CARE HOMES FOR OLDER PEOPLE
Harrison House Liverpool Road South Maghull Liverpool Merseyside L31 8BS Lead Inspector
Mrs Trish Thomas Unannounced Inspection 16th December 2005 10:00 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 Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Harrison House Address Liverpool Road South Maghull Liverpool Merseyside L31 8BS 0151 526 4133 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) suep@parkhaven.org.uk Parkhaven Trust Mrs Carole Michaels Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Service users to include up to 24OP. Variation for 1 named out of category service user under pensionable age. The service should employ a suitably qualified and experienced Manager who is registered with the CSCI. 24/08/05 Date of last inspection Brief Description of the Service: Harrison House is a care home for 24 Older People. The home is situated on the Parkhaven estate and is surrounded by extensive and well-maintained gardens. Harrison House is owned by Parkhaven Trust and the registered manager is Mrs. Claire Burgess. The home block contracts six placements for respite beds with Sefton Social Services. In addition there are eighteen permanent places in Harrison House, which are not included in the contract. The home provides twenty-four hour care and social support, single accommodation, full board and a laundry service. The home is situated in a residential area, close to bus routes and with shops and restaurants in the general area. All permanent residents are registered with a G.P. referrals are made to district nurses and paramedical services in accordance with need. Staff are in the process of training to a minimum of NVQ2, in Direct Care, and undertake further training in Moving and Handling, Food Hygiene, First Aid and Medication Administration. There are three ground floor bedrooms with a passenger lift to upper floors, where the remainder of bedrooms are situated. Those who are admitted to the home on a permanent basis are encouraged to bring possessions with them to personalise their bedrooms. The home is furnished in a comfortable style and is well maintained. There is level access to the garden from the main lounge and this is a beautiful setting, which is enjoyed by residents of this home. Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The methods used in this un-announced inspection were, discussion with residents, the manager and staff, direct observation and reading care, personnel and health & safety records maintained in the home. What the service does well: What has improved since the last inspection?
The majority of requirements from the last inspection have been addressed. Under standards 7 and 15, Regulations 15 and 16 (as to care planning and meals), remedial action required in the last inspection, has been started but not yet completed. Due to the consultation and work involved in meeting these requirements, they are repeated with extended time limits in this report. There were 18 permanent residents, (no residents receiving a respite service) at the time of this inspection. Two members of staff have been transferred from another home owned by the organisation, and staff in Harrison House appeared to be less under pressure to cover absences on the roster, than had been observed during the last inspection. The manager, Mrs. Claire Burgess, has been approved as registered with CSCI since the last inspection. There are plans for a conservatory and additional ground floor toilet this year. Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4 The home was meeting standards 3 and 4. Professional assessments and home’s assessments are carried out for residents who are admitted to the home. Since the last inspection, staff have attended a positive dementia care course. EVIDENCE: Reference was made to four care files and discussion took place with the manager. There are two types of referral to the home, those for permanent care and those for short respite breaks. Professional (social work) assessments and home’s assessments, were contained on care plans. There were no respite residents at the time and the files which were read, were those relating to permanent residents. The manager confirmed that assessments are faxed to the home for respite referrals by the social worker. Mrs. Burgess said that she then makes her decision as to the suitability of the home, for that individual, and will refuse admission if the resources in the home are not adequate to meet assessed needs. The manager does not have the opportunity to assess residents referred to the respite service, prior to their admission, as respite services are often arranged at short notice.
Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 9 She expressed awareness of the need for accurate written professional assessments to ensure that the home’s resources can meet the needs of respite residents, alongside those of permanent residents. For residents to the permanent service, home’s assessments are carried out prior to admission, and the prospective resident has the opportunity to visit the home before making the decision to move in. The manager confirmed that since the last inspection, training in dementia care has been arranged for staff, through a local college. This is in response to the needs of residents who may display behaviour associated with early stages of dementia. Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The home was meeting standards 8,9,10. A shortfall was noted regarding standard 7, as there is scope for further development in care plans, regarding support for residents’ mental health needs. Care plans have been transferred to a revised format and were stored in residents’ bedrooms, with a copy held in the main office. Permanent residents are registered with a local G.P. and respite residents have access to a G.P. when living in the home. Management of residents’ prescribed medication was satisfactory at the time of inspection. The home was meeting the standard relating to residents respect and privacy. EVIDENCE: Reference was made to a sample of care plans, standards were discussed with the manager and residents commented. The manager said that residents’ care plans are stored in their bedrooms. These are in addition to the office copies used for staff reference. Care plans which were read, included assessments, detailed plans of care, review dates and included signatures of those concerned. One very elderly resident who is physically frail, maintains her mobility with staff support, and takes part in social events in the home. Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 11 Staff have now received training in positive dementia care and there is scope in care plans for development (as relevant) of support for the presenting behaviour associated with short-term memory loss and confusion. A requirement from the last inspection is repeated with extended time limit given. There was evidence on care plans that residents receive a G.P. service and have access to health services in general. The home provides training for care staff who administer medication and there is a written medication procedure. Residents’ prescribed medication was secure and records were satisfactory at the time of inspection. Five residents who commented said the care was good, and expressed no concerns regarding respect for their privacy or staff of conduct in general. Staff were observed speaking respectfully with residents and there was evidence to suggest that residents’ privacy is respected through bedroom and bathroom doors being kept closed and records being secured. Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The home was meeting standard 12. There are measures to enable residents have the lifestyle which is in accordance with their preferences and expectations. The home was meeting standard 13 as residents retain contact with family, friends and the local community. The home was meeting standard 14, as residents are enabled to make choices through care plans, reviews and residents’ meetings. Standard 15. A shortfall was noted as developments in catering were in the development stage at the time of this inspection. Menus were under review and consultation with residents as to their preferences was continuing. EVIDENCE: The manager said that the home has an activities programme, which is recorded. Local school children and their teachers were giving a carol concert in the lounge during the inspection, and residents were joining in. One lady said she loves to see the children and hear their singing. She said that Christmas is for children and it is good to see their excitement. Another resident said that there had been a Christmas party the day before and she had a wonderful time. The building had been decorated for Christmas and residents said they thought everywhere looked beautiful. One lady said that no one is forced to take part in activities and that if she wants to stay in her bedroom or go out, that is what she does.
Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 13 There is a residents’ notice board where useful information is displayed and residents have access to independent advocacy services if necessary. The respite service has been established in partnership with the local authority, to help residents to return to their own homes after a short-stay in Harrison House, often following personal crisis or a period of illness. Residents said they have visitors and may entertain them in the lounge or in their bedrooms. Residents’ religion/non belief, diet and some social background are recorded in their individual care plans. These are held in residents’ bedrooms and they attend reviews and residents’ meetings and are consulted as to their diet preferences. Mrs. Burgess said that management of all aspects of catering is now within her control, having been transferred from an outside contractor. She said that menu content was currently under review and consultation with residents ongoing. A minor shortfall is noted until such time as developments are complete and meals are demonstrably to the satisfaction of residents. The requirement from the last inspection is repeated with extended time limit given. The manager gave examples of the breakfast choices provided, cereals, toast, cooked breakfast, grapefruit/ prunes, juices. The food stores were well stocked and storage areas and the kitchen were clean and well organised. The dining room provides a relaxed and beautiful setting for meals and the dining tables were well-presented. Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The home was meeting standards 16 and 18 regarding complaints and protection. EVIDENCE: The home has a complaints procedure, which is made available to residents and their representatives. There have been no complaints to CSCI regarding Harrison House, in the past 12 months. The home has a procedure for protection of vulnerable adults and “whistle blowing” and staff receive related training. Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The home was meeting standards 19 and 26. The home was in a good state of repair and in good decorative order, at the time of inspection. EVIDENCE: There is an ongoing maintenance programme and the areas visited (lounge, dining room, kitchen and laundry), were in good order at the time of inspection. Ongoing plans for the home include a conservatory and an additional toilet on the ground floor. The home has systems in place for infection control through training and provision of protective clothing. Designated domestic staff are employed in the home, which was clean and odour free at the time of inspection. Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 The home was meeting standards 28 and 29. Staff receive ongoing training and recruitment procedures in place were satisfactory. EVIDENCE: Reference was made to staff training schedules, the home’s recruitment policy and discussion took place with the manager and a member of staff. Over 50 of staff have achieved a minimum standard of NVQ2. Mandatory training is ongoing and service specific training, for example, in medication, oral hygiene protection of vulnerable adults, and dementia care, had recently been undertaken, or was arranged. The organisation has a recruitment policy, which includes completion of an application form, formal interviews and vetting of applicants, including CRB clearances. The manager confirmed that staff receive induction training and are issued with job descriptions. Two members of staff had recently been transferred from another home owned by Parkhaven Trust. Staff rosters were satisfactorily maintained. Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 The home was meeting standards 31,33 and 35, at the time of inspection. The manager, Mrs. Burgess, has recently been registered with CSCI. The home has systems in place to obtain and act upon residents’ opinions of the home. There are systems for managing residents’ personal allowance if necessary, but the home does not control, or have access to, residents’ finances. Standard 38. A shortfall was noted with regards to accident recording. Otherwise the home was meeting the standard. EVIDENCE: Standard 31. Since her recent appointment as manager, Mrs. Burgess has developed systems in the home, which are aimed at providing easy access to information. Staff said there is an open-door management style and they have formal supervision and regular appraisals. Standard 33. Resident questionnaires were not seen at this inspection, but there was evidence of resident meetings, ongoing involvement through care planning and review processes and general consultation regarding meals and lifestyle choices.
Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 18 Residents said they were content and had no complaints. One lady said that the manager and staff were approachable and very kind and she chooses what to do with her day. Standard 35. The manager confirmed that the home does not take control of residents’ finances. For their convenience, personal allowances may be held on residents’ behalf and these are secured in the office. There are written records of transactions, to ensure accurate accounting, and receipts are retained for purchases made by staff on residents’ behalf. Residents’ monies are not pooled and those who have no family have access to independent advocates for support and advice on all matters, including finances. Standard 38. Health & Safety, maintenance certificates and fire records were satisfactory. A shortfall was noted regarding accident recording and a requirement is made. In some instances, records of falls were specific, giving the time date, place and position of the resident when discovered/observed. Other recordings were less detailed and did not contain sufficient information. Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 20 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 OP7 Regulation 15 Requirement The manager must ensure that, for residents who present as confused, their mental health needs are addressed in the individuals care plans. (Outstanding from the last inspection, extended time limit given). The manager must consult with residents (including respite residents) as to their dietary preferences (including special diets) and make arrangements for meals to be provided accordingly. (Outstanding from last inspection, extended time limit given). The manager must instruct staff as to the information required in accident reports and monitor all such reports regarding the content. Timescale for action 30/04/06 2. OP15 16 30/04/06 3. OP38 17 Shed.3 (j) 30/04/06 Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Harrison House DS0000005407.V274083.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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