CARE HOMES FOR OLDER PEOPLE
Harrison House Liverpool Road South Maghull Liverpool Merseyside L31 8BS Lead Inspector
Mrs Trish Thomas Key Unannounced Inspection 7th March 2007 12:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Harrison House DS0000005407.V332246.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. Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Harrison House Address Liverpool Road South Maghull Liverpool Merseyside L31 8BS 0151 526 0564 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 Claire Louise Burgess Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 24 OP. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 26th July 2006 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 provides six placements for respite beds contracted by Sefton Social Services. In addition there are eighteen places in Harrison House for long-term residency. The home provides twenty-four hour care and social support, single accommodation, full board and a laundry service. Harrison House 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., (and those receiving respite care have temporary access to a G.P.). There are arrangements for referrals to be made to district nurses and paramedical services as needed. 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 maintained to good standards of hygiene. Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Claire Burgess, (registered manager) has returned to duty after an absence of several months. Mrs. Burgess was not on duty during the visit and Barbara Corker (Team Leader) provided information as requested. Six residents made comment and reference was made to satisfaction questionnaires, which had been completed in December 06 by residents or their representatives. A tour of the premises was carried out and records compiled in the home relating to care, staffing and health & safety were read. What the service does well: The needs of residents admitted to Harrison House can be met within the services and facilities of the home. There was evidence that the service was responding well to the support needs of those residents who have been recently admitted to the respite service. The lifestyle in Harrison House was meeting the expectations and preferences of those in residence. There is a friendly atmosphere in the home and residents appeared relaxed and at ease. Residents’ beliefs are recorded on their care plans and religious ministers visit the home to give communion and support. Residents have access to advocacy services and they said they entertain their visitors without intrusion from staff. The home has policies and procedures in place to protect residents and investigate their complaints. Residents said they knew about the home’s complaints procedure and would approach the manager if they had a complaint. The home is suitable for its purpose and is comfortable and well maintained. The recent addition of a spacious conservatory with beautiful views of the grounds, has extended the shared areas. There is a ramp and decked area outside to give access to the gardens, which are secluded and well maintained. There is a core group of long-term experienced staff and induction and training is arranged for newly recruited staff. Resident questionnaires record 100 satisfaction with staff reaction to their wishes. Residents who commented said that staff are polite, helpful and always there when needed. Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
In response to an individual resident’s personal circumstances and to ensure that this person receives hospital treatment as needed, and that the home’s duty of care is fulfilled, the following requirement is made. Following consultation with interested parties, the registered person must arrange for a written procedure to be followed in any instance where hospital admission may be necessary for this resident. To ensure the safe recording and administration of medicines and that there is an accurate audit trail of un used medication, the registered person must arrange for staff to enter codes for medication not taken by residents, and must not leave the section blank. The training schedule showed that a minority of staff have not received POVA training and others have not received recent updates. To ensure that staff are aware of the indicators of abuse and procedures to be followed if abuse is Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 Page 7 suspected, the manager should review POVA training and arrange updates as necessary. 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. Harrison House DS0000005407.V332246.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 Harrison House DS0000005407.V332246.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): Quality in this outcome area is good. The needs of residents admitted to Harrison House can be met within the services and facilities in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 3 and 4 were assessed. Harrison House does not provide intermediate care and is not assessed against standard 6. Assessments for three residents were read and discussion took place with the Team Leader on duty, Barbara Corker, in the manager’s absence. Residents who had recently been admitted to the respite service had care needs, which could be met in the home. Pre-admission assessments provided by social workers covered the range of health, social and personal care needs of each individual. Assessment of needs is continued (by care staff), after a person moves in to Harrison House and the outcomes form the basis of the individual’s care plan.
Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 Page 10 Harrison House DS0000005407.V332246.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): Quality in this outcome area is adequate. For the majority of residents, their health, personal care and medication are well supported and documented, but there are some inconsistencies in medication and health care management. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 7,8,9,10. Three care files were read, one for permanent and two for respite services. There were action plans in place to meet the identified needs (contained in assessments) for each resident. Care plans are reviewed three days after admission and then in accordance with assessed change in need. Those living permanently in Harrison House are registered with local G.P.s and there are arrangements in place for residents receiving the temporary respite service to have access to treatment. Hospital treatment for one resident (relating to personal circumstances), was discussed with Mrs. Corker. A requirement is given under Regulation 13 (1) (b) that (following consultation with interested
Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 Page 12 parties), there is a written procedure for staff to follow if hospital treatment for this resident is needed. Staff who administer residents’ prescribed medication have received training in safe handling of medicines and the home has a medication procedure for staff guidance. Medication is secured in a locked trolley. The medication prescribed for three residents was checked against the medication administration records. In one instance gaps had been left on the record for three drugs. To ensure that accurate medication records and audit trails are maintained, a requirement is made under Regulation 13 (2), that staff sign for medication as it is administered or insert the relevant code. Residents who commented said that the staff are polite and kind. One lady said, “I spend time as I please. I like to stay in my room and my family visit up here. Staff are always there when you need them but they don’t intrude.” Another resident confirmed that her mail is received unopened and that staff are always respectful towards her. Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The lifestyle in the home meets residents’ expectations and preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 12,13,14,15. There was a pleasant and friendly atmosphere in Harrison House, throughout the visit. Residents were spending time in the lounge, conservatory or in their bedrooms. The home employs a part time activities co-ordinator and maintains a diary of social events, which was read. In-house activities include tea dances, quizzes, bingo, music and film evenings and visiting pianist. Residents said they were satisfied with the activities and routines in the home. Residents’ personal beliefs are recorded on their care plans and visits from ministers are arranged accordingly. The training schedule shows that staff have had training in equality and diversity, and this was evident in their conduct towards residents, observed during the visit. Resident questionnaires (December 06) record 100 satisfaction with staff reaction to their wishes. Three residents who commented said that staff are polite, helpful and always there when needed.
Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 Page 14 Community contact was to residents’ satisfaction. They said their visitors are made welcome and their privacy when entertaining them, is respected by staff. The respite service helps residents to remain in the community by providing short-term residential care and support (often in crisis situations), with a view to discharge home. One resident said she was looking forward to returning to her own home but was enjoying the attention and restful atmosphere in Harrison House. There was evidence that residents have choice and control over their day-today lives and personal affairs. Residents said they spend their times as they please, and are consulted about their meals and rising and retiring times. Residents have access to local advocacy services to act on their behalf if necessary, contact details are available in the home. There is a record kept of menus and special diets. Residents who commented said their meals were very good and the dining room is pleasant and bright. Quality assurance questionnaires (December 06) record 75 of residents considering meals to be “Very Good”. Residents said drinks are brought round regularly or on request. They said they are offered an alternative if they do not want what is on the menu. One resident said, “Breakfast is substantial and there is plenty of variety, I have no complaints.” Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. The home has policies and procedures in place to protect residents and investigate their complaints however training in this needs updating for some staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 16,18. Reference was made to Parkhaven Trust complaints procedure, a copy of which is given to residents when they move in to Harrison House. Two residents said they had not had cause to make a complaint but would feel comfortable approaching the manager if the situation arose. There have been no complaints to CSCI regarding Harrison House since the last Key Inspection. The home has procedures in place for protection of vulnerable adults, and the training records show that POVA training is provided for staff who work in the home. Some staff have not had the training updated recently. To ensure they are fully aware of abuse indicators and procedures to be followed if abuse is suspected, it is advised under standard 18 that the training schedule is reviewed and training for staff arranged or updated as necessary. Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 Page 16 Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. Harrison House is clean, comfortable and homely, and is suitable for its purpose. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 19, 26. The home is suitable for its purpose and is comfortable and well maintained. The following was observed during this visit. The recent addition of a spacious conservatory with beautiful views of the grounds has extended the shared areas. There is a ramp and decked area outside to give access to the gardens, which are secluded and in good order. Harrison House is bright and warm and is furnished and decorated in a comfortable and homely style. Residents have single bedrooms and those of residents who live permanently in the home, are highly personalised. A resident of the respite service was visited in her bedroom. She said she was comfortable and had all she needs. She said the
Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 Page 18 room is always kept clean and the lighting and temperature were to her satisfaction. She said, “The bed is comfortable and there is a call bell if I need anything. Staff call in for a chat sometimes if I am on my own.” The building was very clean and well organised, whilst maintaining the homely atmosphere, which residents clearly appreciate. Harrison House employs designated domestic staff and has procedures for COSHH and infection control. Cleaning materials were seen as being locked away when not in use. All equipment in the laundry was in working order at the time of this visit. The resident survey questionnaires dated December 06 record 92 satisfaction (Good-Very Good), with cleanliness of communal areas in the home and 92 satisfaction with cleanliness of bedrooms. Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good. In Harrison House, the residents’ care and support needs are met by the numbers and skills of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 27, 28, 29, 30. The staff rosters and training schedules provide evidence that staffing numbers and training is satisfactory (other than as stated under standard 18). There is good ancillary support, there being staff employed to carry out cleaning and cooking, a part time activities co-ordinator and maintenance and gardening staff. Reference was made to the training schedules which provide a record of the NVQ qualifications of Harrison House staff : NVQ2 : 6 staff, NVQ3 : 2 staff. Undertaking NVQ2 : 3 staff. Awaiting Registration for NVQ : 1 staff member. Reference was made to Parkhaven Trust recruitment procedures, which include advertising posts, interviewing job candidates and obtaining two written references. There is a core group of long-term experienced staff and induction and training are arranged for newly recruited staff. Members of staff who
Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 Page 20 commented have been issued with job descriptions and contracts of employment and had CRB clearances. Harrison House mandatory training schedule records a range of courses undertaken by staff including, induction, Health & Safety, Infection Control, Equality & Diversity, First Aid, Fire Safety, Patient Handling. Training recently carried out or arranged includes Safe Handling of Medicines, First Aid, Continence, Health & Safety and End of Life Care. Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. Harrison House is well managed and residents’ safety and welfare are protected through the home’s procedures and practice This judgement has been made using available evidence including a visit to this service. EVIDENCE: Claire Burgess is the registered manager of Harrison House. Mrs. Burgess has a management qualification and staff on duty said they are well supported by the manager and senior staff in the home. There are clear lines of responsibility in the home and throughout the organization. Mrs. Burgess was not on duty at the time of the visit and Barbara Corker, (Senior) provided all the information requested.
Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 Page 22 Reference was made to the home’s quality assurance file. The latest resident questionnaires (December 06) were read. Residents had been consulted on a range of aspects of their life in Harrison House including, the information they received prior to admission, quality of bedrooms, bathrooms, cleanliness, meals, activities, staff and management. Residents said that Parkhaven Trust does not become involved in their financial affairs. Personal allowances are held in safekeeping for some residents if that is their choice. The safekeeping records were read. All transactions had been signed for and there were ongoing accounts, which are regularly audited. Requirements from the last inspection regarding fire safety were checked and had been addressed. The fire exit from the lounge is no longer blocked by building materials, and the work has been completed. A smoke detector had been fitted in the conservatory and fire exits were sign-posted and clear in case of evacuation. The fire roll call list had been updated regarding residents who were in hospital. The fire risk assessment was dated 26/07/06 and the fire book was satisfactorily maintained. Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 Page 23 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 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X 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 3 X 3 X 3 X X 3 Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13 Requirement In response to an individual resident’s personal circumstances, the registered person must (in consultation with interested parties), arrange for a written procedure to be followed in any instance where hospital admission may be needed for this resident. To ensure the safe recording, administration and audit of medicines, the registered person must arrange for staff to enter codes for medication not administered and not leave the section blank. Timescale for action 13/04/07 2. OP9 13 13/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 Page 25 No. 1. Refer to Standard OP18 Good Practice Recommendations The manager should review POVA training and arrange updates as necessary. Harrison House DS0000005407.V332246.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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
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