Inspection on 14/09/07 for Harnham Croft Nursing Home

This inspection was carried out on 14th September 2007.

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 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

Harnham Croft Nursing Home 09/12/05

Harnham Croft Nursing Home 24/06/05

Harnham Croft Nursing Home 10/01/05

Harnham Croft Nursing Home 13/07/04

Harnham Croft Nursing Home 12/03/04

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

CARE HOMES FOR OLDER PEOPLE Harnham Croft Nursing Home 76 Harnham Road Salisbury Wiltshire SP2 8JN Lead Inspector Susie Stratton Unannounced Inspection 14th September 2007 9:45 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 Harnham Croft Nursing Home DS0000015915.V345395.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. Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harnham Croft Nursing Home Address 76 Harnham Road Salisbury Wiltshire SP2 8JN 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) 01722 327623 01722 334983 www.bupa.co.uk BUPA Care Homes (CFC Homes) Limited Mrs Nicola Maguire Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44), Physical disability (4), Terminally ill (4), of places Terminally ill over 65 years of age (4) Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users who may be accommodated in the home at any one time is 44. No more than 4 service users with a terminal illness may be accommodated at any one time No more than 4 service users between the ages of 18 - 65 years with a physical disability may be accommodated at any one time. The staffing levels set out in the Notice of Decision dated 31 March 2005 must be met at all times. 19th May 2006 Date of last inspection Brief Description of the Service: Harnham Croft Nursing Home was first registered as a nursing home in 1947; it was renovated and extended in 1978, 1989, 1993 and a further extensive renovation was completed in 2003. The original building was built in 1898. Accommodation is provided over 3 floors and the grounds extend down to the River Nadder, with views looking towards Salisbury Cathedral. The home is registered to care for 44 persons. At the first site visit, there were 36 persons resident in the home. Some registered double rooms were also being used by single people, so there were in effect two vacant rooms, one of which was booked. The home is owned by BUPA, a national provider of care homes. The manager of Harnham Croft is Mrs Nicky Maguire, she is supported by a deputy and leads a team of registered nursing and care staff. An activities organiser and a team of ancillary and administrative staff are also employed. The home is situated on the main road in Harnham, which is on the outskirts of the city of Salisbury, about a mile from the city centre and three quarters of a mile from Salisbury District Hospital. There is a bus stop immediately outside the entrance and ample parking is available on site. The fee range is £600 per week to £1,179 per week. Items not included in the fees are hairdressing, chiropody, newspapers and telephones. Copies of the service users’ guide are available in the front entrance area and all residents are also given their own copy in their room. Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included visits to the service and takes into account the views and experiences of people using the service. As part of the inspection, 40 questionnaires were sent out to residents and their relatives and 17 were returned. Comments made by residents and their relatives in questionnaires and during the inspection have been included when drawing up the report. The home submitted an annual quality assurance assessment prior to the inspection; this document provided much information to inform the inspection. As Harnham Croft is a larger registration, the site visits took place over two days, on Friday 14th September 2007 between 9:45am and 3:35pm and Thursday 20th September 2007 between 9:30am and 12:45pm. The registered manager, Mrs Nicky Maguire, was on duty for both site visits. During the site visits, the inspector met with ten residents and observed care for nine further residents for whom communication was difficult. The Inspector reviewed care provision and documentation in detail for six residents. As well as meeting with residents and visitors, the inspector met with the deputy manager, three registered nurses, five carers, the activities coordinator, the chef, a catering assistant, two domestics, the laundress, the maintenance man and an administrator. The inspector toured all the building and observed the lunch-time meal and an activities session. A medicines round was observed and systems for administration of medicines and the clinical room was inspected. A range of records were reviewed, including staff training records, staff employment records, maintenance records and financial records. What the service does well: Harnham Croft is a well-maintained building, which has large rooms and extensive views over the water meadows to the rear of the building, looking towards Salisbury Cathedral. The home is stepped back from the main road and is screened from traffic noise by mature trees. One person reported “It exceeds expectations in terms of its glorious aspect”. The home has an active activities programme for residents who wish to be involved. Meals are regarded as a central part of service provision and the chef meets with all new residents. BUPA has recently reviewed all its menus to ensure that they conform to the principals of healthy eating. Mealtimes are social occasions and frail people are supported to maintain independence and to have as normal a diet as possible. The manager regularly reviews service provision, including full investigation of all complaints and issues of concern. She performs Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 6 unannounced visits to the home throughout the 24 hour period, to ensure that the home runs effectively when she is not on duty. Residents and their supporters expressed their appreciation of service provision. One person reported “We are content here”, another “This is a good home”, another “I’m sure as homes go, it’s the best in the area”, another “I think it’s one of the best homes & I’ve been in a few” and another “I was put in an awful home before, not like this one.” People also expressed their appreciation of staff, one person reported “The staff are absolutely brilliant”, another “I must say that staff are always most respectful and willing”, another “The senior staff are very friendly and helpful” and another “I do think the night staff are very good”. What has improved since the last inspection? What they could do better: Two requirements and ten recommendations were identified at this inspection. All care plans must be evaluated and up-dated when a resident’s condition has changed, so that staff can be fully informed of actions needed to meet the resident’s needs. The home should set up a system for audit of frequent care records, so that any deficiencies can be promptly identified and action taken to Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 7 improve staff performance. Care plans relating to the use of thickening agent should state the consistency of the fluids needed for each person. The home should provide more hoists, to improve their availability to staff and residents. All staff must at all times conform to company policy on the administration of medicines, including signing when medicines have been administered and where a resident is prescribed a variable dose of a medicine, documenting how much of a medicine the person has been given. The home should further develop care plans relating to residents’ medication, so that the effectiveness of the drug treatment can be assessed. All topical applications should be labelled with the resident’s name, to ensure that they are used only for the named resident. The home’s statement of purpose should be developed to provide more detail on types of nursing and care need catered for, the home’s skills base in providing such nursing and care and the actual numbers of staff, and skill mix, aimed for each shift. Staff files should be reviewed to ensure that there is a clear photograph of each member of staff on file, where a photocopy of a passport or driving licence is not clear, a further photograph should be obtained. The induction for agency staff should be in writing and signed by the inductee and inductor. All notifications of bruising or skin tears to residents should be documented in the accident book as well as their individual records. Accidents to residents should be reviewed in writing on a regular basis, to identify any trends and reduce risk. 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. Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 8 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 Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 9 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): 1 & 3. The home does not admit for intermediate care, so 6 is N/A Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents have information provided to them about services offered and careful assessment of their individual needs is performed, so that the home can ensure that the person’s needs can be met. EVIDENCE: All residents and their supporters have copies of the home’s service users’ guide available in their rooms. The guide complies with guidelines. Of the ten people who responded to this section of the pre-inspection questionnaire, nine reported that they had received enough information about the home before admission. One person reported “My relatives took me to see several homes and I selected this one as it appeared well positioned – overlooking river and water meadows, comfortably furnished lounge”, another “My doctor sent my relative to the home and we are very pleased he is there” and another My Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 10 daughter did a lot of research while I was in hospital and felt that this was the best of all.” As the home regularly admits people for terminal care and respite care, the information systems would be improved if more information was provided of the home’s service provision and skills base in these areas. Information on staffing numbers would also improve information systems, so that people could be made aware of how many staff and their skills base are planned for each shift. The home have introduced new pre-admission assessment documentation since the previous inspection. The information format is comprehensive and all records inspected had been completed in detail. One resident reported on the extent of the detailed information gained from them and that a full history of all their past medical needs was obtained, as well as other matters, to ensure that the home could care for them. The home strives to develop working links with local healthcare providers, to ensure that they receive full information about prospective residents’ healthcare needs prior to admission. One resident commented on how they were impressed that the home had ensured that they had had the type of bed that they needed provided to them. Another resident reported that when it had become clear that they had needed a profiling bed, that this had been provided within 36 hours of their admission. All staff spoken with showed a very good knowledge of newly admitted residents’ nursing and care needs and reported that if matters where identified shortly after admission, which had not been available at admission that they could report this and that action would be taken to ensure that individual residents’ needs were noted and addressed. Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 11 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): 7, 8, 8 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents’ health and personal care needs are met, with staff showing a good knowledge of individual nursing and care needs. Some improvements are needed in documentation, as some staff are not following all the homes’ procedures to ensure that residents nursing and care needs can be met. EVIDENCE: The home has introduced a new record-keeping system for assessments and care plans since the previous inspection. All residents are assessed for risk, such as manual handling, falls, pressure damage or nutritional need. Where risk is identified, care plans are developed to direct staff on how risk is to be reduced. For example one resident had a history of falls, which was made more complex for them by sight loss. Their records showed that they had had an assessment for risk of falling and there was a clear and individual care plan, which took into account all their individual needs, to direct staff on how risk of falling was to be reduced. Another resident had specific needs relating to Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 12 dietary intake, they had a clear assessment about their dietary risk and a care plan about how their individual needs were to be met, including use of aids to assist them in independence. Some residents with swallowing problems needed thickening agent in their drinks to enable them to swallow safely. Where this is the case, it is advised that the actual thickness of the drink be documented, to ensure that the resident is fully supported and their needs and individual wishes taken into account. Some of the residents at Harnham Croft are very frail and have monitoring charts in place, to ensure that they have their positions moved at the regularity indicated in their care plans and are offered regular fluids. Fluid intake is totalled daily and there was evidence that relevant action had been taken if the person found it difficult to take in adequate amounts of fluids. Nearly all turn charts had been fully completed, to show that the person had had their position changed at the regularity directed in their care plans. There were a few occasions where this did not take place, but it was not frequent. It is recommended that a monitoring system is set up to identify the few occasions where charts were not completed correctly, so that appropriate management action can take place. There was a variability in evaluations where residents’ nursing and care needs had changed. For one person, their needs had changed and their care plan had been promptly reviewed. However for two other people whose conditions had deteriorated, although staff spoken with clearly knew about the situation and their daily record fully reflected their current care needs, care plans had not been drawn up to reflect how their current needs were to be met during the day. For both these people, the night staff had reviewed night care plans at night and these fully reflected their current needs. As one person now had a urinary catheter in place, this should have been documented, with directions on how day care needs in relation to this catheter were to be met. Another person had clear directions in their daily record about management of a flexion contracture but as this had been made several days previously in their daily record, the instructions would be lost in the other information and not available to direct staff on actions to take. One person had clear directions in their care plan about the use of topical applications, but another who had topical applications in their en-suite, had no directions on their use. Discussions with a range of staff indicated that they were very aware of the individual needs of residents and were following information given to them by more senior staff. For example one person who needed thickening agent in their drinks was observed to always have such agent added to all their drinks and to the same consistency. Staff reported they were aware of when and how to pass on more relevant information. Of the seventeen people who responded to this section of the pre-inspection questionnaire, six reported that they always, ten usually and one sometimes received the care and support that they needed. Comments included “I’d never been handled before, they made Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 13 a joke about it and helped me through and I really like the girls now”, “They do keep a very close check on you” and “They look after me very well”. A review of records and discussions with both staff and residents indicated that the home promptly called in residents’ GPs if resident’s conditions changed. Two GPs were visiting the home on the day of the first site visit, at the request of staff. It was clear that there was an effective relationship between staff and external healthcare professionals. For example, records and discussions with staff showed that the home were working with external professionals to ensure that a dying resident could be cared for in the way that they wanted at the end of their days. Where a resident has a wound, there were standard monitoring systems in place to review how the wound responded to treatment. There was also clear evidence that the home had sought support from the tissue viability nurse for a person with a complex wound care need. Staff were observed to knock on residents doors and await a response, prior to entering. All personal care was performed behind closed doors. GPs visits took place in privacy and the GPs were observed to discuss new treatments with registered nurses away from public areas. All residents had been left with their call bell to hand. Residents were addressed by their preferred name, thus one person was called by their title and surname and another by their first name, according to which they preferred. With the new documentation, the home is gradually introducing systems for consultations with relatives, where the resident is not able to self-advocate. The home appears to be midway through this process. This was reflected in responses to questionnaires, where some relatives felt that feedback was not sufficient and others felt that it was, for example “I am never given any info unless I phone and ask to visit” as opposed to “If you pop into the office action is taken.” All drugs and medicines are securely stored and there are records of medicines brought into the home, given to residents and disposed of from the home. Where a resident wishes to self-medicate, risk assessments are drawn up and regularly reviewed. Controlled drugs are correctly stored and full records maintained. The temperature of the medicines refrigerator was regularly reviewed and records maintained. Where medicines administration instructions were made by hand, these were signed and counter-checked. Where a person was administered a variable dose of a medicine, a record was generally made of how much of the medicine they had taken but this did not take place on every occasion, as is stated in the home’s medicines policy. A medicine round was observed during the inspection and the registered nurse was noted to perform the round in a safe manner, ensuring that the drugs trolley was secured when she could not directly observe it and she only signed for the medicine after the resident had taken the medicine. The registered nurse did not rush residents to take their medicines and was kindly and supportive of those residents who needed more time. It was particularly noted as good practice that as the medicines round took place at lunch-time the registered nurse left the trolley away from the dining room, so that it did not Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 14 intrude on what was a social occasion. However some staff are not performing medicines administration to the same standard. It was noted that there were twelve uncompleted medicines administration records, so it was not possible for the home to assess if residents had been given their medicine or not. The home’s policy and procedure states that this must take place, so management must advise registered nurses of their responsibilities in this area and that they must always follow the home’s policy and procedure on administration of medicines. The home is developing care plans relating to use of medication, some of which are clear and assist in analysis of effectiveness of treatment. However others are basic and limited and do not yet do more than state basic prescriptions and do not identify areas for observation of response to treatment. Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 15 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): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The home works hard to ensure that residents are given choices about how they would like to spend their days, including choices at meals. High standards are shown at mealtimes in the support of frail persons. EVIDENCE: Harnham Croft employs an activities coordinator, who is highly motivated in her role. All residents have care plans drawn up about their individual and recreational needs. These documents are varied, according to an individual’s abilities and wishes. For example one resident’s first language was not English, although records showed that their English comprehension was good. Their care plan directed how the person was to be supported, to ensure that any language difficulties were minimised. The activities coordinator does not yet fully complete day-to-day records about resident’s individual involvement in activities; this was because she was awaiting training in the new documentation system. Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 16 The activities coordinator provides all residents a list of proposed activities for the week. She shows a flexible approach, being prepared to visit residents who do not wish to come down to the sitting room in their rooms, as well as providing group activities in the communal areas. Residents expressed their appreciation of activities, one reported “I do all of [the activities coordinator’s] things” another [the activities coordinator] “keeps us all busy”. Residents commented on different activities, including crosswords, scrabble, poetry reading and craft events. Other residents commented on the current “virtual” Mediterranean cruise, which they said they enjoyed. Some residents reported that they did not wish to join in and that this was respected. At least two residents commented on how they liked the outside areas of the home and enjoyed sitting out there whenever they could. Harnham Croft is on a road on the outskirts of Salisbury and its position was reported to be convenient for visitors, who could visit when going into or out of town. Several visitors were in the home on the day of the inspection and all residents reported that their visitors could come when they liked. Many residents went out regularly with their visitors. The home does arrange trips out, but many of the residents are frail and prefer activities to come to them. Some visitors found the seating in the hallway useful, here they could have a drink and a chat together if staff were providing care for their relative or if they needed a period of time away from being with an unwell resident. One relative reported that they appreciated that “They answer the phone quickly here – they don’t keep you waiting”. Residents reported that they could choose if they went down to the communal rooms or not, one reported “I can eat in my room when I want” and another “I prefer time in my room but I do go to the dining room if I want”. One person reported that they appreciated that staff understood how they liked to spend their day, saying “I like to be up by breakfast, sitting at my table and they know that.” As would be anticipated in a large home, there were a wide range of views expressed about the meals. Of the twelve people who responded to this part of the questionnaire, two reported that they always, seven they usually, three sometimes and none never liked the meals. Comments varied through “Very unimaginative”, “Certain days the food is a bit mixed” to “The food is allright”, “Often late and barely warm” to “I enjoy the meals very much”, “The food is always hot and well presented” and “I enjoy the meals thoroughly and I used to be a keen cook”. Many people commented on the chef, one reporting “If I don’t like something, I see [the chef] and tell him & he does something about it” and “I enjoy the food, if we have difficulties, [the chef] is very good in trying to put it right.” The chef is clearly part of the team. Unlike many other care homes, he meets with all residents as soon to their admission as possible, to ensure that he can meet their needs and will continue to meet with them as often as they wish. One resident commented on how they appreciated being able to ask the chef to fill up their bowl of fruit whenever they wanted. Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 17 BUPA has undertaken a process of reviewing all its menus, to ensure that they are complying with principals for health eating and the chef showed detailed knowledge of the principals of health eating. He is currently, following a residents meeting, reviewing the evening menus. All residents are given a weekly menu to complete and the chef is happy to provide a different alternative on the menu, including at short notice if the person wishes. All resident have individual care plans drawn up about their dietary needs and preferences. These are individual in tone. It was noted as good practice that very few liquidised meals were used and that as far as possible, residents were supported in taking in a normal diet for as long as they could manage it or if they were unwell for a period, returned to a normal diet as soon as possible. Where a resident spent all or most of their time in bed, this did not mean that they were automatically put on a liquidised diet, as happens in some homes. Staff spoken with understood the importance of dietary intake and ensuring independence when eating. A full range of feeding aids were supplied, these were non-institutional in appearance. Where residents needed assistance to eat, staff sat with them, supporting them and making it a social occasion. The three registered nurses on duty on the day of the first site visit, were very much in evidence throughout the whole of the lunchtime, supporting carers where residents had difficulties and ensuring that the meal was a sociable occasion and ran smoothly. Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 18 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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents are protected by the home’s polices and procedures, which work in practice, this ensures that their complaints are listened to and abuse prevented. EVIDENCE: Harnham Croft has a complaints procedure, which is available to all residents in the service users’ guide, a copy of which is available in each residents’ room. It is also on display in the main entrance area. Of the seventeen people who responded to this section of the questionnaire, fourteen reported that they knew how to make a complaint. Several people reported that they would rely on relatives to raise issues on their behalf. One person reported that their relative had raised issues directly with BUPA, that they had received correspondence and met with a senior manger. One person reported “I demand to see the manager and she comes up”, another person said about the manager “If something needed sorting out, she would” and another “Since we spoke about time taken with the call bell, response isn’t too bad.” One complaint has been made to the CSCI since the last inspection. It was passed on to BUPA for consideration. The matter was fully investigated by BUPA and where they identified issues, an action plan was put in place. Compliance with the action plan was monitored during regular monthly visits Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 19 by a senior manager. The home also maintains a log of complaints made directly to them. A review of this log shows that the home are complying in full with their own policy and procedure on complaints. It was noted as good practice that issues of concern, as well as complaints, are managed in the same way. In a large organisation like a care home, it is likely that people will at times feel that service provision is not as they want and the home are showing a positive response to residents’ needs by investigating all concerns and taking action were it is found that service provision can be improved. There are management systems in place to ensure that all staff are regularly trained in abuse awareness. Staff at all levels showed an awareness of the importance of the area. For example the laundress knew how important it was for residents to wear their own clothes and have clothing promptly returned to them. This was demonstrated during the inspection where residents were observed to wear their own clothes. During the inspection, the Inspector was very politely addressed by two carers, who wished to assure themselves that the Inspector was permitted to be in the home and perform the work that she was doing. This is regarded as good practice in ensuring security, but unfortunately is not often observed. Staff at more senior levels knew how to report issues of concern relating to vulnerable adults. No safeguarding adults referrals have been made about this home since the last inspection. Where residents need restraints, such as safety rails or lap belts, full risk assessments are drawn up. These are regularly reviewed. Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 20 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): 19, 22 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents have the benefit of a clean, well maintained environment where investment is being progressed in equipment to meet the needs of people with disability. EVIDENCE: BUPA ensures that the building is well maintained and regularly up-graded when needed. The manager reported that a major refurbishment is planned for the next financial year. The maintenance man maintains very clear records, which shows that all areas are regularly attended to. He was observed to be available to staff throughout the two site visits, attending to matters promptly, when needed. Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 21 As Harnham Croft is an older building, many of the rooms were different from each other, enabling each room to reflect each resident’s likes and preferences. Accommodation is provided over three floors with two passenger lifts in between. One of the lifts was not working at the time of the first site visit and the home were awaiting delivery of a new part. At the back of the building, the home looks out over extensive views towards Salisbury Cathedral, several people commented on this, one person described the view as “lovely” and another as “wonderful”. The home supports residents in bring in their own possessions. One resident said how much they liked having their own chair from home with them. A married couple had been provided with a double bed. A range of equipment is provided to meet residents’ diverse needs. The home have been gradually investing in more profiling beds. However not all residents with complex manual handling needs or those who had swallowing difficulties were provided with beds that could be easily adjustable. While all the divan beds can have their heights adjusted, this is not easy to do while giving care. The manager reported that this matter has been identified and is to be addressed during the next financial year when a range of further profiling beds will be supplied to the home. The home has a range of aids and slings to assist residents who are not able to move themselves. They have one standing hoist and one full lifting hoist. Both hoists do fit into the lift. However having only one of each type means that if a resident is using one of these lifts, another resident on a different floor will have to wait, even when there are two staff available to perform the procedure. Several people felt that the home took time to answer call bells and meet immediate needs (see standard 27 below) and if more appropriate hoists were provided, residents might feel that they did not have to wait so long for assistance. Harnham Croft was clean throughout. Of the eleven people who responded to this part of the questionnaire, five reported that the home was always, five usually and one sometimes, clean and fresh. One resident reported “There isn’t any dust – I’ve checked”. Cleaners were observed performing their roles. They were careful, vacuuming behind and under objects as well as round them. They reported that they had a good supply of cleaning chemicals, equipment and protective clothing such as gloves. All communal bathrooms and sluice rooms were clean, with wipable walls and all potentially contaminated items was properly handled and disposed of. The laundry was clean and tidy, even mid-morning, which tends to be the busiest time in a care home. The laundress showed an awareness of prevention of spread of infection and reported that staff complied in full with company policies and procedures on separation of laundry. Some residents were prescribed or used topical applications; some of these applications were labelled with the resident’s name but not all. No topical applications were observed to have been left in bathrooms. As good practice, to reduce any risk of communal use of creams, all topical applications should be labelled with the resident’s name. Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 22 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): 27, 28, 28 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents are supported by committed, well-trained staff. Issues relating to staffing or performance have been identified by the managers and actions taken to develop service provision. EVIDENCE: Harnham Croft works on the basis of a set number of staff and skill mix on duty every shift. At least two registered nurses are always on duty. Of the ten people who responded to this section of the questionnaire, two reported that there were always, six usually and two sometimes staff available when they needed them. Most of the issues raised related to the amount of time it took when residents rang their bell to receive attention. One reported “My main complaint is the time it takes usually to get attention after ringing the pager” another “Long time for bell to be answered” One person felt that this related to “There are very few staff to look after so many disabled people” another one to the use of agency staff who they reported “wander about” and another to equipment availability, reporting “Sometimes when calling for a hoist for the toilet I have to wait an hour as there is a shortage of hoists.” The providers are aware of these comments and concerns and have taken a range of steps to address them. The home has an automatic recording system for response times when the call bells are used, this is regularly reviewed by the deputy Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 23 manager at different times of day and she investigates and issues identified and makes a report. There was evidence that all complaints made by residents or their supporters about response times to the call bells had been followed up. All people in charge of a floor now carry bleeps, which alert them if a bell has been ringing for more than three minutes, so that they can investigate. All residents spoken with confirmed that staff were helpful when they did ring their bell. One person reported “Staff are helpful when they come, they apologise that they can’t come to see to you immediately” and another “They come when I ring and are very helpful when I do”. Staff at all levels showed a keenness to support residents. A catering assistant was observed to suggest to a resident that they might be safer if they moved away from the very edge of the bed and a newly employed cleaner was observed to be helpful to a resident who wanted something in particular to be done. It was observed that many of the residents knew staff by their first names. One person commented on this, saying that they appreciated the way that “Staff like you to call them by their first name”. Harnham Croft has a core of staff who have worked in the home for many years. However like many homes, there is also a turnover, mainly of some staff from overseas who decide to return to their own country after a period of working aboard; occasionally they do that at short notice. Agency staff are being used. At present the annual quality audit showed that only agency registered nurses are being used. The manger reported that an active recruitment process was being undertaken and she was hopeful that nearly all the vacant hours would be filled shortly. Staff reported that training is supported by the provider organisation. One resident reported “Staff are always being trained”. All staff have individual training profiles and these show the range of training offered by the home. Different staff lead on different areas, for example one registered nurse leads on continence and cascades information to staff. The home is supportive of NVQ training. Currently, due to the turnover in staff, under 50 of carers are trained to NVQ 2 or equivalent. The manager has identified this as an issue and has an action plan in place to address this with the newly employed carers. All staff receive BUPA’s standard induction programme to support them when they commence employment. It was reported that agency staff also receive a brief induction, however this is not in writing and it is advisable that it all agency staff receive a written induction, which they and the inductor sign and date, to confirm that this has occurred. The files of nine members of staff were reviewed, six of whom had been newly employed. All people are asked to complete an application from or submit a cv. All staff have two references, one of which is from their most recent employer. All staff have police checks. Where any issues are identified, there is an established system within BUPA for assessing risk to residents managed Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 24 by BUPA’s human resources department. All staff have proof of identity on file, including photographs. However some of the photographs are copies of passport or driving licence photographs, and for some people, these copies are not clear enough to provide a positive proof of identity. All staff files should be reviewed and where photographs are not clear, a new photograph sought. All staff complete a health status questionnaire and where issues are identified, further information is obtained. Staff are interviewed using an interview assessment tool and there was evidence that any gaps in employment history are probed. It was noted as good practice that the home is prepared to employ people with a disability. Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 25 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): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. People are protected by the management systems in the home, which ensures that quality of service provision is regularly assessed and that principals to ensure health and safety are up-held. EVIDENCE: The manager of the home is an experienced registered nurse and manager. She has gained the managers’ award. There is evidence that she has maintained her skills base in a range of areas, both managerial and nursing. She is supported by an experienced deputy, who covers for her in her absence. The manager regularly reviews service provision, for example on the night before the site visit, there was evidence that she had performed an Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 26 unannounced night visit at 2:30am, to assure herself of quality of service provision at night. This is regarded as very good practice and is unfortunately not routinely performed in many other homes. A review of staff files showed that the manager is prepared to take effective action to improve staff performance when indicated, within BUPA’s standard procedures. Clear records of any such meetings are maintained. The manager is also happy to meet with people to improve service provision. For example on the second site visit, the manager was meeting with the relatives of one resident to explore how service could be improved for them. The manager produced a detailed and clear annual quality audit to inform the inspection. This quality audit identified areas for improvement and action place for addressing. For example the home are seeking to develop the evening meals service. BUPA undertakes standard internal quality assurance reviews of service provision, including infection rates and pressure ulcers. The home is also regularly visited by a senior manager who makes a report on service provision. At the most recent relatives meeting, another senior manger attended to receive residents’ relatives’ views on service provision. BUPA regularly sends out questionnaires for residents, relatives and other interested parties to complete. Where issues are identified, the manager develops an action plan to outline how matters will be addressed. BUPA has standard systems for management of residents’ money. No cash is held and all resident’s personal moneys are in the form of computerised accounts. Full records of all additional payments, such as hairdressing or chiropody are maintained, such charges are debited from the individual computerised accounts. The administrator has a system for contacting relatives when residents’ individual accounts are becoming low and need more funds. All accounts are regularly audited by auditors from BUPA. There is a full audit trail for items handed in for safekeeping. The home has a system for supervision of staff, which works in practice. One registered nurse described how she supervised the performance of staff on her floor when she was on duty and how she identified and managed any shortfalls. As noted in Standard 15 above, registered nurses are always available at mealtimes, to ensure that residents receive the help they need at that time. The manager was observed to spend much of her time in the home, away from her office, supervising service provision. One person reported “We see the manger frequently” and another “The manger and deputy both come round, they’re lovely ladies.” Records of supervision are maintained. Staff also reported that if they felt they needed more support, they could approach any of the registered nurses, the deputy or the manager. The manager maintains a matrix to ensure that all staff are regularly trained in areas relating to health and safety such as fire safety, manual handling and infection control. This was observed to work in practice during the inspection, where staff were observed to perform safe manual handling and be aware of Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 27 practice to prevent spread on infection. All safety warning signage was in place, for example where residents were prescribed oxygen, safety warning signage was on their room doors and all oxygen cylinders were safely secured. The maintenance man maintains very clear records of his safety checks. It was noted as good practice that fire safety checks are at a standard higher than required by the local fire brigade. Where a member of the ancillary staff is under eighteen or a member of staff is pregnant, a health and safety assessment is completed. The home maintains accident records. The home’s health and safety committee meets quarterly. At this meeting accidents and ways of reducing risk are discussed. Accident records were clear and the manager audits every accident. It was noted that while accidents such as trips and slips were documented in the home’s accident book, accidents such as skin tears or bruising, while they were clearly documented in residents’ records were not always documented in accident records. It is recommended that this always takes place, to ensure that the manager is aware of all such accidents to residents. She will then be in a position to review in writing all accidents regularly, to identify any trends and take action if indicated. Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 28 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 3 X 3 Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 29 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2)(b,c) Requirement All care plans must be evaluated when relevant and up-dated when a service user’s condition has changed. All staff must at all times conform to company policy on the administration of medicines. Timescale for action 31/10/07 2. OP9 13(2) 31/10/07 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 OP1 Good Practice Recommendations The home’s statement of purpose should be developed to provide more detail on types of service user nursing and care need catered for, the home’s skills base in providing such nursing and care provision and the actual numbers of staff and skill mix aimed for each shift. The home should set up a system for audit of frequent care records, so that any deficiencies can be promptly identified and action taken to improve staff performance. DS0000015915.V345395.R01.S.doc Version 5.2 Page 30 2. OP7 Harnham Croft Nursing Home 3. 4. 5. 6. 7. OP7 OP9 OP22 OP26 OP29 8. 9. 10. OP30 OP38 OP38 Care plans relating to the use of thickening agent should state the consistency of the fluids needed for each service user. The home should further develop care plans relating to residents’ medication, so that the effectiveness of the drug treatment can be assessed. The home should provide more hoists, to improve their availability to staff and residents. All topical applications should be labelled with the resident’s name. Staff files should be reviewed to ensure that there is a clear photograph of each member of staff on file, where a photocopy of a passport or driving licence is not clear, a further photograph should be obtained. The induction for agency staff should be in writing and signed by the inductee and inductor. All notifications of bruising or skin tears to service users should be documented in the accident book, as well as their individual records. Service users’ accidents should be reviewed in writing, on a regular basis to identify any trends and reduce risks. Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Harnham Croft Nursing Home DS0000015915.V345395.R01.S.doc Version 5.2 Page 32 - 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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