CARE HOMES FOR OLDER PEOPLE
Hartisca House Hartwell Road Burley Leeds LS6 1RY Lead Inspector
Sue Dunn Announced 15 September 2005 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. Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Hartisca House Address Hartwell Road, Burley, Leeds, West Yorkshire, LS6 1RY 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) (0113) 2426919 0113) 2426871 hartiscahouse@schealthcare.co.uk Southern Cross Healthcare Services Limited Mrs Edna Patricia Woellner Care Home 26 Category(ies) of Dementia (26) registration, with number of places Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 05/04/05 Brief Description of the Service: Hartisca House provides care for older people with dementia. The home was purpose built as a nursing home therefore not designed for the care of people with dementia. Bedrooms meet the minimum size requirements and some have en suite facilities. The ratio of double to single occupancy rooms is satisfactory. the two storey building has passenger lift access to the first floor. Both floors have a lounge and dining room with catering and laundry services being provided from a central area on the ground floor. Sixteen people are accommodated on the first floor and ten on the ground floor. The outdoor area does not allow a space for people to walk about un supervised due to the steep bank into which the home is built. A very small secure patio area at the front of the building provides a place for residents to sit out in good weather.The home is situated in the Burley area of Leeds close to the city centre. Shops,churches,a day centre and park are nearby.Because of the vulnerability of the residents doors are alarmed and the front door can only be opened by staff. Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection, which was announced, was undertaken by one inspector. The inspection started at 10.00am and finished at 6.00pm. The purpose of the inspection was to ensure the home was operating and being managed for the benefit and well being of the residents. A pre inspection questionnaire and comment cards were sent to the home before the inspection. The inspector spoke to residents, staff members, and the deputy manager. Records were inspected, including resident’s care plans and daily occurrence sheets, staff recruitment and training files, and service records. Two other homes in the city, one a home for people with dementia, have become a part of the Southern Cross Company since the last inspection which has given the manager the opportunity to share ideas. The organisation and the manager did an excellent job of supporting residents and their families and staff during a recent situation in the area which involved an emergency evacuation of the building for a period of several days. What the service does well:
The home’s information pack gives people the information they need to make an informed choice about the home. It is recognised that some relatives have very little knowledge of dementia so a brief explanation of the illness is included in the information pack. The home has a good programme of induction for new staff which requires people to demonstrate in writing their understanding of the training received. The manager uses a distanced learning programme to give staff training on the care of people with dementia. This has improved understanding of the illness and the quality of care. Residents can move about the home freely within the limitations the building imposes. Staff were non confrontational and seen to attend to residents needs with patience and good humour. The manager has a good sense of humour, which, with her enthusiasm and commitment to the home benefits the quality of care residents receive. She has introduced ideas gained whilst studying for a Diploma in Dementia care and has the ability to question practices and look at ways in which improvements can be made. She has been a driving force and provided stability for the home during frequent staff changes.
Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better:
The managers have recognised that the care plans need to be reviewed if they are to be an effective guide to the care required. New care plans are to be introduced and training is to be given. All care plans should focus on how people are to be supported to retain independence as their mental abilities decline. Information in the monthly care evaluation reports must be based on evidence from the daily notes or review meetings with other staff and care plans amended if necessary. The same should be done to evaluate the effectiveness of the activity programme for each person. Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.doc Version 1.40 Page 7 The business plan should reflect the registration category of the home and the financial implications associated with maintaining the environment to a satisfactory standard. The job descriptions are not specific to the needs of the home and should be reviewed in the interests of equality of opportunity to include a relevant employee specification against which candidates can be interviewed. Staff supervision should cover topics relevant to care. The 5 yearly electrical installation safety check should be carried out. 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. Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.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 Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.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) 1,3,4,5 People are able to make an informed decision about the home from the written information they receive and what they see when they visit the home. Pre admission assessments by the manager include a summary of how the home will meet each person’s needs. EVIDENCE: The Statement of Purpose has been updated since the last inspection and remains relevant to the home. The manager continues to request correctly completed assessments from other professionals, which she follows up with her own assessment to confirm, before admission, that the home can meet the person’s needs. The content of the home’s pre admission information has been improved to the point where it can be used as an initial care plan to support people during the early days following admission to the home. Care files for recently admitted residents showed that families had been asked to provide background information which is essential if staff are to get to know residents and provide care which is centred on the person.
Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.doc Version 1.40 Page 10 Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.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, Residents care needs are met but this is not fully evidenced in the care plans. Care plans must place more emphasis on mental abilities and understanding and provide guidance for staff on each residents preferences The organisation is aware of this. New care plans are to be introduced and staff are to receive training. EVIDENCE: The staff are to receive training later in September on new care planning documentation which is to be introduced. The new pro forma’s were seen and there were concerns that staff would be overwhelmed with a large amount of documentation which was based on nursing care and not relevant to the home’s statement of purpose. The care planning must place more emphasis on how staff are to work with cognitive impairments and provide guidance on suitable and meaningful activity. The content in recording of daily events has improved and the care is evaluated on a monthly basis. It was not clear where the evidence for evaluating the care plans came from. A statement giving the impression that one person was regularly behaving in a certain way was, when the daily records were examined, apparently based on a single incident. The care plans
Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.doc Version 1.40 Page 12 must be evaluated from information in the daily records and the plans amended if necessary. Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.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) 12,13,14,15 The home attempts to gather information which gives staff the knowledge to understand past lifestyles and interests and introduce activities which satisfy each person preferences. There had been a marked improvement in the social and recreational activity in the home. It is recommended that some system of evaluating the quality of activity be introduced for each resident to ensure this is person centred. People are supported to maintain contact with family and friends and visitors are welcomed at the home. A good, varied and nutritious diet taking into account individual choices and abilities is provided at the home. EVIDENCE: Relatives and friends are asked to share their knowledge of a resident in the form of a pen picture to give staff some understanding of past lifestyles and preferences. The manager has purchased equipment for staff to create life story boards for people to display on their bedroom walls. The home has employed an activity coordinator. On the day of the inspection there was a cheerful sociable atmosphere. Several people were knitting and this was stimulating conversation within the group. Staff were overheard to be communicating well by patiently explaining and encouraging.
Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.doc Version 1.40 Page 14 A record of activities is completed for each resident to show what they did and the level of participation. It is recommended that this be evaluated each month to show what activities were enjoyed and what failed in order to create a plan of suitable activity for each person. Three residents and staff recently went to an Hotel in St Anne’s for a weekend break. The photographs showed that everyone had a good time. People were observed to move about the home freely and interact well with the staff they met. The lunchtime food was sampled. This was well presented and tasty with two choices of very tender meat followed by a hot dessert. Assorted sandwiches, pork pie and sausage rolls offered a further alternative for those people who wanted to walk about. This food which was fresh and well presented was available during the course of the day. Pieces of fresh fruit were also available. The meal served in the ground floor dining room was a relaxed sociable event. Staff assisted as required and plate guards were provided to aid eating. Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.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) 16,17,18 The home has a detailed complaints and adult protection procedure which is robust and protects service users. EVIDENCE: Comment cards from professional health care workers who visit the home stated that they were not aware of the home’s complaints procedure. This is clearly on display in the entrance porch to be seen by anyone visiting the home with a further copy in the service users guide. It is suggested the manager sends a copy to the district nurse manager and local health centre. Staff have an understanding of what constitutes abuse and have shown their ability to put that knowledge into practice. Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.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) 19,20,21,22,23,24,25,26 Work to improve the environment and make it more suitable for the needs of the people accommodated has taken place. The manager continues to look at ways in which the space inside and outside the home can be put to better use for the residents Odour control has improved. New products are being tested to try to eliminate all odours. This may also require floor coverings to be replaced by a suitable none slip easily cleaned surface in some areas. The business plan should reflect the cost implications of maintaining a satisfactory odour free environment. Work to bring the toilets in en suite rooms up to a satisfactory standard must be carried out and the laundry area must be redecorated and maintained to a satisfactory standard to avoid cross infection. EVIDENCE: The manager continues to look at ways in which the environment can be improved for the benefit of the residents. New handrails to provide a better grip for residents have been fitted on the corridors to reduce the risk of falls. Communal areas are pleasantly furnished and there was a better level of odour control in communal areas. An unused staff room on the first floor is to be
Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.doc Version 1.40 Page 17 converted into a dining area to provide more lounge space for the people living on that floor. The manager is currently testing the effectiveness of a new odour control product. Some work to upgrade the toilet pans in the en suite bathrooms is still outstanding and some bedrooms had an unpleasant odour. The manager should consider replacing carpets with a suitable non slip floor covering in those rooms where it is difficult to maintain a satisfactory level of odour control. The laundry area is cramped and looked cluttered and grubby on the day of the inspection. The hand washbasin could not be accessed which raised concerns about the risks of cross infection. The discoloured toilets in the en suite bathrooms have not yet been replaced. Some of the bedroom doors have been repainted in different colours, fitted with handles, door knocker, a mock letter box and a discrete name label. This has made them more easily identified to their occupants and raises awareness about the need to respect privacy. A decked ramp has been fitted to one of the doors into the outdoor area at the back of the building in an attempt to make this area more accessible for residents. Two way portable intercoms are used by staff and visitors if they accompany residents into the garden. The manager has already identified space in the home which could be used as a sensory area and has discussed the equipment and training required for this project. Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.doc Version 1.40 Page 18 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) 27,28,29,30 The home’s recruitment practices, training for new staff and ongoing training programme including dementia care supports and protects residents. The organisation should review the job descriptions and introduce employee specifications to improve the staff selection process and make it more relevant to the home and the people being cared for. EVIDENCE: Apart from one night care worker vacancy the home was fully staffed. The staff were alert and carrying out their duties in a confident way. A member of staff was enthusiastic about the key-worker system (named care worker for each resident) as she felt this gave each resident more person centred care. The manager has attempted to look for a satisfactory balance of skills and cultural mix within the staff team and for people who are able to offer a commitment to longer term employment in the interests of the residents. This was apparent at the time of the inspection. Interviews are carried out by two people with questions based on a job description. It is strongly recommended that the manager develops an employee specification which identifies the essential and desirable requirements for the role of care worker. This will provide more focus for selecting the best person for the job at the interview stage and justify any decisions made. One application form inspected did not provide enough information for the person’s full employment history to be checked This must be a part of the selection process. The home has a good induction training programme for all new staff which covers all the principles of care. The manager provides a distanced learning
Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.doc Version 1.40 Page 19 training programme on dementia care which is extended to staff from other homes within the organisation. The benefits of this training were observed during the inspection. Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.doc Version 1.40 Page 20 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) 31,32,33,34,36,37,38 The home is well managed and the manager is well able to discharge her responsibilities. She offers good leadership to the staff who were pleasant and attentive to the residents needs. Systems are in place to ensure the residents are protected and cared for in a correct manner. The content of staff supervision should cover topics relating to the care of residents. The business plan should reflect the home’s category of registration EVIDENCE: The manager of the home who is enthusiastic and well motivated is completing the final part of a Diploma in Dementia Care. She is constantly striving to improve the quality of life for people living in the home through training, research, questioning practices and if necessary making changes. A deputy manager has been appointed who was also able to demonstrate an ability to question and a commitment to good practice. She felt she was receiving good
Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.doc Version 1.40 Page 21 support from the manager as an introduction to her new responsibilities. The job description for the deputy was examined. This was generic to the whole company and not particularly relevant to the care home. It is recommended that this be reviewed. All staff have received some formal staff supervision. The deputy manager will need training to supervise staff if the programme of supervision is to meet the required minimum of 6 supervisions for each person by the end of the year. The present supervision format is rather limited. To be effective it should cover a wider range of topics to include care plans, recording skills and look at strengths and weaknesses. Relatives meetings are held. The times are changed to allow people more opportunity to attend. It is credit to the manager that she continues to have the meetings despite the poor attendance. The business plan for the period April – October was inspected. Overall this was good but the author of the plan did not appear to have an understanding of the registration category of the home. There was no reference made to the specialist service provided by the home and any cost implications. The report referred to staffing requirements agreed with Leeds Health Authority being met. The home, which provides residential care is not registered or inspected by the Health Authority. Any staffing proposals have to be agreed with the CSCI and have to be sufficient to meet the needs of the residents in the home at any given time. Routine Health and Safety checks are carried out and recorded. Inspection of the records showed that the Electrical Installation check carried out every 5 years was overdue. Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.doc Version 1.40 Page 22 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 4 3 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4
COMPLAINTS AND PROTECTION 3 3 2 3 3 3 3 2 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 Standard No 16 17 18 Score 3 3 3 4 4 3 3 x 3 3 3 Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.doc Version 1.40 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement Timescale for action 31.12.05 2. 21 23 3. 4. 26 26 16 16 There must be evidence in the care plans to show how residents needs are being met and how judgements are made when care plans are evaluated The toilets in the en suite areas 31.03.06 must be of a satisfactory standard. This work is outstanding from previous inspections The laundry area must be kept 31.12.05 to a standard which reduces the risks of cross infection. Odour control must be 31.12.05 satisfactory throughout the home RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 12 26 29 Good Practice Recommendations Activities should be evaluated on a regular basis to make sure they are suited to the preferences of each resident Alternative none slip floor coverings should be considered in those bedrooms where odour control is a problem The organisation should review job descriptions and
20050915 Hartisca House AN Stage 4 S1458 V181903 J52.doc Version 1.40 Page 24 Hartisca House 4. 5. 6. 36 38 34 develop employee specifications which are relevant to the home in the interests of equal opportunities Staff supervision should cover topics relevant to the care of residents The electrical safety checks should be completed before the end of the year The homes business plan should reflect the registration category of the care provided and any special needs of the residents Hartisca House 20050915 Hartisca House AN Stage 4 S1458 V181903 J52.doc Version 1.40 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley Leedsm, LD13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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