CARE HOMES FOR OLDER PEOPLE
Harton Grange Boldon Lane South Shields Tyne and Wear NE34 0LZ Lead Inspector
Mrs Elsie Allnutt Key Unannounced Inspection 10:00 10 and 24th May 2007
th 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 Harton Grange DS0000069206.V338073.R02.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. Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Harton Grange Address Boldon Lane South Shields Tyne and Wear NE34 0LZ 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) 0191 4546000 01914546002 Barchester Healthcare Homes Ltd Lesley Gregg Care Home 61 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (31), Mental disorder, excluding learning of places disability or dementia (3), Mental Disorder, excluding learning disability or dementia - over 65 years of age (10), Old age, not falling within any other category (61), Physical disability over 65 years of age (10) Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The Manager will be supernumerary to the staffing compliment. A minimum of 2.5 hours catering per person per week is to ne provided. Regardless of the number of service users at the home a minimum of 56 hours per week will be provided for catering. A minimum of 110 hours per week will be provided for domestic cover. A minimum of 35 hours per week will be provided for dedicated laundry staff. The service may from time-to-time admit people under the age of 65 within the OP category. 22nd 23rd and 30th May 2006 3. 4. 5. Date of last inspection Brief Description of the Service: Harton Grange is a care home offering personal care to 61 older people, some of whom may have dementia, mental health needs or a physical disability. The registration of this home is currently under review and any changes made will be reflected in the next report. Situated just off a busy main road, the home is a short walk from local shops and other amenities. The local library is next door and shares the same access road. The home has 3 floors, although residents use only 2 floors, as the 3rd floor provides staff facilities. All the rooms are single, meet National Minimum Standard sizes and benefit from en-suite toilet facilities. A choice of lounges is available and lobby areas were designed to provide additional seating areas and are popular with residents. Access into the building is level and a shaft lift provides access to the other floors. A door entry system is operated on the front door as a security measure. Externally, an enclosed garden area can be accessed via the ground floor but residents on the first floor also have access to a balcony area. The home has developed a Service User Guide that offers information about the home and the service offered for service users and other interested parties. The current fees charged by the home are between £395 and £425 per week. Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This scheduled unannounced Key Inspection was carried out over one day in May 2007 and to consolidate the information gathered a follow up telephone conversation was made to the manager later in the same month. The care experienced by a sample of service users was looked at in detail and time was spent chatting with service users, their relatives and staff as well as observing life in the home. The inspector looked around the building and a sample of staffing and service users’ records was inspected. A meal was taken with service users. The judgements made are based on the evidence available to the inspector during the inspection. What the service does well:
There is both a warm and welcoming atmosphere in this home. Staff interact with service users in a positive and stimulating way, encouraging conversation and response by using the knowledge of the service users’ interests and also using humour with respect and sensitivity. People interested in using this service were observed visiting the home not having made an appointment but being welcomed by staff in an accommodating and friendly manner. Although the manager was very busy at the time, time was found to give information about the home and to give a conducted tour. One visitor stated “ We are always made to feel welcome here.” As a result of effective cleaning and maintenance routines the home maintains a high standard of cleanliness, tidiness and safety. The laundry particularly reflects good cleaning and organisational routines and as a result service users’ clothing is well looked after. Personal photographs and small items of personal furnishings and furniture decorate service users’ rooms. This helps people to settle into the home while maintaining their identity and to recognise that they have their own personal, private space. Married couples are accommodated together. One couple share a bedroom and have a separate sitting room. One commented, “this is all our own furniture brought from home, we’ve set it out just as it was and it makes us feel that we are still in our own house.” Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 6 The home has an enthusiastic staff team who aim to provide a good and supportive service. One member of staff commented, “ I love working here, everyone works as a team it’s good.” Staff are well trained which means that service users are supported appropriately and with skill. Service users are well cared for and this is reflected in their appearance which promotes their dignity and self-respect. Several cards and letters received by the home from family members contained compliments to the staff in relation to the care given. These include several positive comments made by visiting GPs, community nurses and other health professionals. They all reflect the positive care delivered and as one health professional said, “The warmth and sensitivity given.” A variety of activities are offered within the home. This means that service users are stimulated to take part in activities that interest them. There are meetings organised to include service users and their relatives/friends where they can discuss what activities they want to see taking place and also how they want the service to develop. Relatives, staff and service users discussed an Easter Bonnet Competition that had take place and spoke with interest about the developments of a working kitchen currently being developed and also extensions planned for the garden. The home supports people with dementia and other illnesses related to memory loss extremely well. The dementia care unit is particularly well organised and furnished with stimulating objects and activities that attract service users and engage their interests. Staff are trained well so that they understand the needs and behaviours of service users which in turn promotes their well-being. Service users are supported to make choices in relation to their daily routines and so that staff can support them to do this information about their lives and their likes and dislikes are recorded in their care files. The meals are well planned, nutritious and nicely presented and service users with special dietary needs are effectively catered for. One service user commented, “you get a choice of meals, and they’re good.” What has improved since the last inspection?
A range of training opportunities has enabled staff to put care plans in place that reflect sufficient detail so that they can meet service users’ needs. Staff are now beginning to use service users’ personal care records in an effective way. Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 7 So that appropriate care is given to service users and they are supported in an appropriate way staff now request advice from a range of healthcare professionals and so that a consistent approach is given guidelines given by the professionals are recorded in some individual care plans. A new assessment tool is currently in use. This encourages more information to be produced about service users’ social, emotional, cultural and sexual needs, as well as their physical and mental health needs. However some staff still need to learn how these documents should be appropriately completed. A great effort has been made by the home to gather as much background information about individual service users as possible. This has now become standard practice and includes past events and routines associated with individual service user’s lives. This is beginning to be compiled into individual life histories so that staff have the important information that will enable them to support the service user and stimulate them to become involved in activities that interests them. While promoting the well being of service users it also enables staff to understand their behaviours. This is good and has much improved care practices in this home. Great improvements have been made in the dementia care unit. The manager has made memory boxes for individual service users and has furnished the dementia care unit with artefacts that triggers individual memories. This has resulted in a stimulating environment for people with memory loss who now can engage in activities that relates to their past and that also have current meaning to them. Since the last inspection the staffing ratio has improved. As a result of this and the way staff are now delegated to identified tasks, service users are now receiving improved direct care and support. The overall systems for assessing the quality of the service have been reviewed. The manager follows good practice in being a visible presence in the home and this has assisted staff to also improve their practice. What they could do better:
The Statement of Purpose and Service User Guide needs to be updated to reflect the changes in management in the home. Service users should be issued with a copy of the updated Service User Guide so that they have current information about the home and the service delivered. The use of the new assessment document should be monitored so that all staff complete it appropriately. This will mean that no important information about the individual service user’s needs or interests will be lost. Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 8 When a preadmission assessment has been received from the referring agency and the home has made a decision about whether they can meet the service user’s needs, the registered manager must confirm this in writing to the prospective service user whether they can meet their needs in respect of their health and welfare. It is suggested that the activity coordinator records the outcomes of service users activities and coordinates these with individual care plans so that useful information is not lost and can be used in an effective way to promote and support future individual choices. The home must ensure that they address the recommendations made by the Environmental Health department during their recent visit. So that the safety of the service users is maintained and promoted fire doors must only be kept open by a mechanism that is connected to the fire alarm system and that automatically releases the open door in the event of a fire. Wooden chocks must not be used. 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. Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 9 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 Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 10 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): 1,3,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users are given adequate information about the service on which to base a decision about whether they want to live there. Service users are admitted to the home only after a comprehensive preadmission assessment is carried out by, and a current care plan is received from, the referring agency. This means that the home has the relevant information on which to base a decision and that they are in a position to confidently inform the prospective service user that they can meet their needs. EVIDENCE: The service has developed a comprehensive Statement of Purpose and Service User Guide both of which are currently being reviewed and modified to reflect the recent changes made to the management of the service. The manager confirmed that all current, as well as prospective service users, are to be given Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 11 a copy of the new documents. This will be part of the Welcome Pack currently in use. A copy of the previous inspection report is available in the entrance hall, where other various pieces of important information about the service are on display. This is in an area where all visitors and present service users have access. Of the care files sampled a preadmission assessment and care plan had been received from the referring agencies for each service user, all of which were comprehensive and included sufficient information about the service user on which an informed decision about whether the service could meet their needs could be made. The home is making considerable progress to improve their own assessment process. This has recently been reviewed but there is some confusion as to which document is in use. The sample of files examined showed inconsistency in relation to this. Some of the documents have been completed well, however one was not fully complete and it was uncertain whether more information could have been gathered. The manager confirmed plans to improve this process. The manager gave an example of good practice where one service user and their family have gathered important information about the service user’s life history. This has culminated in an illustrated account entitled My Life Story and includes important information about the person’s life, areas of importance and feelings and emotions experienced at different times. The manager confirmed that this practice is planned at the assessment stage with all service users and such information will become a basis from which a person centred plan will be developed. Currently prospective service users are not formally informed whether the home can meet their needs. This was discussed with the manager who agreed to address this. This service does not provide intermediate care. Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 12 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 good. This judgement has been made using available evidence including a visit to this service. Improvements have been made in addressing the healthcare needs of the service users and these now are generally well met in detailed care plans. Although risks are addressed and the safety and independence of the service users are promoted, risk management plans could be used in a more effective and consistent way. Staff interact with service users in a respectful way and in so doing promote their dignity and right to privacy. EVIDENCE: Care plans are in place for all service users, the content of which continues to improve. Care plans are now beginning to be written in sufficient detail so staff can effectively meet service users’ needs.
Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 13 The care plans are monitored monthly however it was not always identified who had carried out the monitoring process. Although the date was entered there was no signature. Although two service users spoken to were aware of what areas of their lives they needed support in, they were not aware that a care plan was in place. The manager discussed details of how she plans to improve the care planning process and further empower service users by using person centred planning. Staff training has been planned in relation to this. The manager also discussed plans to re-organise the care files so that they are more accessible. Different areas of individuals’ healthcare needs are recorded in the care plan and details of when individual service users are referred to healthcare specialists are recorded for example one person who had been identified as needing support with continence problems there was a continence chart in place and a record of medical intervention. Discussions with staff and the manager identified that although some time had passed no results had been returned by the GP therefore this needed to be followed up by the home. It was suggested that such contacts with the GP should be recorded with dates so that everyone is aware of the action taken and the outcome. Although risk assessments are carried out there is some inconsistency in relation to how and when risk management plans are used. Although for one person the preadmission assessment had identified a high risk of falls there was no risk management plan in place. Such guidance would ensure that staff carry out consistent care practice and in turn reduce the risk of possible falls. However for another service user who was not able to pull their call cord, good practice was demonstrated by having a risk assessment carried out and guidance for staff to reduce the identified risk recorded in the care plan. There are assessment tools in place in relation to falls and nutrition that promote the well being of service users. Discussions with the manager confirmed that the practice of using risk assessments effectively could be improved with training. The day following this inspection the manager confirmed to CSCI (Commission for Social Care Inspection) that training had been arranged to be carried out in the near future for herself and members of the staff team. The administration of the lunchtime medication was observed being appropriately carried out and medication records were accurate. Staff confirmed that they had attended training in relation to these procedures. A care plan was in place for one service user to ensure that pain relief was used appropriately and the service user was pain free. Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 14 Staff were observed interacting and supporting service users with respect and in a way that promotes their dignity. Service users were discreetly approached and gently supported with personal care tasks. Harton Grange DS0000069206.V338073.R02.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 excellent. This judgement has been made using available evidence including a visit to this service. Activity plays a major role in the daily life of this home while the diverse interests and preferred ways of life are respected and supported. Service users are supported to maintain contact with family and friends and at the same time they are supported to make choices about their own lives. Service users receive a wholesome and balanced diet that meets their nutritional needs. EVIDENCE: This home employs an activity coordinator for 25 hours per week and although she is responsible for organising much of the activity in the home, in her absence care staff encourage and support service users to take part in daily activities that they choose. Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 16 Both the activities coordinator and the care staff discussed with enthusiasm the different activities that go on in the home. An activities programme displayed in the entrance hall informs service users and visitors what is planned for the week ahead. Activities include pamper days, pet therapy, chair exercises, quizzes, bingo and outings. As the majority of the people who use this service have some degree of memory loss many of the activities are centred on the Memory Lane theme. Three service users had used taxis to take them to a local park to feed the ducks. The home also has access to a mini bus that is shared with another service within the Company. Students from a local secondary school regularly visit the home to meet with the service users, the aim being that both the service users and the students benefit from this experience. The manager stated feedback from the school has identified that the students now have a greater understanding of the needs and strengths of older people and the service users themselves enjoy the companionship and discussion of the students. A collage mural on the wall of the home depicting a seaside scene is an example of an ongoing activity within the home that service users and visitors can become involved in together. Much effort is made to encourage families and friends into the home. A series of meetings with service users and their relatives have taken place to discuss developments and events within the home. A working kitchen is in the last stages of being developed where service users can go with support from staff or relatives to bake bread and cakes, while at the same time to rekindle old skills and maintain independence while carrying out domestic chores. The manager, service users, staff and relatives showed enthusiasm about this project. While different activities are arranged, different ways of life and cultures are encouraged. Some service users were observed in organised activities while others enjoyed the privacy of their room reading or chatting to relatives. One relative commented “We are always made welcome and sometimes I even have my dinner or tea here with my …” . A member of staff stated that different theme nights are organised to encourage visitors into the home. Events that have taken place have included Fish and Chip, Cheese and Wine and Curry nights. Service users have the opportunity of attending services and meetings held by different religious and faith groups. Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 17 Items of memorabilia decorate the home throughout and much of the activity is based on the Memory Lane ideas. The dementia care unit was particularly buzzing with activity. Stimulating objects and pictures decorate this area. Pictures of old film stars and entertainers decorate the walls and murals made out of materials that can stimulate the mind when touched are available for service users to stop at and admire and feel. Individual service users’ rooms are easily identified with memorabilia boxes that are fixed to the wall outside and individually created depicting past interests and activities of the individual service user. Staff were observed focussing on different small groups of service users where they gently encouraged and supported individuals to take part in short spells of activities that they used to enjoy in their past. The home is commended on their successful attempt to develop this unit with stimulating activity and in so doing promoting the well being of the people who live there. Although service users needs are high and at times have been seen as challenging there was little evidence of frustration or boredom. A meal was taken with service users and the food was found to be both nutritious and enjoyable. Service users confirmed that it is consistently good and that they have a choice of menu. Staff were observed discreetly assisting service users with their meals if needed and offering a choice of food. Harton Grange DS0000069206.V338073.R02.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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. So that the service users are appropriately protected from abuse this home effectively implements the local authority’s adult protection procedures in relation to the protection of vulnerable adults. The home also has a satisfactory complaints system that addresses concerns and complaints appropriately. EVIDENCE: The home has relevant policies and procedures in place to address complaints. Several complaints were recorded and responded to appropriately. A discussion took place with the manager about recording concerns and it was accepted that even though someone may not want to make a formal complaint recording their concern would reflect good practice. The manager stated that it was the home’s aim to address concerns with service users and visitors on a daily basis and she felt that this helped to avoid issues developing into complaints. She also felt that this promoted more positive relationships with service users and their families. All staff have attended POVA training and those spoken to were able to confirm appropriate action to take in the event of observing or having abuse reported
Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 19 to them. There were plans in place for staff to attend training regarding the local authority’s POVA procedures for the following week. The manager confirmed that following this most staff will have received training in relation to the local authority’s procedures. The service users’ individual financial accounts were examined. All were in order and good practices confirmed. The administrator and manager only have access to the records and monies. Pocket money is kept by the home for named service users only and all other financial transactions in relation to fees etc is conducted through individual bank accounts and the Company finance department. Clear and audited accounts are kept of all individual financial transactions. Money spent is confirmed with receipts and entries on to individual records and witnessed with two signatures. Service users who have control of their own money have locked facilities to store it in their individual rooms. Harton Grange DS0000069206.V338073.R02.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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home is decorated and furnished to a good standard. It is clean, warm and well maintained offering service users a homely, stimulating and safe environment in which to live. EVIDENCE: Although generally the standard of décor and furnishings in this home are of a good standard there are some areas currently showing signs of wear and tear. The manager confirmed that plans are in place to address this. There are plans to replace the badly stained carpet in the ground floor dining room and to restore the paintwork throughout the home. There are also plans in place to revamp the kitchen. Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 21 There are high standards of cleanliness throughout the home that reflect good cleaning routines. The laundry in particular is well organised and reflects good and hygienic cleaning practices. Service users’ clothing is well looked after and seldom now goes missing due to effective storage and checks on unidentified items of clothing. A recent visit from the Environmental Health department has resulted in four recommendations being made. The manager confirmed that all have been addressed. A wooden wedge was used to keep the office door open. The manager was advised to remove this and if needed to have a mechanism fitted that would be connected to the fire alarm system and would automatically release the door in the event of fire. The manager immediately removed the wooden chock. Effort by the manager and staff has focussed on making the dementia care unit more stimulating and appropriate to the needs of the people who live there. This has had positive outcomes. People who live here are now occupied in meaningful activity in an environment that is interesting, accessible and suited to their needs. Pictures and small pieces of memorabilia decorate the surroundings. These help to engage service users in pleasurable activity that provides reminiscent experiences, while at the same time providing an environment where service users’ feel safe, occupied and empowered. A small room has been converted into a comfortable old sitting room where service users can go to spend some quiet time. This is set out with an old fireplace and period furniture to match. It is an area where service users might feel safe to relax and reminisce. Service users have access to the gardens that are kept tidy and attractive. One married couple discussed how they enjoy walking around the gardens and under the trellis archways. The manager discussed plans to further develop this area. The garden is to be extended to provide a vegetable patch a sensory garden, cobble pathways and a water feature. Service users and their relatives are involved in these plans and different expert advice in relation to various plants etc. is being offered. A washing line hangs in one part of the garden where some of the home’s washing was blowing freely. This is part of the ethos of the home, to encourage service users to take part in domestic activities that have been part of their lives. Service users are encouraged to hang out and take in the washing. Harton Grange DS0000069206.V338073.R02.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 good. This judgement has been made using available evidence including a visit to this service. The home employs a competent and qualified staff complement that effectively meets the needs of the service users. The robust recruitment procedures ensures that the welfare and interests of the service users are protected. EVIDENCE: The manager deploys staff in a manner that promotes the effective operation of the home. Since the last inspection an additional care member of staff has been employed. This means that there are now nine care staff on duty throughout the day and in addition to this, sufficient ancillary staff. Currently five staff work night shift. This is a sufficient number of staff to address the needs of the people currently living at this home. However the number of staff needed must be regularly reviewed to ensure that any changing needs or activities arranged are appropriately supported. The home employs a team of staff with diverse experiences and qualifications. In recent months some staff have left the home but others have been employed to take their place. One of the new members of staff who previously
Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 23 had not worked in care was awarded a special Care Award by the training agency in recognition of their progress and development. Other members of staff have attained NVQ levels 2 and 3 and some have worked at the home since it opened. The manager confirmed that most staff have now achieved NVQ and those who have not are working towards it. The manager ensures that all staff receives a range of training including an emphasis on dementia care training. Staff confirmed that the dementia care training is a distant learning course that is detailed and motivating. . Some staff have also recently completed distant learning training regarding Equality and Diversity and Health and Safety. A training record is kept and a computer programme identifies who needs to update certain mandatory training. Care practices observed in the home reflect the skill and dedication of a well trained and motivated team. Staff were observed sensitively interacting with service users and working as a team. A sample of staff files was examined; this included the recruitment records of staff recently employed. All included appropriate documents, for example an application form identifying a clear up to date record of employment, 2 written references and a satisfactory CRB (Criminal Records Bureau) check. Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 24 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): 31,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager offers clear leadership and direction to the staff team. This has resulted in a well-trained workforce that offers consistency of care and a home that is run in the best interests of the service users. EVIDENCE: The registered manager is well experienced in this line of work. Prior to taking this position she was the deputy manager at this home. She is qualified in the Registered Managers Award (RMA) and NVQ 4 in Care and she is a qualified NVQ Assessor. She is also up to date with mandatory training. So that the quality of the training delivered to the staff at the home can be monitored the
Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 25 manager attends all of the same training events. In addition to this she also attends training in relation to her role as a manager. Although the manager’s hours are not included in the care hours needed in this home she spends part of her role directly working with and supervising staff so that the staff team is led by example. She has proved to be strong in principle and innovative in her approach. The manager has addressed many of the issues that previously questioned the quality of this service and as a result, the people who live here now receive an improved service and lifestyle. This in particular relates to practices carried out in relation to dementia care in which the manager is a strong leader to all staff. The manager is commended for this. There is an atmosphere of openness and respect in the home and service users staff and relatives were observed approaching the manager with confidence and ease. The manager was observed taking time to listen and respond sensitively. There is a robust quality assurance system in place that is monitored by the Company. The home has also achieved the Investors in People Award this reflects a professional approach to quality assurance. Appropriate records in the fire log and accident book are kept however there was one anomaly found in the accident book. Although the accident was recorded for one service user, the outcome had not been. This was brought to the attention of the manager who agreed to address it. Apart from health and safety issues previously mentioned in this report no others have been identified. Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 26 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 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 4 X 3 X 3 3 X 2 Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 27 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 OP1 Regulation 6(a)(b) Timescale for action The information in the Statement 31/07/07 of Purpose and Service User Guide must be brought up to date and a copy given to all service users. The Company’s assessment tool 31/07/07 must be consistently used and fully completed. The registered manager must ensure that all staff are trained to use and complete this tool so that important information is recorded and not missed. On completion of the 31/07/07 preadmission assessment the registered manager must confirm in writing to the prospective service user whether they can meet their needs in respect of their health and welfare. The registered manager must 31/07/07 ensure that the service user or their representative are involved in the development of their care plan. All risks identified must be clearly addressed and recorded
DS0000069206.V338073.R02.S.doc Requirement 2 OP3 14(1) 3 OP3 14(1)(d) 4 OP7 15(1) 5 OP8 12(4) 31/07/07 Harton Grange Version 5.2 Page 28 6 OP19 23(5) 23(4) 7 OP38 23(4)(5) in enough detail to guide staff to reduce or eliminate the risk to the service user. The home must ensure that they address the recommendations made by the Environmental Health department during their recent visit to the home. Fire doors must only be kept open by a mechanism that is connected to the fire alarm system and that automatically releases the open door in the event of a fire. The home must ensure that they address the recommendations made by the Environmental Health department during their recent visit to the home. Fire doors must only be kept open by a mechanism that is connected to the fire alarm system and that automatically releases the open door in the event of a fire. 31/07/07 31/07/07 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 Refer to Standard OP7 OP12 Good Practice Recommendations The monthly monitoring of the care plans should be signed so that the person recording them can be identified. It is strongly recommended that the activities coordinator records and monitors the activities enjoyed and requested by service users in their care plans so that in her absence care staff can pick up and continue. The response to activities will also provide care staff with important information about the individual’s preferences, likes and dislikes which will help when assisting service users to make decisions and choices. So that service users and their relatives are confident that
DS0000069206.V338073.R02.S.doc Version 5.2 Page 29 3 OP16 Harton Grange 4 OP19 their concerns are taken seriously it is recommended that concerns raised are recorded with details on how they were addressed. The areas of the home that are showing signs of wear and tear should be addressed as soon as possible. Harton Grange DS0000069206.V338073.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South Shields Area Office 4th Floor St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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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