Inspection on 24/08/05 for Harrison House

This inspection was carried out on 24th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Harrison House 21/08/07

Harrison House 07/03/07

Harrison House 26/07/06

Harrison House 16/12/05

Harrison House 10/12/04

Harrison House 01/07/04

Harrison House 12/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Harrison House Liverpool Road South Maghull Liverpool L31 8BS Lead Inspector Trish Thomas Unannounced 24 August 2005 th 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 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 F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Harrison House Address Liverpool Road South Maghull Liverpool L31 8BS 0151 526 4133 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Parkhaven Trust N/A Care Home 24 Category(ies) of OP Old Age (24) registration, with number of places Harrison House F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Service users to include up to 24 OP Variation for 1 named out of category service user under pensionable age. This variation is applicable only to the named service user, should the named service user leave the home or become of pensionable age the variation will cease to apply. Harrison House to notify the CSCI of the named service users discharge, when the variation will be removed. The service should employ a suitably qualified and experienced manager who is registered with the CSCI. Date of last inspection 10/12/04 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. The home is owned by Parkhaven Trust and the recently appointed manager is Mrs. Claire Burgess. Mrs. Burgess has applied for registration as manager, with CSCI. The home block contracts six respite beds with Sefton Social Services, in addition to eighteen permanent places not included in the contract. The home provides twenty-four hour care and social support, single accommodation, full board and 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. There is level exterior access. 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 direct access to the garden from the main lounge and this is a beautiful setting, which is enjoyed by residents of this home. Harrison House F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The methods used during the inspection were, discussion with residents and staff, direct observation and reading records maintained in the home. The manager of the home, Mrs. Claire Burgess, was on leave at the time of inspection. Due to the managers’ absence, requirements from the inspections of July and December 2004 were not checked. This will be done at a future unannounced inspection. Staff on duty were observed to be busy and under pressure. They said they had been working long shifts to cover staff sickness absences. Residents’ comments confirmed that staff appear to be busy at times and an example was given (by a resident) of a staff member being too busy to assist a resident who needed support. The home is now providing a respite service, which involves regular admissions and discharges, in addition to support to long-term residents whose permanent home is Harrison House. There was no evidence that, in planning the respite service, consideration had been given to revising the admission/discharge procedure, reviewing staffing levels, revising the content of social activities, or to meeting the needs of long-term residents, who are becoming more dependent. The home appeared to have lost direction to some extent as the main priority related to covering the roster, due to the high level of staff sickness absence. Activities and social support at this time were not in accordance with the range of needs and preferences of those who now receive a service in Harrison House. Registered numbers have been increased from 23 to 24 since the last inspection. What the service does well: Harrison House is an established care home, set in beautiful grounds and the building is comfortable and well maintained. The home is owned by Parkhaven Trust and this organisation provides H.R., training, maintenance and management support to their services. The majority of staff are long-term employed and have undertaken mandatory training (Basic Food Hygiene, Patient Handling, Health and Safety etc.) and NVQ training. A manager has been appointed who has applied for registration with CSCI. The majority of those residents who commented said they were content with their life in the home. Their main concerns appeared to relate to staff numbers, social activities and meals. They expressed no concerns with staff conduct. Harrison House F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: The manager must arrange for staff to be trained in dementia and challenging behaviour. The manager must ensure that residents increased dependency/deterioration in mental condition, is referred for professional assessment in accordance with need. Ongoing from the date stated. The manager must ensure that, for residents who present as confused, their mental health needs are addressed in the individuals care plans. The manager must arrange formal arrangements for respite residents to have access to a G.P. The manager must consult with service users and provide a programme of activities, (which is adhered to), in accordance with residents needs and preferences. 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. The manager must review staffing levels with regards to the needs of residents and change of purpose of Harrison House (ie permanent and respite). The manager must update staff fire instruction to ensure their awareness of the need to keep an accurate record of resident numbers. This is a priority in relation to the regular and increased number of admissions and discharges to the respite service. The manager must ensure that the fire roll call list is held in a place of safety which is known to all staff and that updating the list is included in the homes admission and discharge procedure. Harrison House F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Version 1.40 Page 7 The manager must ensure that a pharmacy label is obtained for any changes to residents prescribed medication. Where this is not possible and staff write the MAR sheet, the manager must instruct staff that alterations must be signed by the writer and checked and signed by a colleague. 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 F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Harrison House F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4 The home was meeting standard 3. All admissions to the home are subject to professional assessment. Standard 4. The home was not meeting this standard with regards to training, social activities, staff availability and personal safety. Harrison House will not be measured against standard 6 as intermediate care is not within the home’s registered category. EVIDENCE: Standard 3. Since the last inspection a respite service has been established in the home, alongside the permanent service for long-term residents. All residents admitted to the home have professional assessment undertaken and a home’s assessment, post admission, which forms the basis of the care plan. Two respite and two permanent residents’ care files were read as evidence for this standard. Standard 4. Shortfalls were noted with regards to staff training with regards to the presenting needs of those in residence, who have short-term memory loss/confusion. It is recognised that with advancing age and frailty, the residents’ mental state may also deteriorate. The welfare of the resident must be paramount when reviewing whether the home can continue to meet an individual’s assessed needs within available resources. Harrison House F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Version 1.40 Page 10 Staffing levels have not been reviewed/increased to accommodate permanent residents’ changing needs and the newly established respite service, and a number of staff were on sick leave. The comments of residents implied that social activities are not varied to meet the numerous levels of need and preference of those in residence. Further comments in shortfalls in meeting need, are made under standards 12, 27, 30 and 38. Harrison House F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10. The home was not meeting standard 7, a shortfall is referred to in the evidence below. Care plans have been transferred to the recently established revised format and were stored in residents’ bedrooms. The home was not fully meeting standard 8 as problems have been experienced in accessing general practitioners for respite residents, who are not registered with local doctors. The home was not meeting standard 9 with regards to prescribed medication records. The home was meeting standard standard 10 with regards to respect and privacy. EVIDENCE: Standard 7. Care plans for four residents were read and were satisfactorily maintained with regards to the presenting needs of the residents concerned. In reading care plans and discussing levels of dependency with staff and in discussion with residents, it was established that a number of the permanent residents present varying levels of confusion. There were no strategies in place in a further general sample of care plans to address short-term memory loss or confusion. Standard 8. Staff on duty said that the home was experiencing some difficulty in accessing G.P.s for respite residents. Staff said that in some instances, this had been achieved via NHS Direct. Harrison House F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Version 1.40 Page 12 According to staff’s comments, there did not appear to be a reliable arrangement in place regarding respite residents’ access to a doctor while resident in Harrison House. Standard 9. The home has a procedure in place for administering residents’ prescribed medication. The senior member of staff on duty was advised regarding medication administration records, handwritten by staff, (which had not been signed by the writer, nor checked and signed by a colleague). Standard 10, the home was meeting standard 10. Residents who commented said that they had no complaints with regards to staff respecting their privacy. Good practice was observed in that care plans were stored in residents’ bedrooms. Harrison House F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Version 1.40 Page 13 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 standard(s) 12,15 The home was not meeting standards 12 and 15. Standard 12, The evidence obtained would suggest that there is no established activities programme in place, which meets residents’ needs. Standard 15. The catering service was contracted out, at the time of inspection. Meals were cooked on the premises by staff not under the direct supervision of the home’s manager, and provisions ordered by the catering company. Staff said that changes to the present catering arrangements were due to be implemented. EVIDENCE: Standard 12. Residents who commented said that the range of social activities on offer includes, bingo, manicures and card games. There was a clothes sale in progress at the time of inspection and some of the residents were choosing clothing, assisted by staff. None of the residents who commented could recall having gone on an outing recently. One lady made her way out to the garden to a seat, saying she enjoys the fresh air. Outside seating is placed close to the French doors for convenience. The majority of residents were in the lounge where the television was on. Three residents had visitors. One lady said “Staff are very kind, but there aren’t enough of them”. There was no activities programme available. Staff said that the in-house activities co-ordinator visits the home twice a week. Standard 15. Residents who commented said that the food was satisfactory or could be better, and that drinks were served regularly throughout the day and at night on request. Harrison House F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Version 1.40 Page 14 One resident said that diabetic diets could be catered for “more imaginatively.” She compared the food to that she had experience of in another care home, and said there was “room for improvement” in Harrison House. The kitchen was organised and basic food stocks were in good quantity. Records maintained in the kitchen were satisfactory and all kitchen equipment was in working order. Harrison House F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Version 1.40 Page 15 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 standard(s) x The home was not measured against these standards. EVIDENCE: Harrison House F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Version 1.40 Page 16 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 standard(s) 19, 26 The home was meeting standards 19 and 26. The home was in a good state of repair and decoration in the areas which were visited and rooms were clean and odour free. EVIDENCE: Standard 19. The home has an ongoing maintenance programme and a number of areas have been decorated in the recent past. The lounge and dining room were suitably furnished to accommodate 24 residents. The gardens were well maintained, not overlooked and accessible to residents. There is a car park at the front of the building. Standard 26. The building was clean and odour free. There were good stocks of cleaning materials in the building and domestic staff supplied with protective clothing. Harrison House F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,30 The home was not meeting standards 27 and 30. Standard 27. There were two members of care staff and one senior care on duty throughout the inspection, which covered the am/pm handover period. Five members of staff were on sick leave. The manager and deputy were on annual leave. Standard 30. Further training will be necessary, in accordance with residents’ presenting needs. EVIDENCE: In discussion with staff, it was confirmed that the home has established a respite service since the last inspection. Six respite beds are block contracted with Sefton Council. Staffing levels have not been reviewed to accommodate admissions and discharges and the needs of residents admitted on a temporary basis. These residents may be of lower dependency than long-term residents, but would require a high level of social stimulation and support with maintaining independence. A number of permanent residents present shortterm memory loss/confusion and would require a structured activities programme in addition to support with their personal care needs. Staffing levels were in accordance with the roster, but staff appeared under pressure at the time of inspection. Five members of staff were on sick leave and two on holiday. Staff said they are covering absences by working longer shifts. They did not consider use of agency staff to be suitable in maintaining continuity of care. A resident said that one day she had witnessed a resident using the call bell for assistance to the toilet. A member of staff responded but said she would return later as she was busy elsewhere. Three residents who commented said the staff appear to be busy and under pressure at times. Harrison House F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Version 1.40 Page 18 They expressed no concerns with the general conduct of staff, saying they were kind and hard working. Standard 30. In discussion with staff, it was established that they are providing a service to a number of permanent residents who are confused and they have not received training in dementia or challenging behaviour. Harrison House F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The home was not meeting standard 38 with regards to the fire roll call. EVIDENCE: Standard 38. The fire roll call list was not available. Staff appeared unclear as to how many were in residence. (One said 22, another 21). A discussion took place between two members of staff, but neither could produce the list of residents, which would be used in an instance of evacuation in case of fire. Harrison House F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 1 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x 1 Harrison House F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Version 1.40 Page 21 Not known 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. 2. Standard 4, 30 4 Regulation 18 14 Requirement The manager must arrange for staff to be trained in dementia and challenging behaviour. The manager must ensure that residents increased dependency/deterioration in mental state, is referred for professional assessment in accordance with need. Ongoing from the date stated. The manager must ensure that, for residents who present as confused, their mental health needs are addressed in the individuals care plans. The manager must arrange formal arrangements for respite residents to have access to a G.P. The manager must consult with service users and provide a programme of activities, (which is adhered to), in accordance with residents needs and preferences. 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 F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Timescale for action By 30/11/05 30/9/05 3. 7 15 By 14/10/05 4. 8 13 By 14/10/05 By 30/10/05 5. 12 16 6. 15 16 By 30/10/05 Harrison House Version 1.40 Page 22 accordingly. 7. 27 18 The manager must review staffing levels with regards to the needs of residents and change of purpose (ie permanent and respite). The manager must update staff fire instruction to ensure their awareness of the need to maintain an accurate record of resident numbers. The manager must ensure that the fire roll call list is held in a place of safety which is known to all staff and that updating the list is included in the homes admission and discharge procedure. The manager must ensure that a pharmacy label is obtained for any changes to residents prescribed medication. Where this is not possible and staff write the MAR sheet, the manager must instruct staff that alterations must be signed by the writer and checked and signed by a colleague. By 30/10/05 8. 38 23 By 30/10/05 9. 38 23 By 30/9/05 10. 9 13 By 30/9/05 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 None Good Practice Recommendations Harrison House F53 F03 S5407 Harrison House V239288 240805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 2nd Floor Burlington House Crosby Road North Waterloo L22 0LG 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. 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