CARE HOME ADULTS 18-65
Harwood House Birtley Lane Birtley Chester-le-street County Durham DH3 1AX Lead Inspector
Trevor Jarvis Unannounced Inspection 10th January 2006 10:00 Harwood House DS0000007433.V256350.R01.S.doc Version 5.1 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 Harwood House DS0000007433.V256350.R01.S.doc Version 5.1 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 Adults 18-65. 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. Harwood House DS0000007433.V256350.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Harwood House Address Birtley Lane Birtley Chester-le-street County Durham DH3 1AX 0191 492 3921 0191 492 3892 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) Northgate & Prudhoe NHS Trust Mrs Jean McNestry Care Home 5 Category(ies) of Learning disability (2), Learning disability over registration, with number 65 years of age (4), Physical disability over 65 of places years of age (1), Sensory Impairment over 65 years of age (1) Harwood House DS0000007433.V256350.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd August 2005 Brief Description of the Service: Harwood House is a spacious, purpose-build bungalow with five generously sized bedrooms of which one is with en-suite facilities offering 24 - hour care, supporting and encouraging adults with learning difficulties and complex needs, who are not quite able to look after themselves. The home cannot provide nursing care. Facilities, including bathrooms and toilets are adapted for service users who are physically frail or disabled, and also has an emergency pull cord system. Access to the front of the dwelling is ramped and ample car parking for staff and visitors is available to the side. The pleasant well-kept, enclosed gardens at the back of the home include raised flowerbeds, to which service users may tend to if they choose. The home currently provides accommodation for five people with a learning disability, one of whom also has physical disabilities and uses a wheelchair. Northgate & Prudhoe NHS Trust owns the home. Staff are available 24 hours per day, seven days a week to guide people in their daily lives and to provide waking night cover. The home is situated in a residential area of Birtley and is within walking distance of local shops, pubs, churches and other community facilities. The area is well served by public transport, which include those running to central Gateshead, Washington and Chester-le Street, and the people living at the home have the use of a privately owned adapted people carrier as well. Harwood House DS0000007433.V256350.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This surprise visit was carried out over 7 hours during the late morning afternoon and early evening and on the day the inspector: • • Was shown around the home and checked the general maintenance and hygiene of the building Talked with service users the manager and staff and looked at how they all talked to each other. Some of the people have difficulty making their views known. Therefore staff practice, attitude and approach were observed and judgements were made about how well the approaches that were used were working Read a sample of the service users records Had two meals with service users and staff and checked the home’s paperwork Telephone conversations with two relatives • • • During this inspection key standards were focused on but not all were checked. What the service does well:
Service users and staff appear to get along really well and spend a lot of time talking and doing purposeful things together during the day. Service users have the chance to do lots of things whilst at Harwood House they can choose whether to go to their normal day service or not. If they do not want to then they can do lots of other things during the day on an individual and group basis according to everyone’s expressed preferences. Trips to the theatre, cinema and shopping centres take place regularly. People eat out at local restaurants and pubs and everyone gets the chance to go away on holiday once a year with staff support. This can happen because there are lots of staff at Harwood House. One person told the inspector about a recent holiday to London and photographs taken at the time have been mounted in albums to provide enduring memories. Staff appreciate service users individual needs and were seen to be gracious, respectful and attentive and this warm, friendly approach is clearly strength of Harwood House. Service users said how they are always smiling and happy. Relatives of two service users were highly complimentary about Harwood House and comments included, “she’s a different women since going to live at Harwood House, she’s come on leaps and bounds,” “she is more outgoing, even a medical complaint cleared up,” “I would give it a 100 out of 100.” Another relative said, “I’m absolutely delighted with Harwood House”, “staff keep me informed on a very regular basis.”
Harwood House DS0000007433.V256350.R01.S.doc Version 5.1 Page 6 The bungalow is very well decorated and furnished and odour free. It is comfortable and has a relaxed, friendly atmosphere where people are happy to invite family or friends. It is spacious and has two lounges/sitting areas for the people whom live here to choose from. It also has good access for the person who has a physical disability. Service users have chosen their own colour schemes for their bedrooms so they are all different and individual. People here know that they can spend time in their room whenever they wish. Staff encourage service users to view their bedrooms as their own, and also include them in choosing new furniture, ornaments, pictures and the like for their home. The manager gives a strong lead to a well-qualified, enthusiastic, caring and hard-working 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Harwood House DS0000007433.V256350.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Harwood House DS0000007433.V256350.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 5 Standard 2 was not assessed during this inspection but will be assessed during the next inspection. Progress still needs to be made to ensure that service users or their representatives have updated contracts and terms and conditions of their accommodation in order to expand choice and control over their lives. EVIDENCE: The manager informed the inspector that the home used an original contract with terms and conditions, acknowledging that this document would benefit from revision and updating. Harwood House DS0000007433.V256350.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8 and 9 Each service user has an individual care plan, which clearly sets out how assessed needs will be met. These also demonstrate the involvement of service users in making choices about day-to-day living. Staff support service users to develop their capacity to do what they want and are guided in taking risks in their daily social and leisure interests that form part of an independent lifestyle, which make a significant contribution to improving quality of life. EVIDENCE: There are regular house meetings (weekly) to enable service users to actively participate in the day to day running of the home and a meeting was held during this visit. There are records of house meetings, which give service users the opportunity to discuss, for instance how they wished to spend their time and where they wished to go on holiday later in the year. The organisation has a policy relating to risk management. A sample of risk assessments linked to individual service user support plans were inspected during the day. Risk assessments are prepared routinely and encompassing specific guidelines for certain activities or routines for example dressing.
Harwood House DS0000007433.V256350.R01.S.doc Version 5.1 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 13 When staying at the home, service users are supported to try creative and new things, make friends and be a part of the community providing stimulation and interest for people living in the home. Consequently service users lead active fulfilled lives. EVIDENCE: Staff support the communication skills of the service users by encouraging them to join in conversations, and also use pictorial symbols to help service users make sense of the pattern of their day. A range of opportunities and activities are available to service users both inside and outside the home and these have been developed by staff so that service users can take part in events, which are appropriate to their ability and interests. A number of activities were seen during the inspection, for example one service user accompanied by two staff members went along to try out sensory equipment at a local centre and the rest spend a relaxing but stimulating time working on a card making kit or painting and drawing. If service users do not want to join in with any activities or become weary staff respect this and do not try to make them join in.
Harwood House DS0000007433.V256350.R01.S.doc Version 5.1 Page 11 Service users attend church and local college courses (care & beauty) visit local hairdressers, weight watchers clubs, shop locally and eat out at pubs and restaurants and appreciate evenings at the cinema and theatre. Two service users have seen the production of Chitty Chitty Bang Bang at Sunderland Empire and thoroughly enjoyed the experience. In this way the home provides service users with gratifying, active and appropriate leisure interests and contact with local communities. Harwood House DS0000007433.V256350.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed on this occasion but will be at the next scheduled inspection of the home. EVIDENCE: Harwood House DS0000007433.V256350.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Whilst service users communication skills are limited, arrangements are in place through the complaints process to promote their safety and offer protection. The home cares well for its entire service users well being through its arrangements for safeguarding service users from harm and exploitation and staff actively promote the protection of service users. EVIDENCE: Service users lack the ability and comprehension to fully understand what is included in the complaints procedure but staff are very much aware of observing changes in service user’s behaviour and body language recognising that this could be an indication of when they may not be satisfied. From discussion with staff and from examination of case files it was clear that staff were able to take examples of this and demonstrate what actions have and would be taken. The home has information and measures on abuse and on what staff should do if they think someone is being harmed. Staff confirmed that they have access to this information and are aware and confident enough to report any concerns should this be necessary. All staff have had training about this. Key workers who care for service users know the needs of their service users well and quietly and effectively check on their charges’ welfare continually. The service users turn to them readily for help. Service users said they are happy to talk to the staff or manager about any worries they have about the service. They said or indicated that they are content and like living at the home and feel safe there. There have been no Safeguarding Adults Meetings since the last inspection.
Harwood House DS0000007433.V256350.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection therefore will be reviewed at the next inspection. EVIDENCE: Harwood House DS0000007433.V256350.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 35 and 36 The homes uplifted and well-qualified staffing complement is well deployed to meet even the most complex need. These service users are in competent and safe hands with their care needs being met by a well-trained, supervised staff team. EVIDENCE: Positive steps have been taken to recruit staff for vacant posts thereby ensuring that a consistent and able staff team supports service users. The home has a favourable staff service user ratio with a minimum of three members of staff on duty during the day and sometimes four. Over 50 of staff have the NVQ Level 2 qualification. The age range of the staff is well balanced, with a good gender mix at all levels of responsibility. The home has the Trust’s induction programme for all new members of staff. The appraisal system is now fully developed. The manager explained that staff supervision has been occurring approximately every two months. A record is kept. Staff confirmed that there were regular opportunities for supervision and they felt that the manager was accessible and supportive as part of her management responsibilities. Harwood House DS0000007433.V256350.R01.S.doc Version 5.1 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 The service is being run well and there is experienced leadership, guidance and direction to staff to ensure service users receive consistent quality care. The service users are kept safe and their rights are respected. EVIDENCE: Service users as a matter of course are asked about all manner of things and how they feel about the home through informal discussions and service user meetings. The manager is responsible for ensuring the home’s aims to provide high quality care to adults are fulfilled and the day-to-day running of the home. Leading by example, she effectively maintains a cohesive and committed team and develops the home’s reputation for good caring practices. She is accessible to all and open to ideas enabling her to keep her finger on the pulse of the home. Routine administration is efficient and effective and financial control is good. The newly appointed member of the staff team who commenced working this week is well supported.
Harwood House DS0000007433.V256350.R01.S.doc Version 5.1 Page 17 Staff have training in health and safety, moving people, food and what to do if there was a fire. Service users are told what to do if there is a fire, when they arrive at the home and are reminded regularly. The home has looked at keeping people safe when doing things around the home like preparing snacks in the kitchen or when they try a new activity, like swimming. Relatives are asked what they think. The home keeps information about any accidents people have. Harwood House DS0000007433.V256350.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 X 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 4 33 X 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X 3 3 x LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 X 16 X 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X x 4 3 3 X X 3 x Harwood House DS0000007433.V256350.R01.S.doc Version 5.1 Page 19 No 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 YA5 Regulation 5 Requirement The provider must update its original standard form of contract to service users for the provision of services Timescale for action 30/03/06 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 YA35 Good Practice Recommendations The manager to develop a system to ensure experienced staff receive refresher training about safeguarding adults. Harwood House DS0000007433.V256350.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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