Inspection on 14/07/08 for Harry Lord House

This inspection was carried out on 14th July 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Harry Lord House 21/07/09

Harry Lord House 23/08/06

Harry Lord House 25/01/06

Harry Lord House 09/05/05

Harry Lord House 23/11/04

Harry Lord House 16/06/04

Harry Lord 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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Harry Lord House 120 Humphrey Road Old Trafford Manchester M16 9DF Lead Inspector Sylvia Brown Unannounced Inspection 7.30 14th July 2008 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 Harry Lord House DS0000032586.V367426.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. Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harry Lord House Address 120 Humphrey Road Old Trafford Manchester M16 9DF 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) 0161 872 4156 sue.burrell@trafford.gov.uk Trafford Metropolitan Borough Council Mrs Susan Burrell Care Home 45 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home provides accommodation for a maximum of 45 service users, 29 of whom require care by reason of old age (OP) and 16 of whom are older people who require care by reason of dementia (DE (E)). Separate lounge and dining space must be provided to meet the needs of the service users who require care by reason of dementia (DE(E)). There are currently 8 named older service users who require care primarily by reason of mental ill health (MD(E)) and 1 named older service user who requires care primarily by reason of physical disability (PD(E)). Should any of these service users no longer require accommodation at the home, 7 of the places will revert to the category (DE(E)) and 2 of the places will revert to the category (OP). The Statement of Purpose must be maintained in line with the requirements of Schedule 1, of Regulation 4(1) of the Care Homes Regulations. The Statement must be kept under review and updated. Any changes to the homes purpose must be agreed with the Commission for Social Care Inspection prior to implementation. The staffing arrangements at the home must be maintained in line with the minimum levels set out in the guidance published by the Residential Forum, `Care Staffing in Care Homes for Older People`. This must be reflected in the Statement of Purpose. The home must be managed at all times in accordance with the guidance and regulations issued in respect of older peoples` homes by the Secretary of State for Health under Sections 22 and 23(1) of the Care Standards Act 2000. The authority must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 2. 3. 4. 5. 6. Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 5 Date of last inspection 23rd August 2006 Brief Description of the Service: Harry Lord House is a care home, owned and managed by Trafford Metropolitan Borough Council. It is situated in a quiet residential area close to shops, public park and the Metro link at Trafford Bar The home is on the top two floors of Harry Lord House. Access to the first and second floors, where bedrooms and communal areas are located, is by a staircase as you enter the building, or by passenger lift which is situated within the ground floor accommodation. There are four lounges within dining areas and various bathing facilities, including shower and Parker bath. All bedrooms offer single occupancy. The fees for the home are £380:29 Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service would experience adequate quality outcomes. The inspection report is based on information and evidence gathered by the Commission for Social Care Inspection (CSCI) since the last key inspection, which was completed on the 23rd August 2006. This was a key inspection which included a site visit to the service. The site visit was unannounced, which means the registered manager and staff were not told that we would be visiting. The registered manager was on duty throughout the site visit. We gathered information from a number of people, which included talking with and seeking the views of service users. We sent out surveys to service users, relatives and members of staff. This gave them an opportunity to talk with us about their opinions on the services provided at Harry Lord. Comments received from service users, relatives and staff are, where appropriate included within the report. We looked in depth at the care support of two people living at the home which included looking at their records in detail. We also spent time sitting with service users and observing their day-to-day routines as they received care support from care staff. This helped us get a better view about how people living at home are looked after and supported. In June 2008 the registered manager of Harry Lord completed a selfassessment form, which is called an Annual Quality Assessment Audit (AQAA). This told us what the home had been doing since the last key inspection to meet and maintain the National Minimum Standards. It also told us what they felt they were doing well, how they had improved within the past 12 months and their plans to develop in the next 12 months. We also gathered information through general contact with the home; through their reporting procedures, which are called ‘Notifications’, and through information we received from other people, such as the general public, including concerns and complaints procedures. We have not received any complaints about this service. Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 7 Since the last inspection we have received one concern/allegation of abuse. This matter continues to be investigated under Local Authority Safeguarding Procedures. What the service does well: Service users receive support from staff who are well trained and competent. The AQAA states, that 95 of staff have or are completing National Vocational Training (NVQ) at level 2 or above. In addition, staff have individual training and development plans which ensures that training continues. Relatives spoke favourable about the staff team stating “Staff are very kind to all residents” “Generally they appear to look after the residents in a proper manner. The home is clean the staff appear to do their best” When asked what the home did well we were told “Kindness towards resident.” “Staff seem kind and caring.” One staff told us “The residents here are well looked after, mainly due to the dedication of staff who work here”. Whilst the report identifies many areas where improvements can be made including improving staffing levels, we found that on the day of the site visit, staff providing direct care were attentive, polite, making sure service users were appropriately dressed and prepared for the day without rushing them. Service users and visitors have confidence in the registered manager to deal with complaints seriously, this means service users are more likely to report anything of concern to them. Care planning processes are good, with records reflecting the individuals requirements and preferences for how they wish to receive support. What has improved since the last inspection? The registered manager informs us within the AQAA that since the last inspection improvements have been made in the following areas. The appearance of the building outside and inside has improved due to new windows. We are told that the registered manager now has more control over the admission of people, and continue to review after admission that the bedroom and lounge they are allocated to meet the persons needs and that they do fit in and are happy in their new home. Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 8 The registered manager reports that due to increased supervision and new staff induction, staff have increased their awareness and understanding of their role. They are confident in reporting concerns and practise of their colleagues. Newsletters have been produced and provided to people to keep them up to date with things happening within the home. One relative confirmed this and told us “that there is a focus group meeting” relatives find the focus meetings useful and have confidence in the manager, we were told the relative feels that the registered manager is “open and honest” ““ we are kept informed of changes through this meeting” What they could do better: The statement of purpose and service users guide contained out of date information, both documents should contain accurate and up to date information to make sure all prospective service users have the correct information, to assist them to make informed decisions about their future. Recoding of information should be developed to ensure it accurately reflects practice, particularly where service users are being supported to maintain specialised diets. Effective and routine systems need introducing to monitor such records in a timely manner to make sure service users are receiving enough nutrition. To improve the day to day experiences for some service users and to promote better mental health, an activities programme should be designed to meet the needs of all service users and where required adapted to meet the needs of individuals on each unit. Individual and group activities should be detailed, and where required specialise advice should be sought on ways to occupy, stimulate and support those service users who have dementia, which will enable them to have meaningful daily enjoyable experiences. Meals and mealtime should be reviewed and new systems introduced to make sure that such occassions support service users to socialise, and enjoy their meals. Those requiring support should have it provided in a timely manner. Service users should as far as possible be able to choose their own meal and information should be provided to them in a manner that they can understand. Food served should always be nutritious, tasty, hot and enjoyable. Such developments are likely to improve service users eating abilities and habits, and improve their general health condition. The numbers of staff supporting service users must be increased, particularly at peak periods and especially where service users need two staff to support them or require additional supervision and support because of dementia related illnesses. This should ensure they receive the care and supervision they Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 9 require and have assistance in a timely manner. Staff should not just “turn up from the community care workforce ” to support staffing levels. Staffing levels should be planned for in advance to meet the individual needs and dependency of service users. When asked how the home could improve, most comments received were about staffing levels. Such comments as “Have more staff so they can provide more individual care and attention. “ “Provide them with more staff” “sometimes they appear to be understaffed.” “ some staff let others down” were made. We think parts of the home could be upgraded to make sure it is homely, inviting and fit for purpose, particularly bathing and toileting areas and kitchenettes. 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. Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 10 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 Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3 Quality in this outcome area is good. Standard 6 is not applicable to this service. The statement of purpose and service user guide does not contain up to date and accurate information which may hinder prospective service users from being able to make an informed decision about their future. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager and or one of the management team continue with pre assessment procedures with all prospective service users. The registered manager was able to demonstrate where after assessing a service users needs, she felt that the services provided at Harry Lord could not meet the specific needs of the service user. This demonstrates that service users Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 12 individual needs are considered and how they can be met are given appropriate consideration before they are offered accommodation. Service users surveys told us that they are able to look around the home before making any decisions about their future. One service user told us “I was shown around the home by my family and I decided I liked the home and the surroundings.” Although most people told us they were provided with sufficient information when they moved in, we looked at the statement of purposes and service users guide and found they both contained out of date information. The service users guide though stating it was updated in September 2007 referred to staffing details as of 2004. and refers to the National Care Standards Commission (NCSC) and not the Commission for Social Care Inspection (CSCI). The statement of purpose is somewhat confusing and contains a blank staffing form, it also refers to NCSC. The last inspection identified that information was out of date in both documents and made a recommendation to ensure information was accurate, but this was not done. Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10. Quality in this outcome area is adequate. In the main service users have their healthcare needs met. Recorded routines within care plans were not always as required, which may place service users at risk of not having their deteriorating health reorganised in a timely manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each service users has a written care plan in place. There was evidence that some have been consulted about their needs and have signed their agreement to the plan and care and support. The general health care needs of service users were met appropriately with routine checks and support services such as the doctor, district nurse services, chiropody, option and dental treatments being in place. Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 14 Nutritional screening was in place, however there was little evidence to support nutritional health care plans were being followed for the two people case tracked. Both service users had nutritional assessments in place, however they were not being followed as required. Weekly weight monitoring was not always carried out, food intake charts were not completed appropriately and there was no evidence of monitoring by an appropriate person to ensure appropriate nutritional intake was being taken daily. Both service users were not reaching the set goals to either increase or reduce their weight, but due to failing record keeping we could not assess why. There are further comments made about nutrition and support at mealtimes made within the Daily Life and Social Activities section of this report. When we asked the service users about the care support they received they told us “ They are alright, nice really” another said “sometimes its better than others” We think this fluctuation in services may be due to the use of agency staff and the inappropriate deployment of contracted staff. We have looked at this issue in more depth within the staffing section of this report. Relatives said, “The care home does as much as possible for the residents. Staff seem very patient with all residents.” Another said “My mother tells me she is happy and well looked after. Medication administration practices were observed and found to be satisfactory, with record keeping accurate. Systems were on place for the auditing on medication stocks and records, and all staff have received appropriate training in safe management and administration of medication. Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. Some service users independence was compromised and routines did not support all service users to live self directed lifestyles. There is insufficient recording and monitoring of service users dietary intake, and individual support was not always available when required, to ensure service users receive the nutrition they require. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users care plans reflected the individual interest of each service users and their preferred routines. Service users surveys were mainly positive about the services they received at the home. When we asked service users and relatives “if the home supported people to live the life they choose”, three people said they always did, with a further two saying they usually got the support they required. Because of what we observed on the day of the site visit, we feel the deployment of staff greatly affects how support is provided at Harry Lord, particularly for those who have dementia and or have increased Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 16 needs. One service user who prefers care support by a female, had to wait in bed until 10:45 until a female carer was available to support her with rising routines and because of the delay, the service user did not receive breakfast until approximately 11:10 am. We also observed that some service users were left for long periods of time without support or supervision, some sat at the breakfast table for two hours attempting unsuccessfully to eat their breakfast. Only when a member of staff became available and made one service users a fresh breakfast at 11.30am and supported them to eat did they actually eat their meal. Other service users were observed asleep at the breakfast table mid morning having sat there for over two hours. Because of what we saw, we do not think all service users are able to live as they desire or are able to make choices and decisions for themselves. All the relatives spoken to stated that they were made to feel welcome, were kept informed of significant issues about their loved ones and were able to visit when they wished. Though activities records were not individually well maintained, we were told that service users had daily activities made available to them and were able to socialise with each other at weekly social events. Service users confirmed that they met together and occasionally they are able to go on a ‘trip’. The registered manager recognises that daily activities need to be developed further. Within the AQAA she stated that she plans to speak with senior managers about additional training for staff so they have the skills and confidence to provide activities that are suitable to meet the needs of all service users. The statement of purpose states that fourteen places are dedicated to service users with dementia. Those service users live on two units with a specially trained staffing compliment. Whilst we can confirm that the staff files we looked at identified that staff had receive training in dementia awareness, there was nothing to support they were trained in how to occupy and stimulate people with dementia type illnesses. Throughout the morning on one unit, there was a lack of staff presence and minimal interaction between service users and staff when they were available. When we observed one service user asleep at the table with their head in their hand, staff informed us, “They always do that” We do not think the routines on the upper floors have been designed in the best interest of service users with dementia. Again poor staffing levels and or inappropriate deployment of staff has negatively impacted on service users. This will be addressed within the staffing section of this report. Main meals served at the home are provided from a central kitchen which also caters for other services provided within the building. On the day of the inspection the lunch time meals served were not good. A number of service users left their meat, saying it was ‘tough’, we also tasted the pudding served Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 17 to service users and found it stodgy and without taste, the custard served was lacking in taste and was powdery. One service user who specifically had their ‘calorie controlled’ diet made up from the main kitchen was observed to have most of the items which the care plan stated should not be provided. Furthermore, when staff were asked why this had been provided, they shrugged their shoulders and did not seem aware of their responsibility to support the service user to received the required diet. The recorded diet restriction for the service users allowed for no treats at all. Staff told us that the service user was putting weight on instead of losing weight, with staff seeming to blame other ‘service users’. Time and consideration should be given to spending time with the service user and finding out what foods are desired and as far as possible include them within the required calorie controlled diet. We also think short term goals would also enable the service used to have a sense of achievement, which when reached could be celebrated in some way. When we asked service users about the meals they told us, “The menus could do with being updated.” And “There should be a better variety of vegetarian meals”. Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Service users are kept safe by good adult protection procedures and staff who are aware of their responsibility to safeguard service users. Service users were aware of the homes complaints procedure and felt able to use it if they were not satisfied or felt concerned about anything. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager informed us within the AQAA that the complaints information is displayed for all service users and visitors to see. We observed this to be true. We also asked service users and relatives if they thought their complaints were taken seriously and if they had confidence in the complaints procedure. Without exception we received positive feedback about how the home manages complaints. We were told, “I would contact the home directly If I had a complaint” “ I have never had to complain” “Any concerns with my relative are discussed and acted upon satisfactorily and sympathetically” another said “I have no complaints whatsoever.” A record of all complaints is maintained and monitored by senior managers each month. Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 19 Adult protection procedures are in place and staff have POVA training provided to them, which makes them aware of their responsibility to report any concerns or suspicions of abuse. There has been one allegation of abuse made at the home. The registered manager followed Local Authority Safeguarding Procedures. To make sure service users have someone else to talk through, a senior manager visits the home each moth and talks to service users to find out if they have any concerns or worries. Furthermore the home provides focus group meetings that mean service users and relatives are able to join together and meet with the manager to take about the services at the home. Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,23,24 & 26. Quality in this outcome area is adequate. Service users private living space is well maintained and homely, however other parts of the home do not offer them a homely and inviting living environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Harry Lord offers service users ample space and personal accommodation. All parts of the home were clean and when asked their opinions about the cleanliness of the home one person told us “The home is spotless.” We looked around most parts of the building and found that incontinence bins were over loaded. Many had used continence aids exposed and black bags on top of the bins also contained used aids. We were told that contactors had not Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 21 been to empty the bins when required, however because management systems were not put into place to effectively manage the matter, the risk of service users being exposed to the spread of infection was increased, and their living environment was not respected. We found many bathrooms and toilets impersonal and institutionalised in style and design. Windows were without curtaining, plastic aprons; gloves and new continence aids were openly displayed. One bathroom contained what looked like communal toiletries and brushes. There were no homely fixtures and fitting within bathrooms making them functional rather than homely. Though the home stated it has a walk in shower, staff told us the shower unit on the second floor was not suitable for service users as it was to small. Furthermore staff told us that due to the needs of at least one service user, that bathing facilities were not suitable and that because of this the service user more often then not had a “strip wash” Lounge areas were in the main pleasant places to sit and some kitchenette areas having received some upgrading. Some however had not. Worktops were lifting and units were shabby. Furthermore there was no record keeping to support that cleaning routines were being carried out at the correct frequency where food preparation was completed food stored. Also when staff were preparing breakfast, we observed that due to a lack of working surfaces, their working space was crowded with little space to put all the required equipment, this could be a potential health and safety risk to both service users and staff. Bedrooms were personalised according to individual service users tastes and requirements. Service users are encouraged to bring personal items from their own home and small items of furniture. Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. Whilst service users receive support from staff who are appropriately recruited and trained. But insufficient staffing levels meant some service users did not receive the care and attention they require in a timely manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager ensures appropriate recruitment and selection procedures are followed. New staff completed a twelve-week induction and skills for care induction standards are met. The home has a highly trained work force with 95 of staff completing training at NVQ 2 or above. This exceeds the required standard. Throughout the inspection we spent a considerable amount of time sitting with service users and watching their day to day routines and support given by staff. We found that the staffing levels on the second floor where service users who have dementia type illnesses are accommodated was severely short staffed. Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 23 One staff was designated to support each unit that accommodates seven service users. On one unit a service user wandered around alone and appeared distressed and confused, the only member staff was attending to another service user in a bedroom. The service user became incontinent and requested assistance from the inspector. We had to summon the staff member who in turn then had to leave the service user they were supporting whilst they supported the service user in distress. On another lounge service users were left sat at the breakfast table for long periods of time, as the one member of staff support others in rising. One service user was observed eating from a cereal bowl and drinking from a cup even though both were empty. Another service users was observed being left to support themselves to eat their breakfast for two hours, when their care plan clearly stated that they needed support at mealtimes. One service user was not able to be supported to rise until a female care was available to support her, as the only carer on the unit was male. This worker arrived on the unit approximately 10:45 am. On arriving they waited until the only staff member was free to explain where support was required. When asked who the staff member was, we were told that they had come from the ‘district’ and that when the home care service had spare time they sent the staff ‘over’ until they were due back within the community. This is not acceptable practice. Not only did service users not know who to expect to support them, the staff member was initially unclear on what to do. We were later informed that the community support staff had worked at the home before. We also noted that when the ‘community worker’ arrived on the unit, it was time for the morning staff to have their breaks, which meant staffing levels were not improved. Throughout the morning the registered manager was on the premises as were two seniors, however there was no system to monitor staffing levels on the upper floor or ensure that service users were being attended to in a timely manner. Furthermore, one service user’s care plan stated that two staff were required to support all transfers, and yet staffing levels were designed to have staff support the service user alone. The staffing rota failed to identify where staff were deployed and did not record where agency staff were allocated. The home is currently using a considerable amount of agency workers, therefore it is impetrative that their deployment is managed to ensure that service users do not receive support solely from agency workers. When we asked how the home could improve, relatives told us, “As far as I am concerned I think they do an exceptional job under very difficult circumstances” “Staff are very kind to all residents. - Certificates of qualifications are displayed for all to see. I assume that all agency staff will Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 24 have their own records of competence and police checks” another said “Generally they appear to look after the residents in a proper manner. The home is clean the staff appear to do their best, sometimes they appear to be understaffed.” And “Have more staff so they can provide more individual care and attention” Although we have commented on the serious shortfalls in staffing levels, the staff observed were kind, courteous and considerate to service users. They did not rush service users, who all appeared well dressed and relaxed when arriving to the lounge/dining room. Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is adequate. Service users live in a home that is managed by a competent and experienced manager, who promotes their health and safety. However some service users did not receive support and supervision in a well managed way, which compromised their daily living experiences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager of Harry lord has been there for some considerable time. She is skilled and trained in caring for older people. She has completed NVQ 4 and achieved the registered managers award. The registered manager Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 26 is well respected by people and is called upon to support other homes to develop their practices. Whilst this inspection has identified a number of failing management systems we feel that due to manager supporting other services and having time off work due to ill health, the designated management team have not managed to maintain standards as required. The day of the inspection was the first day back after authorised leave. Relatives stated their confidence in the manager and told us she was open and honest and kept them fully informed of what was happening with their relative and within the home. We feel there continues to be on opportunity for development regarding the division of management responsibilities in the absence of the manager. Quality assurance procedures have been conducted and a report published, however the audit did not include seeking the views of staff and or other professionals and visitors to the service. Appropriate procedures were in place to support resident in the management of their finances. Service users health and safety is protected by good health and safety systems. Servicing records were up to date and showed all equipment was serviced by contracting specialise. Health and safety officers have been to inspect the home, has have fire safety officers and environmental health inspectors. All within the last twelve months. Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 27 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 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x 2 x 3 3 x 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 3 Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 28 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 OP27 Regulation 18 (1)(a) Requirement To make sure service users receive the support they require in a timely and safe manner staffing levels must be provided in appropriate numbers at all times, to meet the assessed needs and dependency of service use, ensuring their health and welfare is safe guarded. Timescale for action 05/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations To ensure that prospective service users are supported to make informed decision about their future. The statement of purpose and service users guide provided to them should contain accurate and un date information. To ensure service users receive the dietary intake and nutrition they require, effective systems should be in place to support, record and monitor service users diet and nutrition, as they individually require. DS0000032586.V367426.R01.S.doc Version 5.2 Page 29 2. OP8 Harry Lord House 3. OP12 For the benefit of those service users who have dementia, the registered manager should seek specialist advice on ways to improve daytime occupation for service users and provide sufficient stimulation which will improve their self worth, and mental heath. To ensure as far as possible that service users live self directed life styles, they should receive encouragement and individual support to maintain their independence and make decisions and choices for themselves, particularly rising and mealtimes. When service users are on specific diets, they should be consulted about their favourite food and as far as possible incorporate them in to the diet. This means they are more like to enjoy their diet and be successful in achieving set goals. To make sure all parts of the home used by service users are homely and fit for purpose, all bathing and toileting facilities should be evaluated and up graded where required. To protect service users from infection and ensure their home is respected. Management systems should be introduced which makes sure used incontinence equipment is disposed of correctly at all times. Because parts of the home need upgrading to make sure service users live in a well maintained home, a full audit of each room should be conducted with consideration given to upgrading all parts which are below the required or expected standard. A copy of the audit should be provided to us which includes the times scales for completion. To enable the home to demonstrate it has sufficient numbers of staff on duty to support service users, the rota should detail all staff on duty, including agency staff and where they are deployed at any given time. 4. OP14 5 OP15 6 OP19 OP21 7 OP26 8 OP19 OP26 9 OP21 Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Harry Lord House DS0000032586.V367426.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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