Inspection on 21/02/06 for Harper House

This inspection was carried out on 21st February 2006.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Harper House 16/02/07

Harper House 10/11/05

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

CARE HOME ADULTS 18-65 Harper House Harper House 2 Cathcart Road Stourbridge West Midlands DY8 3YZ Lead Inspector Debbie Sharman Unannounced Inspection 21st February 2006 10:00 Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Harper House Address Harper House 2 Cathcart Road Stourbridge West Midlands DY8 3YZ 01384 441469 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) Miss Gail Louise Harper Mrs Nicola Stevens Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th November 2005 Brief Description of the Service: Harper House is a large detached property, located in a residential area of Stourbridge. It is within close proximity of Stourbridge Ring Road. The location enables residents to access local amenities and facilities and also neighbouring towns. The home is registered to provide care for a maximum of five younger adults, all of whom have a varying degree of learning disability. There is a small drive to the front of the property and there is parking available on the road. There is a neat garden that is well maintained. The garden has mature shrubs and trees. There is a lounge and dining room on the ground floor. Resident’s bedrooms are all located on the first floor. The home offers two shared and one single occupancy rooms, which do not have en-suite facilities. Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector carried out this inspection. The inspection, which began at 10.00am and finished at 2.00pm, was unannounced. Unannounced inspections do not provide the home with the opportunity to prepare. However on this occasion the proprietor/Manager was given 1.5 hours notice of the Inspector’s arrival. This was to ensure a presence at the home as a previous inspection had to be rearranged as upon arrival all staff and service users were out. The plan for this inspection was to assess four core Standards not assessed at the previous inspection and to also assess progress made towards meeting requirements issued for improvement at the last inspection. The Inspector was able to interview the proprietor/Manager, a service user and a visiting relative. Documentation was also assessed and the Inspector conducted a brief tour of the internal premises. Since the last inspection the Registered Manager has resigned so the proprietor is Acting as Manager with a view to becoming the permanent manager. An application has been forwarded to the Commission for Social care Inspection for registration. The Manager, staff and service users made the Inspector welcome and thanks are extended to all those present. What the service does well: The new proprietor has demonstrated her commitment to improving the premises. Since taking over thermostatic valves have been fitted to water outlets, a new boiler and fire alarm system has been provided. New bedding has been provided along with new flooring and furniture in the lounge and dining rooms. Radiators have been covered too to prevent the risk of burns to service users. A service user spoken to likes living at the home, is appreciative of the choices and freedoms available to him. He enjoys having showers when he wants to and is able to take responsibility for the things that are important to him giving him a new sense of satisfaction. This he said makes him ‘happy’. He also ‘likes his bedroom very well’. A relative spoken to is very happy with the service provided and appreciates recent improvements. She feels that under the new management service users are going out more. She said that her relative at the home didn’t go out before ‘but now he goes out several times a week’. She added ‘it’s like home from home. I can come and go as I please. It’s the next best thing to home. I’ve found no complaints. Service users are clean and well dressed’. Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Environmentally the kitchen and bathrooms need upgrading as they are now worn and outdated. Damage to décor in the hall when fitting radiator guards needs attention and décor up the stairs and on the first floor landing needs updating. However these issues are all to be addressed with the proposed extension. Records and the storage of records require some improvement. For example some records for all service users are kept in one file for convenience when they should be held in individual files appertaining to the service users they are in respect of. Similarly supervision records for all staff members, which are confidential, were held on one file and were being stored on the office desk instead of being locked away on individuals’ files. There are some omissions in care planning. For example systems are not in place to assess or respond to service users identified nutritional need and potentially this compromises health. Continence needs are not included, the Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 7 regularity of health screening is not specified and record keeping in respect of health appointments is inconsistent. Systems used to record and monitor health appointments must be reviewed to provide better accountability and to facilitate monitoring. Medication is not included in the plans of care and behaviour plans whilst detailed, do not provide guidance to staff in the event of escalating behaviours not responding to diffusion strategies. Behaviour plans similarly do not include guidance in respect of medications administered as required to support behaviour management. This does not safeguard service users or staff members. A reportable incident involving a service user, which was reported appropriately to, the Commission for Social care Inspection was not sufficiently recorded in care records. The method of recording incidents therefore must be reviewed to ensure better accountability. None of the care staff have an NVQ qualification. The home has therefore fallen short of the national target for 50 of staff to be appropriately qualified by the end of 2005. However all staff have been enrolled and are due to start in April 2006. The home must begin to programme courses for staff that will provide them with specific knowledge about service users conditions and disabilities as well as general mandatory training. Quality assurance systems where the home assesses its own performance and responds to its findings have commenced but not yet been completed. The contract between the home and service users has been reviewed which is pleasing but there are some omissions remaining, which mean that it currently does not meet the national minimum standard. 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. Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 5 Individual contracts outlining most but not all aspects of terms and conditions are available and have been issued. EVIDENCE: Contracts were assessed as the need for improvement had been previously identified and progress was assessed at this inspection. Minor omissions remain which need addressing in order for performance to fully comply with the required standard e.g. the room to be occupied, arrangements for reviewing need and elements of the care management plan, which are to be provided outside of the home. The contract is also not in an accessible format with no evidence of how efforts had been made to explain the contract to the service user. Representatives however had signed it on service users behalf. Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These Standards were not assessed separately but during the course of the inspection some omissions in care planning were noted and these are described in the summary at the beginning of this report. Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Service users rights and responsibilities are generally recognised and respected in their day-to-day lives. EVIDENCE: A service user spoke positively of changes under the new management, which have provided him with several freedoms that, he values. He also said that he could have showers everyday when he feels like it. He is happy with how his mail is managed and has unrestricted access to the grounds. In fact lighting has been provided in the gardens and in his shed recently to promote his accessibility, enjoyment, freedoms and safety. He described how he helps with some domestic tasks and inferred that he would like to be more involved. He commented that he would like a key to his bedroom and although this presents complications in a shared room, the Acting Manager said that she would address this. The service user said his main concern was not being allowed down for a drink the previous night after retiring to bed. Inspection of care records did not refer to his request for a drink but the Acting Manager confirmed that it is usual for him to want a drink. A care plan must be in place to support free access to drinks at all times of the day and night and systems to monitor this must be in place. Preferred terms of address are not noted in Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 12 care plans but from observation staff were heard to be abbreviating service users names. This should be reviewed with service users and their preferences noted and adhered to. There was recorded evidence that staff have been advised that service users wishes in respect of the time they retire to bed must be respected. Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Some health needs are met but improved systems to better manage and monitor health needs and appointments will support improved outcomes for service users. EVIDENCE: Systems are not in place to assess or respond to service users identified nutritional need and potentially this compromises health. Weight records for example show that all service users have put on either approximately half a stone or a stone in weight since the new provider has taken over. The relative spoken to had noticed this and was delighted. However systems are not in place to judge whether these are acceptable outcomes for each service user and for one service user an increase in weight is not desirable. Continence needs are not included in care plans. Also the required frequency of health screening is not specified in care plans and record keeping in respect of health appointments is inconsistent. There was evidence that service users have received dental care and eye tests. There is also evidence of good support provided by community nurses. The Manager said that two GPs support service users at the home well. The Manager said that she has requested a referral for chiropody care but this could not be evidenced. There was no evidence in care records that a service Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 14 user had been supported to attend an appointment sent by letter for cancer screening. Records for the day of the appointment were read and there was no reference to the appointment at all. It is therefore not known whether the service user attended and cooperated with the screening or whether a repeat appointment is required for example. Systems used to record and monitor health appointments must be reviewed to provide better accountability and to facilitate better management and monitoring. Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These Standards were not assessed at this inspection. A service user and a relative said that Harper House is a safe place to be. Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These Standards were not assessed at this inspection but improvements to the environment have been referred to in the summary at the beginning of this report. Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 36 Service users are not supported by qualified staff. The Manager has begun to establish a culture of supervision but its style and content must be improved in order for service users to directly benefit. EVIDENCE: A service user spoken to said that he liked most staff and that most staff are good listeners. He didn’t however feel that staff always enjoyed coming to work. The Manager could consider carrying out a survey of staff satisfaction as part of the quality assurance programme to take steps to assess the validity and or extent of this. The Manager feels that the home has a good working relationship with partner agencies including GPs, nurses, social workers and day centres. The Manager is aware of the need to provide training for staff in specific knowledge areas such as mental Health Awareness, challenging behaviour training and epilepsy awareness training. Behaviour care plans demonstrate that there is an understanding that physical and verbal aggression is a way of communicating needs and frustrations and staff have signed these plans to evidence that they have read and understood this. None of the care staff have an NVQ award, which falls below the national standard expected but all staff are enrolled to begin in April 06. No staff are under the age of 18. Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 18 It was a previous requirement to commence formal supervision for staff and therefore progress was assessed. Each staff member has had two recorded supervisions with the manager since November 2005. This is a pleasing start. The plan is for senior staff to become responsible for supervising care staff. The structure and content of supervision however must be reviewed to reflect the function of supervision as currently it does not meet the Standard, is brief, repetitive and more resembles an appraisal. The Manager agreed that she and senior staff would benefit from training to provide a greater understanding of the function of supervision and to develop the required supervision skills. Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 Self-assessment by the home is not sufficiently in place currently to assure service users that their views underpin all self-monitoring and development. Minutes of service user meetings however evidence a good degree of consultation with service users. EVIDENCE: The proprietor has purchased a quality assurance tool to be completed annually that is detailed and appears to reflect the national minimum standards. The proprietor completed it in respect of Harper House at the end of 2005 and it would appear from its conclusion that there are few if any omissions in the homes performance. Satisfaction questionnaires have been sent out to relatives and one (not dated) has been returned which showed a good level of satisfaction across a range of performance areas. All aspects were scored as ‘good’ which was the highest score option available. Service users have not yet been asked to provide Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 20 formal feedback as part of the homes quality assurance system but the Manager is aware of the need for this and said it is planned. A service user commented that he didn’t feel that staff always enjoys coming to work. The Manager could consider carrying out a survey of staff satisfaction as part of the quality assurance programme to take steps to assess the validity and or extent of this. There is not an annual development plan for the home based upon the aims and outcomes for service users but the Manager stated her intention to do this upon the completion and return of all satisfaction questionnaires. Two residents meetings have been held by the new proprietor and are well documented. They show a good level of consultation with service users about for example food, personal care, the allocation of key workers, the presence of a dog in the home etc. Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 1 33 X 34 X 35 X 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 2 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 2 X X X X 2 X X X X Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA5 Regulation 4 Requirement Omissions identified in the revised contract must be addressed. New Requirement at February 2006. Care plans must include all aspects of assessed need e.g. continence, diet, nutrition, frequency of health screening, medication, as required medication (based upon medical advice) and preferred terms of address as agreed with service users. Behaviour care plans must include guidance on the use of ‘as required’ medication for the management of behaviour for the protection of service users. Behaviour care plans must provide guidance in the event of diffusion strategies not being effective. Timescale for action 30/04/06 2 YA6 15,13(6) 16(1)(i) 31/03/06 Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 23 The provision of drinks to service user ‘D’ throughout the night must be included in plans of care and monitored. New Requirement at February 2006. The provision of keys to 31/03/06 bedrooms must be reviewed with keys provided to service users where they are requested. Any restrictions preventing this must be accounted for in plans of care. 3 YA16 12 4 YA17 New Requirement at February 2006. 17(1)(a) Systems to identify and support Sch3(3)(m) nutritional need must be implemented. New Requirement at February 2006. The Manager must confirm in writing to CSCI with timescales for completion how she will ensure that 50 of the staff will become qualified to NVQ level 2. Staff must be provided with training in: • • • Mental Health Awareness Challenging Behaviour training Epilepsy awareness training 31/03/06 5 YA32 18 31/03/06 6 YA35 18 New Requirement at February 2006. The Manager and senior staff must receive training to provide knowledge and skills in relation to the functions of supervision. New Requirement at February 2006. DS0000064200.V283916.R01.S.doc 31/05/06 Harper House Version 5.1 Page 24 7 YA36 18(2) The format of supervision must be reviewed and improved to meet National Standard 36.4 New Requirement at February 2006. The results of the quality review audit should be included in the service user’s guide. Requirement first made November 2005 and is not met at this inspection. However the timescale provided had not expired at the time of inspection. Records maintained in respect of service users (e.g., health / weights) and staff (supervision) should be held individually and not communally to maintain confidentiality. Staff supervision records must without delay be locked away to maintain confidentiality. Systems used to record and monitor service user health appointment outcomes must be reviewed to ensure they are accurate, effective and efficient. Formats for recording incidents must be reviewed to ensure greater provision of information and accountability. New Requirement at February 2006. 30/06/06 8 YA39 35 30/03/06 9 YA41 17 28/02/06 Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 25 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 Refer to Standard YA35 YA39 Good Practice Recommendations The home should develop a staff-training matrix for all staff working at the home. The Manager should consider seeking feedback about satisfaction from staff as part of the quality assurance system. Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Harper House DS0000064200.V283916.R01.S.doc Version 5.1 Page 27 - 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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