CARE HOMES FOR OLDER PEOPLE
Robert Harvey House Hawthorne Park Drive Handsworth Wood Birmingham West Midlands B20 1AD Lead Inspector
Amanda Lyndon Key Unannounced Inspection 11th April 2007 09:15 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 Robert Harvey House DS0000024882.V335742.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. Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Robert Harvey House Address Hawthorne Park Drive Handsworth Wood Birmingham West Midlands B20 1AD 0121 554 8964 0121 554 3351 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) general@bcop.org.uk www.bcop.org.uk Broadening Choices for Older People Mrs Margaret Diane Matthews Care Home 42 Category(ies) of Dementia - over 65 years of age (42), registration, with number Terminally ill over 65 years of age (42) of places Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: none Date of last inspection 28th June 2006 Brief Description of the Service: Robert Harvey House is registered to provide general nursing care for forty-two people aged 65 years and above for reasons of old age and dementia. The purpose-built Home run as one unit and is set in a quiet residential area of Handsworth Wood, within easy access to bus routes. There is a car park to the front of the Home and a secure, well maintained private garden to the rear of the building. The Home is owned and operated by Broadening Choices for Older People, a local charity whose head office is based in Birmingham. Robert Harvey House offers 32 single en-suite rooms, 2 double en-suite rooms and a 6 bedded high dependency “ward area”. All people living in this area of the Home had dementia. All bedrooms have a suitable shower facility and additional communal assisted bathing facilities are provided with staff available to provide assistance in these areas. Aids and adaptations are available in order to enhance the quality of the lives of people using the service. There is a communal lounge, dining area and smaller seating areas throughout the Home. There is a passenger lift for access to the upper level. The home is decorated to a good standard and is well maintained throughout. Smoking is not permitted within the building. There is a variety of in-house activities for people to participate in should they choose. A copy of the most recent CSCI inspection report is available at the Home for all interested parties to refer to. The weekly fee to live at Robert Harvey House is £600 including all meals, physiotherapy and most activities. Items not covered by the weekly fee include newspapers, hairdressing, toiletries, private chiropody and staff escorts for routine hospital appointments. Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Information obtained and used in the planning of the field work visit included Regulation 37 notification reports of any accidents or incidents involving people using the service and reports of visits made to the Home by Senior Managers. The unannounced key field work visit was undertaken over one day by one Inspector when there were thirty eight people using the service. Due to the size of the service the information included within this report relating to the field work visit reflects a “sample” of the service. Information was gathered by speaking with six people that use the service, two visitors and five staff members and in most cases positive comments were made about the service provided at Robert Harvey House. Additional methods of obtaining information included case tracking people that use the service, examining care, medication, staffing and health and safety records and observing the staff perform their duties. A partial tour of the Home was undertaken. No immediate requirements were made on the day of the visit Following the field work visit a self assessment was sent to the Organisation in order to obtain further information about the service provided and the quality of outcomes for people using the service. What the service does well:
Prior to coming to stay at the Home people are encouraged to make informed decisions about whether they would like to live at the Home and are provided with enough information in order to make that decision. People are encouraged to sample what life would be like to live at the Home prior to living there. Following assessment people know before coming to live at the Home that their care needs could be met whilst living there. People using the service have access to a range of Health and Social Care Professionals and staff provide support to ensure that any medical instructions are carried out and this ensures that any health care needs are met. Staff are proactive and assist in identifying residents’ health care needs and medication is administered in a safe manner. People using the service are happy with the support that they receive from the Home’s staff in order to meet their personal care needs and any preferences in respect of the gender of care staff providing the care is respected.
Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 6 One person said “ I have a shower sitting on a chair, the staff help me, it is very good” People using the service are cared for in a respectful manner by staff working at the Home and this ensures that their self esteem and dignity are maintained. One person said “ I have a telephone in my room with my own private number. I have my post delivered to my room so that I can read it in private” People using the service are encouraged and supported by the staff team to maintain their independence based on their individual abilities, for example adapted cutlery and drinking utensils are available at meal times. People using the service are able to exercise choice over their daily lives and the activities that they choose or choose not to participate in and this promotes their independence and individuality. Social stimulation is provided for people that are unable to participate in group activities. People using the service are able to exercise choice over their daily lives and there were no rigid rules or routines. One person using the service said “ You are pretty much left to choose what you want to do here. We can do our own thing” People using the service are supported to continue to practice their chosen religions whilst living at Robert Harvey House and this ensures that beliefs and individuality are respected. Cultural values of people using the service are respected in areas such as diet, clothing, activities provided and communication. Visitors are made to feel welcome and a good rapport had been built up between people using the service, staff and their visitors. There is a choice of wholesome and nutritious meals which meet any dietary needs for reasons of health, religion, culture or taste. One person using the service said “ There are routines regarding meal times however breakfasts can be served at varying times. I am perfectly satisfied with the meals here” Robert Harvey House provides people using the service with a clean and homely living environment in which they feel safe and secure and their privacy is respected. People are encouraged to personalise their bedrooms to reflect their individual tastes so that they feel comfortable in their surroundings. One person said “ The cleaners come and tidy my room. They tidy my room every day”. Aids and adaptations are provided so that the independence, choice and dignity of people using the service is promoted whilst maintaining their safety. Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 7 The culture and gender mix of the staff team reflected the diverse needs of the people using the service so that staff provided support in an understanding manner. One visitor met during the field work visit said “ The staff are so friendly here, I am happy with the care my mother receives” Staff training is provided to ensure that staff have the appropriate knowledge to work competently within their job roles and meet the needs of the people using the service. Staff are well supported by the senior staff and management team and this ensures that they have the confidence and support to work in a competent manner. People that use the service are encouraged to put forward their suggestions about the service provided at the Home using service satisfaction questionnaires. What has improved since the last inspection?
Written information about the services and facilities provided at the Home had been updated so that anyone considering coming to live there had an insight in to what it would be like to live there. Confidential personal care records of people using the service were stored securely and this upholds their privacy and dignity. The complaints procedure had been amended and included all relevant information so that people that use the service and their visitors could report any concerns or complaints that they may have about the service provided. Complaints are investigated in an appropriate and timely manner so that people are confident that their views are listened to. One person using the service said “ I will tell one of the nurses if I am not happy about anything, they are very good” Staff had undertaken training about the protection of vulnerable adults and this safeguards people using the service. Extra working hours had been provided for ironing the personal clothing of people that use the service so that their clothes are laundered to a good standard. Since the last field work visit dining and lounge furniture had been replaced and this promotes the comfort of people using the service. More than 50 of care staff had achieved a minimum of NVQ level 2 and this ensures that they have the appropriate knowledge to provide a good standard of care for people using the service.
Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 8 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. The summary of this inspection report can be made available in other formats on request. Robert Harvey House DS0000024882.V335742.R01.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 Robert Harvey House DS0000024882.V335742.R01.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, 2, 3 & 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Admission processes are thorough so that people are able to make informed decisions about whether they would like to live at the Home. People know before admission that their care needs could be met at the Home. An exception to this may be regarding people for whom English is not their first language as information about the Home was not readily available for these people. EVIDENCE: Since the last field work visit the statement of purpose and service user guide had been updated to include all information required by people who are deciding whether to choose to come and live at the Home. The Manager said that this could be available in a large print format of alternative language if requested however copies of these were not available at the Home. These identified the facilities and services available for people with disabilities and specific religious needs. Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 11 People are encouraged to visit the Home in order to sample what life would be like to live there and during this time a pre admission assessment is undertaken by senior staff to ensure that the person’s individual care needs could be met whilst living at the Home. The assessment document used for this was found to be comprehensive and informative. If people are too frail to visit the Home prior to coming to stay there, senior staff will visit them in order to undertake the pre admission assessment. People using the service are issued with a contract of terms and conditions of residency so that they were aware of all services included and excluded from the weekly fee. Staff members are available to escort people that use the service to hospital appointments however a charge to the individual for this service may be incurred. Further consideration should be made in respect of the fairness of this in order to meet the health and welfare needs of the people using the service as a charge for this may not be considered to be appropriate. Intermediate care is not provided at Robert Harvey House Robert Harvey House DS0000024882.V335742.R01.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 adequate. This judgement has been made using available evidence including a visit to this service. Health provision and care delivery are generally good however improvements are required as identified during the recent tissue viability audit so that the care needs of all people using the service are being met. Generic care plans do not contain information about the individualised needs and preferred routines of people using the service. People using the service receive their medication safely so that their health is promoted. People using the service are supported in a respectful manner by staff and this ensures that their dignity and self-esteem are maintained. EVIDENCE: During the field work visit people using the service expressed their satisfaction about the ways in which their personal and health care needs were being met whilst living at the Home. One person said “ I have a shower sitting on a chair, the staff help me, it is very good” On admission to the Home comprehensive assessments are undertaken of the individual’s care needs and care plans are derived from this information. This is
Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 13 a written plan of action about how the individual care needs of people using the service are going to be met whilst living there. However “pre- printed” care plans did not always include detail of the specific support required from staff and this may prevent person focused care from being provided. Some care plans included information that was out of date and did not reflect the actual care needs of the person using the service. Hand written care plans included good detail of the preferences of people using the service and the support required by staff in these areas and this included specific religious care and cultural needs. In respect of the care plans sampled, there was no evidence that care plans had been written or reviewed with the involvement of the people using the service or their representatives and this may prevent their preferred routines from being maintained whilst staying at the Home. Care plans were reviewed monthly however the evaluation of these was poor and did not reflect the care provided to people using the service. Personal risk assessments had been undertaken including the risk of the development of sore skin, poor diet, falls and mobility so that any risks to individuals could be minimised however these had not always been reviewed to ensure that the information included within them was current. Individual risk assessments had been written and consent had been obtained from people using the service or their relatives regarding the use of bed safety rails. These should be further developed to include detail of the risks involved in the use of these in order for informed consent to be obtained. People using the service can retain their own General Practitioner on admission to the Home (if the GP is in agreement). One GP visits the Home each week and other visits are arranged by the nursing staff as required. There is access to other visiting Health and Social Care Professionals including tissue viability nurses, chiropody, opticial services and dental care. The tissue viability service had recently undertaken an audit of the incidence of pressure sores (sore skin) of people using the service and the suitability of equipment available at the Home. The outcome of this was that there was a low incidence of pressure sores at the Home as the people using the service were receiving a good standard of care in this area. However, advice was given in respect of the suitability of some of the equipment provided, poor care planning, poor documentation of pressure relief provided and poor documentation of skin inspection. Further advice was given about a rolling programme of replacing existing pressure relieving equipment so that the care needs of people using the service could be met. Systems in place for the management of medication were robust thus safeguarding people using the service. Medication administration charts were well maintained and identified that medication was administered accurately. A comprehensive audit had recently been undertaken by the community pharmacist and the outcome of this was “excellent”. Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 14 The preferred term of address of individuals using the service was recorded in their care plans and staff greeted the people that used the service by their preferred names. All persons met during the visit had been supported by staff to choose clothing appropriate to the time of year, their age, culture and gender and it was apparent that their personal hygiene care needs were being met whilst living at the Home. There is a policy about the importance of respecting individual’s preferences in respect of the gender of the staff member providing personal care so that their dignity is maintained. Confidential information relating to the care needs of people using the service were stored securely and this upholds their privacy. During the field work visit one person using the service said “ I have a telephone in my room with my own private number. I have my post delivered to my room so that I can read it in private” People using the service had the option of having a key for their bedroom door and one person had currently chosen to use this facility so that he could lock his door during the night. Robert Harvey House DS0000024882.V335742.R01.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 good. This judgement has been made using available evidence including a visit to this service. The activities on offer meet the needs, interests and expectations of people using the service. People who use this service have a choice of healthy meals and their diverse needs are well supported so that their individuality is maintained. EVIDENCE: There was a number of activities on offer for people to participate in should they choose including movement to music, scrabble, bingo and coffee mornings. A selection of large print books were available at the Home for people to borrow if interested and the hairdresser visits once a week. It was pleasing that particular attention is given to people unable to participate in group activities and people are encouraged to put forward their suggestions for future activities during group meetings. People using the service have a choice of whether they wish to participate in activities. One person said “ I enjoy taking part in activities during mornings and then I like it to be quieter in afternoons as this is the time my family visit or telephone me”
Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 16 During the field work visit one person using the service said “ I have made friends here”. A number of people using the service choose to have newspapers delivered and two people had access to the internet so that their interests could be maintained. Opportunities for people using the service to go outside of the Home on organised trips is limited as there had only been one trip arranged during the last twelve months and this was during the winter. One person using the service stated that he would prefer to go on a trip during warmer months and staff met during the visit agreed with this suggestion. This was brought to the attention of the Home Manager who said that further consideration would be given regarding this. People using the service are able to go outside of the Home with their friends and families as they choose. There is an open visiting policy and people using the service have opportunities to meet with their visitors in private if they choose Relatives met during the visit said that they were always made to feel welcome at the Home however one visitor expressed his disappointment that there was no facility for him to have lunch at the Home whilst visiting his wife, except for on special occasions. This was brought to the attention of the Home Manager who stated that she would look in to this on his behalf. People using the service are able to exercise choice over their daily lives and there were no rigid rules or routines. One person using the service said “ You are pretty much left to choose what you want to do here. We can do our own thing” Opportunities for worship for people of all faiths could be arranged and one person regularly attends church. Roman Catholic and Church of England Ministers visit the Home regularly so that people who are unable to go outside of the Home are able to continue to practice their chosen religions. One person using the service was a practising Sikh and he was encouraged to decorate his room with his objects of worship and it was evident that the staff team respected his beliefs. There were a number of people using the service for whom English was not their first language. One person who had recently come to stay at the Home had very limited knowledge of the English language and as a consequence of this communication between this person and the staff team was difficult. Methods had been introduced to ensure that this person’s needs and wishes could be expressed including the use of an independent interpreter, staff members who were fluent in the language and input from his relatives. The menus identified a variety of wholesome meals and people using the service confirmed that they were offered a choice of these.
Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 17 A cooked breakfast was available once a week and a snack meal was available at supper time and during the night so that people using the service were not hungry and their health was maintained. Special diets could be arranged for reasons of health, taste or religious/cultural preferences. Vegetarian and diabetic meals were currently being prepared and the components of pureed meals were served separately ensuring that people had a choice of whether they wished to eat each portion. It was pleasing that following dietetic advice, foods were prepared using full fat, nutritious ingredients in order to ensure that people using the service received the required amount of calories each day to promote their health and well-being. The pre admission assessment of one person using the service identified that he enjoyed traditional Indian cuisine and whilst this was offered to him at the Home he was also enjoying other types of food being served. People using the service can choose where they are served their meals so that they are comfortable when having their meal. There is an option for people to dine in their own rooms if they choose. The main meal option for lunch on the day of the field work visit were either lamb or Cornish pasty served with vegetables. Alternatives to these were also available so that all people using the service were encouraged to enjoy their meal thus promote their health. The lunch time meal was relaxed and unhurried, providing opportunities for social interactions between people that used the service. Adapted cutlery, drinking utensils and plate guards were in use so that the independence and dignity of people assessed as requiring these was promoted. One person using the service said “ There are routines regarding meal times however breakfasts can be served at varying times. I am perfectly satisfied with the meals here” Robert Harvey House DS0000024882.V335742.R01.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. The complaints procedure is accessible to the majority of people using the service and their visitors and complaints are investigated in an appropriate and timely manner so that people using the service are confident that their views are listened to. Systems are in place to protect people from harm. EVIDENCE: Since the last field work visit CSCI have not received any concerns, complaints or allegations about the service provided at Robert Harvey House. The complaints procedure had been amended and included all relevant information so that people that use the service and their visitors could report any concerns or complaints that they may have about the service provided. This was on display in the Home, in a leaflet format and included within the service user guide. This information must be available in a large print format and other languages so that it is accessible to all people using the service. During the field work visit, one person using the service said “ I will tell one of the nurses if I am not happy about anything, they are very good” The complaints register held at the Home identified that there had been three complaints received since the last field work visit and all of these were concerning the level of basic personal care being afforded to people using the service. There was evidence that these had been investigated in a timely
Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 19 manner and remedial action had been undertaken including staff supervision to ensure that further incidences of the same did not occur. The adult protection policy included local multi agency guidelines and staff had undertaken recent training in this area so that they had the appropriate knowledge to ensure that people using the service were protected from harm. Robert Harvey House DS0000024882.V335742.R01.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, 22, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are provided with a homely, clean and comfortable living environment in which they feel safe and secure. Aids and adaptations are provided that are fit for purpose and need so that the independence, choice and dignity of people using the service is promoted whilst maintaining their safety. EVIDENCE: The external gardens were attractive, well, maintained and were easily accessible for wheelchair users to enjoy. During the field work visit one person using the service said “ I particularly enjoy using the lovely, beautiful garden” However, staff met during the visit suggested that additional garden furniture was required so that more people were able to use the garden at one time. Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 21 The internal environment was homely and inviting and decoration was generally of a good standard throughout. Since the last field work visit dining and lounge furniture had been replaced and the lounge had been redecorated and this promotes the comfort of people using the service. A number of people using the service had access to specialist equipment in order to enhance their quality of life, comfort, independence and dignity. This included specialist wheelchairs, seating, a large button remote control system for the television and telephone, talking clocks and transfer hoists for the safe moving and handling of people with reduced mobility. This equipment is obtained following specialist assessment so that it is deemed to be safe and appropriate to meet the needs of individuals. Bedrooms were homely, clean and spacious and were decorated to reflect the taste, age, interests and gender of the person occupying the room so that they were comfortable in their surroundings. During the field work visit one person said “ I have a lovely bedroom. My family visit and I get lots of flowers”. There was a nurse call facility in each bedroom so that assistance could be sought at any time. A storage facility for the safekeeping of valuables and private items was provided in bedrooms however these were placed out of the easy reach of some people. This was discussed with the Home Manager during the visit and is being addressed by the Organisation. An alarm had been fitted to the bedroom door of one person using the service who had dementia. This was to protect this person by alerting the staff team if they came out of the bedroom during night time hours. There is a six bedded “ward” area for the more dependent and frail people using the service and whilst the overall design of this area was one of an institutional nature, no negative comments were received about this during the field work visit. However, space is limited in this area and this may not promote the comfort and dignity of the people living there. Staff provide constant supervision in this area so that the health and welfare of the vulnerable people in this area is safeguarded and social stimulation is provided. Lighting throughout the Home was domestic in style and was appropriate to meet the needs and safety of people using the service who had poor eyesight. There was a hygienic system in place for the cleaning of personal clothing and bed linen. Since the last field work visit extra working hours had been provided for the ironing of personal clothing of people that use the service so that their clothes are laundered to a good standard. The Home was clean and fresh and there were hygienic hand washing facilities located throughout the Home and this will assist in preventing the spread of infection. Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 22 During the field work visit one person using the service said “ it is spotlessly clean here” Another person said “ The cleaners come and tidy my room. They tidy my room every day”. Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 23 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 adequate. This judgement has been made using available evidence including a visit to this service. People using the service receive support from appropriately trained and recruited staff so that they are safeguarded and receive a good standard of care. The skill mix of staff during evening and night- time hours may prevent people using the service from receiving nursing care at the time that they require. A lapse in recruitment procedure on one occasion does not safeguard people using the service. EVIDENCE: Staffing rotas identified that there was one registered nurse on duty during the evening and night time hours from 19:00hours. CSCI would consider this to be inadequate to meet the needs of people using the service based on the complex nursing care needs of a number of people currently using the service. All people met during the field work visit including people using the service and registered nurses expressed their satisfaction about this arrangement. Regular monitoring of this must be undertaken in order to ensure that the changing care needs and dependencies of people using the service are being met. There were currently no vacancies for registered nurses and agency staff of this grade were not used, ensuring continuity of care for the people using the service. However, agency care assistants were used to cover periods of annual leave and staff sickness, especially during weekend hours and this must not prevent continuity of care for people using the service during these times.
Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 24 Housekeeping and kitchen staff provided ancillary support to the care team ensuring that all people using the service were supported in all aspects of their daily lives. One person said “ I am very glad to be here. The staff are very good to me as I use my call bell at night and they come and help me” The culture and gender mix of the staff team reflected the diverse needs of the people using the service so that staff provided support in an understanding manner. One visitor met during the field work visit said “ The staff are so friendly here, I am happy with the care my mother receives” Staff recruitment files sampled included all of the information required by Regulations in order to safeguard people using the service. However, an exception to this was that an updated criminal records or protection of vulnerable adults (POVA) check had not been obtained for a staff member who had recently commenced employment at the Home and this does not safeguard people using the service. New staff undertake comprehensive induction training including health and safety issues so that they have the appropriate knowledge to care for people using the service in a competent manner. Staff had received recent training relevant to their job roles including nutrition, tissue viability, first aid, dementia care, infection control, fire safety, moving and handling and food hygiene to ensure that they can meet the needs of people using the service. “Link nurses” had been trained in specific areas of nursing in order to provide support and training for the rest of the staff team in these areas, thus improve the standard of care for people using the service. The amended statement of purpose identified that 51 of care staff had achieved a minimum of NVQ level 2 in care so that they had the appropriate knowledge to provide a good standard of care. Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 25 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, 32, 33 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home is run in the best interests of the people using the service however the current systems in place for consulting with people using the service is poor and may prevent individuals from putting forward their views about the service provided. Generally the arrangements for health and safety are adequate, however some lapses in procedures does not safeguard people using the service. EVIDENCE: The Registered Manager has had much experience working within her role and positive comments were received about her management style. She is supported by the Assistant Manager who is responsible for the administration of the Home and there are clear lines of accountability within the management team.
Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 26 Visits are undertaken regularly by external Senior Managers so that the quality of the service provided is regularly monitored. The most recent “resident’s and relatives meeting” was held six months ago and the minutes of this was available in the reception area of the Home for all interested parties to read. The Home Manager stated that this could be available in a large print format or alternative language if requested. The meeting was an opportunity for people using the service to put forward their views and suggestions about the service provided at the Home. Another meeting was planned for the near future and details of this were on display so that people using the service were aware of this. It is recommended that group meetings be held more frequently so that people using the service have more opportunities to put forward their views about the service. Staff meetings were held regularly and comprehensive minutes of these were available. This ensures that staff are informed about any new procedures or services provided at the Home. People using the service, their relatives and the staff team are involved in the implementation of the quality assurance system that is due to commence at the Home. This included service satisfaction questionnaires and group meetings to discuss the importance of this system and the role that each person has regarding this in order to continually monitor and improve the standard of service provided for people using it. The Home’s staff do not manage the personal finances of people using the service and the majority of people are supported by their families in this area. Regular checks on equipment are undertaken so that they were safe for people using the service to use and staff had undertaken recent training about health and safety issues, thus safeguarding people using the service. Accident records identified that there had been a high number of incidences of unexplained bruising and skin tears sustained by people using the service, however there was no evidence that this had been monitored or audited in order to establish possible causes for this. An audit of this must be undertaken so that any trends in the incidence of this may be identified in order to take remedial action to minimise the risk of future incidence thus safeguard people using the service. A variety of suitable moving and handling aids were available and staff had undertaken recent training in this area however a recent care review of a person using the service identified a concern about the manual handling skills of some staff members and the Home Manager stated that this would be explored in order to ensure the health and safety of people using the service. Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 27 During the field work visit we observed that housekeeping staff had left a cleaning trolley with chemical cleaning products unattended on two occasions despite the Home Manager addressing this at the time of the first incidence of this. This poses a risk of harm for vulnerable people using the service who may access the chemicals. Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 28 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 2 3 3 x N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 x x 3 x 2 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x x x x 2 Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15.1 Requirement All people using the service must have an up to date, detailed care plan and this must be written and reviewed with the involvement of the person using the service or their representative. This will ensure that they receive person centred support that meets their needs. (timescales of 01/06/06 and 30/09/06 not met) 2 OP8 12.1 Remedial action must be taken in response to the advice and recommendations made during the recent tissue viability audit so that people using the service receive an excellent standard of care in this area. A written record of care interventions, for example pressure area care must be maintained. The complaints procedure must be available in other formats and languages so that all people using the service are aware of how to raise any concerns
DS0000024882.V335742.R01.S.doc Timescale for action 01/07/07 01/06/07 3 OP16 22.2 01/07/07 Robert Harvey House Version 5.2 Page 30 4 OP29 13.6 A satisfactory protection of vulnerable adults check must be obtained for all new staff members prior to commencing employment at the Home so that people using the service are safeguarded. (timescale of 01/08/06 not met) 15/05/07 5 OP38 13.4 (c ) 6 OP38 13.4 (a) Any incidence of unexplained bruising or skin tear injuries to people using the service must be regularly audited in order to identify any trends in occurrence and minimise the risk of further incidence. Referrals to appropriate authorities must be made as deemed to be necessary in order to safeguard people using the service. Chemical cleaning products must be stored securely at all times in order to safeguard people using the service. 15/05/07 15/05/07 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 Refer to Standard OP1 Good Practice Recommendations The statement of purpose and service user guides should be accessible to all people and be available in different formats and languages Further consideration should be given regarding the appropriateness of charging people using the service for the provision of a staff escort for hospital appointments. Bed safety rails consent documentation should include detail of the risks involved in the use of these so that
DS0000024882.V335742.R01.S.doc Version 5.2 Page 31 2 OP2 3 OP8 Robert Harvey House 4 5 6 7 8 OP12 OP24 OP24 OP27 OP27 9 OP32 informed consent can be obtained Further consideration should be made to increase opportunities for people using the service to participate in trips outside of the Home. A review of the use of the multi-occupancy ward area should be undertaken to promote the privacy and dignity of people in this area. A review of the sitting of the lockable facilities within the bedrooms to ensure that residents can easily access these. The use of agency staff should not prevent residents from receiving continuity of care Periodic reviewing of the skill mix of staff provided during evening and night time hours should be undertaken based on the changing dependency needs of people using the service so that their care needs are being met. “Residents meetings” should be held regularly so that people using the service have the opportunity to put forward their views about the service provided. Robert Harvey House DS0000024882.V335742.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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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