CARE HOMES FOR OLDER PEOPLE
Harwood House Nursing Home Spring Lane Cookham Dean Berkshire SL6 6PW Lead Inspector
Marie Carvell Unannounced Inspection 27th September 2006 10:15 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 DS0000010987.V305608.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000010987.V305608.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Harwood House Nursing Home Address Spring Lane Cookham Dean Berkshire SL6 6PW 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) 01628 478000 01628 478012 Harwood House Limited Ms Morag Forsyth Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (30) of places DS0000010987.V305608.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No physically disabled adults under the age of 60 to be admitted. Date of last inspection 22nd November 2005 Brief Description of the Service: Harwood House is located approximately three miles from Maidenhead in a rural setting at the end of a hedged driveway on raised ground with views over trees and fields with Windsor and the Thames Valley beyond. The home provides twenty four hour nursing care for up to 30 residents over the age of sixty years. There is a sitting room and separate sun lounge with French windows leading onto a large patio, used extensively in the summer months. The accommodation is on three floors with a small passenger lift available to transport wheelchairs between floors. The house stands in attractive grounds and gardens. The gardens can be approached from various areas of the house and are laid out to lawns, flowerbeds and trees. There are pleasant views from most areas of the house and garden. The current scales of charges as at September 2006 are between £725.00 and £1,200.00 per week. There are additional costs for newspapers, magazines, hairdressing, chiropody and phone calls. DS0000010987.V305608.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 10.15am and was in the service for seven hours, forty five minutes. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the services and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. By agreement with the manager the service users are called residents within this report. What the service does well:
Staff communicate with residents in a respectful and appropriate manner. The inspector gained the impression that there is a good rapport in the home between the residents and all grades of staff. Several residents and relatives described the care as excellent. One resident survey stated, “ In general I am impressed by the attitude and competence of staff”. Comments made in the visitors’ book included “ Very friendly and happy staff”, “Very happy with care provided. 1st class. Can’t fault”. The majority of residents were complementary about the variety and choice of food provided. Menus demonstrated that a varied, appealing, wholesome and nutritious diet is provided. There is always a choice of meals and residents confirmed that the cook is very flexible and will prepare an alternate meal if requested. There appears to be sufficient numbers of staff employed in the home to meet the needs of residents. There is an effective skills mix of registered nurses,
DS0000010987.V305608.R01.S.doc Version 5.2 Page 6 care assistants and ancillary staff deployed in the home. At the time of the site visit there were two registered nurses and six care assistants on duty to meet the care needs of residents. The manager is present in the home full time and is not included in the staffing numbers to provide direct care to residents. The manager is a registered nurse and has completed the Registered Managers Award and recently the Berkshire Leadership programme. The manager has a clear sense of direction and leadership. Residents and staff were complementary about the manager and her management approach. Records relating to fire, health and safety are maintained to a high standard. During this site visit an external consultant was carrying out a health and safety audit. What has improved since the last inspection? What they could do better:
The gardens are extensive and enjoyed by the residents and visitors in the warmer weather. The rear lawn area is banked and could pose a risk of an
DS0000010987.V305608.R01.S.doc Version 5.2 Page 7 accident to some residents. The manager is to take appropriate action to reduce the risk of an accident. Staff supervision and annual appraisals have not yet commenced in the home. The manager has identified this as needing urgent action. 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. DS0000010987.V305608.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000010987.V305608.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents are assessed prior to admission and are given the opportunity to visit the home before moving in. The manager is currently developing the home’s Service User Guide and Statement of Purpose. EVIDENCE: The Statement of Purpose and Service User Guide are being developed and updated to include additional information. The manager or a senior nurse undertakes a pre-assessment of all prospective residents to ensure that the home is able to meet their needs. The assessment covers health, welfare and social circumstances. Prospective residents are encouraged to visit the home and move in on a trial period. DS0000010987.V305608.R01.S.doc Version 5.2 Page 10 Fourteen of the fifteen surveys returned to CSCI confirmed that sufficient information was received in order to decide whether the home was the right place to live in. Comments received included “Offered and accepted a trial period of two weeks stay, returned some weeks later. I have never regretted the move here, although I hated the idea of leaving my delightful home”,“ I used the Internet to gather information about the home”,“ Decision made for me as I was leaving hospital”. Several residents said that the decision to move into the home was made following short stays or by recommendation from other residents and family members. During the site visit a prospective resident and relative were looking around the home. The member of staff accompanying the visitors was observed to be attentive and answering questions as they arose in a courteous and relaxed manner. From a sample of resident files it was evidenced that a written contract is provided following admission to the home. Contracts are detailed and written in an easy to read format. DS0000010987.V305608.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Resident’s care needs and health care needs are well met. The manager is currently updating and developing resident’s care plans. Medication administration, storage and recordings are satisfactory. Residents feel that they are treated with dignity and respect. EVIDENCE: A sample of resident’s files were case tracked and evidenced that the home is pro-active in meeting the health, personal and social care needs of residents in a dignified and caring manner. Care plans are being developed to include nutritional screening, psychological wellbeing and details of end of life care. Risk assessments are being developed to include safe bathing. Healthcare needs are provided by several local GP practices and it was evidenced that a wide range of healthcare professionals are involved in residents care as necessary. Residents and relatives spoken to during the site visit expressed their satisfaction about the care and support given.
DS0000010987.V305608.R01.S.doc Version 5.2 Page 12 A sample of medication administration records seen were well maintained with no obvious gaps in recordings. The home has a contract for pharmacy advice from the supplying pharmacist who visits the home regularly. Staff were observed to communicate with residents in a respectful and appropriate manner. The inspector gained the impression that there is a good rapport in the home between the residents and all grades of staff. One resident said that staff were very aware of his/her feeling, when personal care was being provided, but staff dealt with this by introducing a sense of humour and this was very much appreciated. Several residents and relatives described the care as excellent. One resident survey stated, “ In general I am impressed by the attitude and competence of staff”. Comments made in the visitors’ book included “ Very friendly and happy staff”, “Very happy with care provided. 1st class. Can’t fault”. Staff were observed knocking on bedroom doors and waiting to be invited in. Residents’ post is delivered to bedrooms at the time of delivery and residents confirmed that they are able to see visiting healthcare professionals in private. DS0000010987.V305608.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents are encouraged to maintain their independence and contact with friends and the local community. EVIDENCE: Residents confirmed that the home matches their expectations and preferences well. Routines are flexible to meet the wishes of residents. There is a part time activity organiser in post and several care staff also have specific allocated time to be involved with a wide range of activities. Relatives and friends are invited to some events held in the home. Comments made in the visitors’ book included “ Thank you for a lovely tea party for the Queen’s birthday. Father enjoyed it too.” “Staff always welcoming and offered a drink”. One survey, completed by a relative commented, “ My perception is that the majority of the activities are geared towards the more mentally able residents.” The manager is actively encouraging all carers to participate in activities to develop a more holistic approach to residents’ care. The majority of residents have friends and family members who visit frequently. Residents confirmed that they maintain contact with the local
DS0000010987.V305608.R01.S.doc Version 5.2 Page 14 community by attending functions, visits to local attractions, meals out and attendance at places of worship. There is a choice as to how residents spend their day, to join in activities or join other residents for meals. Several residents have rooms with a separate sitting area and spend their time in their rooms. The majority of residents were complementary about the variety and choice of food provided. Menus demonstrated that a varied, appealing, wholesome and nutritious diet is provided. There is always a choice of meals and residents confirmed that the cook is very flexible and will prepare an alternative meal if requested. The cook on duty was observed asking the residents whether they had enjoyed their meal and residents confirmed that this happens daily. The inspector joined residents for the midday meal, which was tasty and attractively served. The cook and care staff were attentive and assisted residents in a dignified and responsive manner. Comments made on surveys included “ Mother has a very poor appetite, but the kitchen staff make an effort to accommodate her.”,“ Food is too bland”. In discussion with the cook on duty, job satisfaction is important and this is achieved by providing a quality service and knowing the residents individually. At the last inspection in November 2005, two requirements were made, that fridge and freezer temperatures are taken and recorded daily and that frozen meat has a label with contents and dated. These have been addressed. DS0000010987.V305608.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents are confident that their concerns and complaints will be taken seriously and acted upon. Residents are protected from abuse. EVIDENCE: Residents confirmed that if they had a concern or complaint that they would speak to the manager or nurse in charge, in her absence. All residents felt that their concerns or complaints would be acted upon immediately. The manager is updating the complaints procedure to make it more user friendly. There is a minor complaints file, kept in the entrance hall. The manager has agreed to remove this file as some entries breached resident confidentiality. No information concerning complaints about the service has been received by CSCI since the last inspection. All staff have received training in the protection of vulnerable adults from abuse, this was confirmed by staff and evidenced in training records. There have been no concerns about the protection of vulnerable adults made to CSCI since the last inspection. Policies and procedures are in place and staff are aware of the home’s whistle blowing policy. DS0000010987.V305608.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,23,24,25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The premises and facilities are maintained to a high standard. The home is clean, homely and free from unpleasant odours. EVIDENCE: Since the last inspection bathrooms, toilets and some en-suite facilities have been replaced or upgraded. Two bedrooms have been extended and completely refurbished and eight bedrooms have been refurbished. The dining room and larger of the two lounges have been redecorated and carpets replaced. The laundry has been refurbished and upgraded; this was subject to a recommendation at the last inspection. There is an extensive programme of refurbishment and redecoration of the whole building in progress. Residents live in a well-maintained environment. Bedrooms are personalised and the ability to do this is appreciated by residents. Appropriate aids and adaptations are provided throughout the home.
DS0000010987.V305608.R01.S.doc Version 5.2 Page 17 All areas of the home were found to be clean and free from unpleasant odours. It was evident that the housekeeping staff work hard to keep the home clean, pleasant and hygienic. The gardens are extensive and enjoyed by the residents and visitors in the warmer weather. The rear lawn area is banked and could pose a risk of an accident to some residents. The manager is to take appropriate action to reduce the risk of an accident. DS0000010987.V305608.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents’ benefit from a stable and well trained staff team, in sufficient numbers to meet the needs of the residents. There are satisfactory recruitment procedures in place. EVIDENCE: There appears to be sufficient numbers of staff employed in the home to meet the needs of residents. There is an effective skills mix of registered nurses, care assistants and ancillary staff deployed in the home. At the time of the site visit there were two registered nurses and six care assistants on duty to meet the care needs of residents. There are currently twenty-six care staff in post some are employed part time. Fourteen have achieved NVQ level II and four level III. Recruitment procedures are satisfactory. The manager is currently developing the application to include the full employment history of the applicant. The home has a staff training and development programme and a training budget. Staff training is well organised in the home, this was subject to a recommendation at the last inspection. In discussion with staff on duty it was evident that the manager promotes training opportunities. One care assistant said that she had achieved NVQ training and although difficult at times has given her a sense of achievement and enhanced her job satisfaction.
DS0000010987.V305608.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. This is a well-managed care home. Residents’ finances are safeguarded. Health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: The manager is a registered nurse and has completed the Registered Managers Award and recently the Berkshire Leadership programme. The manager has a clear sense of direction and leadership. Residents and staff were complementary about the manager and her management approach. Staff morale in the home is good. A deputy manager who is also a registered nurse and a part time administrator supports her.
DS0000010987.V305608.R01.S.doc Version 5.2 Page 20 Quality assurance systems in the home are well organised. The manager actively seeks the views of residents, relatives and staff. Staff meetings are held on a regular basis and are minuted. Comprehensive reports written by the Responsible Individual, following a visit to the home on a monthly basis, were seen to be in place and comprehensive. No monies are held on behalf of residents. All purchases are billed at the end of the month. The manager has recently commenced a programme of supervision and annual appraisals for all staff. The registered nurses will provide formal supervision to care staff, following completion of supervisory training. Staff feel supported and valued by the manager. All policies and procedures are being reviewed and developed. Records relating to fire, health and safety are maintained to a high standard. During this site visit an external consultant was carrying out a health and safety audit. DS0000010987.V305608.R01.S.doc Version 5.2 Page 21 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 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 x 3 3 3 3 3 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 3 X 3 X 3 2 X 3 DS0000010987.V305608.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP36 Regulation 18 Timescale for action The manager is to ensure that all 27/11/06 nursing and care staff receive formal supervision at least six times per year, by individuals who have undertaken supervisory training. Requirement 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 OP19 Good Practice Recommendations That appropriate action to reduce the risk of an accident to service users in the garden is taken as soon as possible. DS0000010987.V305608.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park, South Cowley, Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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