care Home DS0000065174.V255933.R01.S.doc Version 5.0 Page 15 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): Standards 27 and 29. The number and skill mix of the staff is sufficient to meet the needs of the residents. Staff appear committed and have personal qualities that are important to the residents. The procedures for the recruitment of staff are satisfactory and protect the residents. EVIDENCE: Duty rotas seen for the period of a month demonstrate that staffing is maintained within previously agreed levels. Staff do additional shifts to cover for sickness and annual leave. A small number of staff are working in excess of 48 hours per week. The manager said that she monitors these staff to ensure that they are fit and able to continue to work longer hours. Staff and residents told the inspector that the staffing levels were suitable to meet current care needs of residents. The inspector examined the records of four staff members, which included those who had recently been appointed. Each file contained evidence of suitable CRB checks, references and all other information as required by the standard. Harmony House Care Home DS0000065174.V255933.R01.S.doc Version 5.0 Page 16 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): Standards 33 and 36. The quality management systems in this home are developing, with evidence that residents’ views are being sought and acted upon. A suitable system for staff supervision is being implemented to ensure that staff has the support, skills, practices and knowledge to meet all of the residents needs. EVIDENCE: The manager and staff are currently implementing a corporate quality assurance system and have commenced an annual plan of audits. Evidence was seen of the audits already undertaken and action planned as a result of these. Audits undertaken include: infection control, care plan and medications. Harmony House Care Home DS0000065174.V255933.R01.S.doc Version 5.0 Page 17 The manager said resident and relative meetings are usually held twice yearly. Views of those using the service are encouraged with comment cards available. The manager said that she was looking to develop a questionnaire to obtain resident and relative feedback. Residents and three relatives visiting at the time of the inspection said that they were happy with the quality of the service and one said, “Nothing is too much trouble for the staff.” Observation of records and discussion with the manager demonstrate that some staff supervision is taking place. The manager said that this is being developed further with the introduction of new corporate documentation and the home was aiming to achieve a minimum of six supervisions each year for care staff. Harmony House Care Home DS0000065174.V255933.R01.S.doc Version 5.0 Page 18 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X 2 X X Harmony House Care Home DS0000065174.V255933.R01.S.doc Version 5.0 Page 19 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 15 Requirement The registered manager must ensure that the care plans are current and accurately record each residents, health, social and personal care needs. The registered manager must ensure that accurate records are maintained of wound care and treatment provided. The registered manager must make arrangments for the recording, safe administration and disposal of medicines received into the care home. Issues identified in the main body of this report must be actioned. The registered manager must forward a copy of the results of resident surveys to the commission and make these available to current/prospective residents. Timescale for action 28/02/06 2 OP8 17 Schedule 3 13 31/01/06 3 OP9 01/10/05 4 OP33 24 28/02/06 Harmony House Care Home DS0000065174.V255933.R01.S.doc Version 5.0 Page 20 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 Refer to Standard OP7 OP8 OP36 Good Practice Recommendations The inspector recommends that core care plans are individualised to each resident’s specific needs prior to their use. The inspector recommends that wounds are assessed and information recorded on site, grade, size and appearance in line with good practice guidelines. The inspector recommends that the staff in the home receive formal supervision at least six times a year and that all the areas listed in the standard are included in the process. Harmony House Care Home DS0000065174.V255933.R01.S.doc Version 5.0 Page 21 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.V255933.R01.S.doc Version 5.0 Page 22 - 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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