Inspection on 18/04/05 for Harts House Nursing Home

This inspection was carried out on 18th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Harts House Nursing Home 03/10/07

Harts House Nursing Home 25/07/06

Harts House Nursing Home 27/10/05

Harts House Nursing Home 12/10/04

Harts House Nursing Home 13/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Harts House Nursing Home Harts Grove Woodford Green Essex IG8 ODP Lead Inspector Gwen Lording Unannounced 18 April 2005 11:00 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. Harts House Nursing Home G55_S0000025955_Harts House_V221851_180405_Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Harts House Nursing Home Address Harts Grove, Woodford Green, Essex, IG8 ODP 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) 020 8502 9111 020 8502 9444 BUPA Care Homes (GL) Ltd Mrs Julie Harris CRH Care Home 61 Category(ies) of OP Old Age 61 registration, with number of places Harts House Nursing Home G55_S0000025955_Harts House_V221851_180405_Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 2 beds may be used for respite care for residents aged between 50 and 65 years. To include one named person under 65 years of age. Date of last inspection 12th October 2004 Brief Description of the Service: Harts House Nursing Home is owned and operated by BUPA Care Homes. The home is registered to provide care with nursing for up to 61 elderly people over the age of sixty-five years. The home is situated in a quiet residential area of Woodford in the London Borough of Redbridge. There are good transport links and the home is close to shops and other amenities and community facilities. All the rooms have en-suite facilities and the premises have been fully adapted to accommodate service users with a range of physical disabilities associated with old age and are suitably equipped. The external grounds and the premises are well maintained and secure. The home employs activities co-ordinators, catering, domestic, maintenance, laundry and administrative staff, as well as registered nurses and care staff. Harts House Nursing Home G55_S0000025955_Harts House_V221851_180405_Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 11.00 am. It took place over four and a half hours during the late morning and early afternoon. The Inspector spoke to one service user who was admitted to the home for respite care, one service user recently admitted to the home and five service users who have been resident in the home for a number of years. The deputy manager, senior nursing sister and other nursing and care staff were also spoken to during the inspection. A tour of the home took place and a number of staff and care records were inspected. The current registered manager has been on extended leave due to ill health since January this year. The deputy manager is in charge of the home in her continued absence and is receiving support and supervision from the registered providers. These interim arrangements will be reviewed by BUPA in May this year and discussed with the Commission. What the service does well: The standard of the décor, furnishings and fittings are maintained to a very high standard and provide service users with an attractive and comfortable place in which to live. The home supports service users to exercise choice and control over their lives and the routines of daily living and activities available are flexible and varied to suit individual’s expectations, preferences and capacities. Service users and their relatives are consulted and informed about issues affecting the home through regular newsletters and service user/ relative meetings. All necessary health care services are accessed for service users in order to meet their assessed and specialist needs. Two members of staff take responsibility for arranging a weekly programme of activities, which is circulated in writing to each service user. Harts House Nursing Home G55_S0000025955_Harts House_V221851_180405_Stage 4.doc Version 1.20 Page 6 Visiting times are flexible and visitors commented that they are always made to feel welcome by staff. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Harts House Nursing Home G55_S0000025955_Harts House_V221851_180405_Stage 4.doc Version 1.20 Page 7 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 Harts House Nursing Home G55_S0000025955_Harts House_V221851_180405_Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 A comprehensive pre-admission assessment is undertaken for all service users prior to their admission to the home. This ensures that all the care needs of the individual are understood and met. EVIDENCE: Individual records are kept for each service user and inspection of three records on each floor of the home had full assessment information recorded. The records showed that service users and their relatives/ representatives and all relevant professionals had been involved. The home does not provide intermediate care. Harts House Nursing Home G55_S0000025955_Harts House_V221851_180405_Stage 4.doc Version 1.20 Page 9 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 and 9 The standard of recorded care planning throughout the home is not consistent for all service users and may not provide staff with sufficient information to ensure health care needs are identified and met. Service users are able to take responsibility for their own medication if they wish, but some risk assessments are not being reviewed regularly to ensure service users are protected and changing needs identified. Where the monitoring of fluid intake/ output is indicated, records must be accurately maintained by staff to ensure the information available on the chart at any time is always current. EVIDENCE: Care plans are generally being maintained to a good standard but there is inconsistent practice in some areas. A particularly high standard of care planning was noted on the first floor. Information in some of the care plans was not being regularly reviewed or updated to reflect changing needs. However, discussion with staff and Harts House Nursing Home G55_S0000025955_Harts House_V221851_180405_Stage 4.doc Version 1.20 Page 10 observation of the handover between qualified staff would indicate that needs were being identified verbally and met. This approach is dependent on staff memory and verbal communication systems. Service users are at risk of not having their health care needs met if this system breaks down. (This refers to requirement No. 3) Risk assessments are undertaken for service users wishing to take responsibility for their own medication, where appropriate. A record is maintained of current medication and a lockable facility is provided in which to store the medication. The inspection of three service users’ files showed that two were being reviewed at regular intervals. However, the risk assessment of one service user had not been reviewed for over a year and did not ensure that any changing needs had been identified. (This refers to requirement No. 4) Staff were noted to be completing the recordings of fluid intake/ output for one service user retrospectively. At 1.00pm the last recording on the chart was for 06.00am although the Inspector was aware that the service user had received fluids during this period. It is essential that all monitoring records for service users are maintained accurately and up to date to ensure that nutritional needs are effectively met. (This refers to requirement No. 6) Harts House Nursing Home G55_S0000025955_Harts House_V221851_180405_Stage 4.doc Version 1.20 Page 11 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 and 14 Social activities are well managed and creative providing daily variation and interest for people living in the home. EVIDENCE: Two staff members take responsibility for arranging activities and there is a weekly programme of activities, which is circulated in writing to each service user. One service user said she appreciated that her husband was able to join her in some of the activities that they both enjoyed prior to her being admitted to the home. Another service user said that she did not want to join in some of the activities and that staff respected this. Visiting times are very flexible and visitors commented that they are always made to feel welcome by staff. Service users are able to receive visitors in one of the lounges or in their own rooms, as they wish. Harts House Nursing Home G55_S0000025955_Harts House_V221851_180405_Stage 4.doc Version 1.20 Page 12 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 and 18 The home has a satisfactory complaints system in place and service users and their relatives feel that their views are listened to and acted upon. There has been no progress in all staff working in the home receiving training in Adult Protection/ Abuse Awareness to ensure a proper response for reporting any suspected or witnessed abuse. EVIDENCE: The home has introduced a system for recording all complaints, expressions of concern and issues of dissatisfaction with any part of the service. All complaints recorded are discussed at Heads of Department and qualified nurses meetings to identify any trends and action to be taken to resolve outstanding issues. There is a written policy and procedure for the protection of vulnerable adults and all newly recruited care staff receive training around Abuse Awareness during their induction training. A requirement was made at the last inspection for all staff working in the home, including ancillary and administrative staff, to receive training in Adult Protection/ Abuse Awareness and this has not been progressed. It is a requirement that this is considered to be a priority training need for all staff in the home and must be complied with by the new timescale. (This refers to requirement No. 1) Harts House Nursing Home G55_S0000025955_Harts House_V221851_180405_Stage 4.doc Version 1.20 Page 13 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 and 20 The standard of the environment within the home is very good providing service users with an attractive, safe and comfortable place in which to live. EVIDENCE: The standard of the décor, furnishings and fittings in the home are maintained to a very high standard. There is an ongoing programme of refurbishment and redecoration. The external areas of the home are equally well maintained and there is a secluded garden which is fully accessible to service users. From discussion with service users it is evident that themselves and their relatives/ visitors gain much pleasure from the garden. Service users are very much involved in the seasonal plans for the garden. Harts House Nursing Home G55_S0000025955_Harts House_V221851_180405_Stage 4.doc Version 1.20 Page 14 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 and 29 Staffing levels are satisfactory and there are sufficient staff on duty to meet the individual assessed needs of the service users. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. EVIDENCE: The home has a relatively stable workforce and in discussion with staff it was evident that they fully support the main aims and values of the home. The information on the duty rota was consistent with the names and delegations of staff on duty. Service users commented on the use of agency nursing and care staff, as they did not consider that agency staff always fully understood their needs. A small consistent number of agency staff have been used recently to fill vacant night posts and sickness. The staff files examined of three staff members employed since the last inspection indicated that the home is undertaking all the necessary recruitment checks to ensure the protection of service users. Harts House Nursing Home G55_S0000025955_Harts House_V221851_180405_Stage 4.doc Version 1.20 Page 15 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, 33, 36 and 37 The home is being managed well in the absence of the registered manager and provides a safe environment for the service users in the home. EVIDENCE: The current registered manager has been on extended leave due to ill health since January this year. The deputy manager is managing the home in her continued absence. The registered providers have put in place satisfactory interim arrangements to support the deputy manager during this time and the situation will be reviewed at the end of May. (This refers to requirement No. 5) Regulation 26 visits are undertaken by the responsible individual on a monthly basis. A copy of the report is supplied to the Commission to show that the registered providers are effectively monitoring the service provided in the home. Harts House Nursing Home G55_S0000025955_Harts House_V221851_180405_Stage 4.doc Version 1.20 Page 16 Whilst a system is now in place for all care staff to receive supervision on a regular basis this must also be put in place for all qualified nursing staff working in the home to ensure that they are effectively supported in their work and clinical practice. (This refers to requirement No. 2) The home is well maintained and provides a safe environment for service users and staff. Inspection of a sample of records indicated that regular tests to emergency lights and fire alarms had been carried out. Harts House Nursing Home G55_S0000025955_Harts House_V221851_180405_Stage 4.doc Version 1.20 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION 3 3 x x x x x x STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 x 3 x x 2 3 x Harts House Nursing Home G55_S0000025955_Harts House_V221851_180405_Stage 4.doc Version 1.20 Page 18 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 18 Regulation 13 & 18 Requirement It is a requirement that all staff in the home, including ancillary and administrative staff receive training in Adult protection/ Abuse Awareness (Timescale of 31/12/04 not met) It is a requirement that supervision systems are fully implemented in accordance with Standards 36.2 and 36.3 of the National Minimum Standards (Timescale of 31/01/05 not met) All service users must have have a written care plan in sufficient detail to provide staff with clear guidance on the actions required by staff to meet health, personal and social care needs. The care plan must be regularly reviewed and updated to reflect changing needs. Where service users are able to take responsibility for their own medication, staff must ensure that risk assessments are regularly reviewed. The registered providers must review the interim arrangements for the management of the home in the continued absence of the registered manager Timescale for action 31/07/05 2. 36 18 31/05/05 3. 7 15 31/05/05 4. 9 13 31/05/05 5. 31 8&9 31/05/05 Harts House Nursing Home G55_S0000025955_Harts House_V221851_180405_Stage 4.doc Version 1.20 Page 19 6. 8 12 Where the monitoring of fluid intake/ output is indicated staff must ensure that these records are accurately maintained and up to date 30/04/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Harts House Nursing Home G55_S0000025955_Harts House_V221851_180405_Stage 4.doc Version 1.20 Page 20 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Harts House Nursing Home G55_S0000025955_Harts House_V221851_180405_Stage 4.doc Version 1.20 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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