Inspection on 22/07/05 for Robert Harvey House

This inspection was carried out on 22nd July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Robert Harvey House 18/03/09

Robert Harvey House 11/04/07

Robert Harvey House 28/06/06

Robert Harvey House 14/03/06

Robert Harvey House 06/01/05

Robert Harvey House 25/08/04

Robert Harvey House 11/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Robert Harvey House Hawthorne Park Drive Handsworth Wood Birmingham B20 1AD Lead Inspector Karen Thompson Unannounced 22 July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Robert Harvey House Inspection report OP.doc Version 1.40 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 Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Broadening Choice for Older People Mrs Margaret Diane Matthews Care Home 42 Category(ies) of Dementia over 65 (42) registration, with number Terminally Ill (42) of places Robert Harvey House Inspection report OP.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 06 January 2005 Brief Description of the Service: Robert Harvey House is a large 2 storey purpose built care home that provides 42 beds for service users aged 65 years and above. The home 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, 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 Harborne, Birmingham. Robert Harvey House offers 32 single en-suite rooms, 2 double en-suite rooms and a 6 bedded high dependency ward area. The home has communal a lounge and dining area. There is a passenger lift for access to the upper level. The home is decorated to a very high standard and is well maintained throughout. Robert Harvey House Inspection report OP.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The report findings are based on an unannounced inspection. Two inspectors carried out the inspection over an eight hour and forty minute period. Information was gathered from a number of sources: tour of the building, examination of records and documents, lunch with service users, talking to staff members in addition to the managerial staff, talking to residents and direct and indirect observation. What the service does well: What has improved since the last inspection? What they could do better: Staff training and supervision needs to be developed to improve skill levels and ensure that those who deliver the care to residents are competent and safe. The numbers of staff on duty fluctuates and this needs to be reviewed to ensure safe adequate numbers of staff are available to meet residents’ needs. Care plans must be based on a thorough assessment and tailored to meet individual residents needs. Improvements are needed regarding delivery of care to residents to enhance and protect their privacy and dignity. Robert Harvey House Inspection report OP.doc Version 1.40 Page 6 The kitchen area needs a thorough or deep clean to ensure that food hygiene is maintained to a high standard and that residents are not effected or exposed to unnecessary risk. Maintenance issues need to be addressed swiftly. 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. Robert Harvey House E54 S24882 Robert Harvey House V236826 070705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Robert Harvey House E54 S24882 Robert Harvey House V236826 070705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The assessment procedure is not consistent to ensure that all staff know the needs of all residents at the time of admission. EVIDENCE: Of the four care plans examined one did not contain a pre admission assessment of need, therefore at the time of admission staff were unaware of the individual care needs. Robert Harvey House E54 S24882 Robert Harvey House V236826 070705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 Personal and social care needs are not consistently recorded to ensure that individual needs would be met. Health care needs of residents are promoted and protected by staff. Medication managements need to improve for the safety of residents. Residents’ dignity and privacy are not upheld by some of the routines and practices in the home. EVIDENCE: Care plans were in place however these were not always comprehensive, or detailed and residents care files did not contain information on how short term complications such as chest or urinary infections would be cared for. Carers comment within the care plans need to be recorded in more detail indicating what care was provided to assist in providing continuity of care. Six monthly reviews of care plans were taking place for some residents with the involvement of residents and or their representatives. The Organisation is looking at introducing a computerized care planning system in the future. As part of a falls prevention campaign the home has been working with the local Primary Care Trust and had felt this had been of benefit to the care of residents and staff. Risk assessments need to be undertaken and recorded in Robert Harvey House E54 S24882 Robert Harvey House V236826 070705 Stage 4.doc Version 1.40 Page 10 respect of continence management, nutritional needs and mental health needs. Other risk assessments in place need to be reviewed to ensure they are comprehensive. The Tissue Viability nurse and physiotherapist were observed in the home during the inspection. Records kept in regards to health professional visits did not indicate reason for the visit or outcome. A Dentist visits the home but not all residents have an annual oral health check. Staff were observed leaving an open medication trolley unattended in the dining room this practice needs to cease. Management of prescribed creams need to be reviewed to ensure prescriber’s instructions are being followed. Medication received in the home was not being audited accurately. One resident sitting in a chair had the screens pulled around them with no thought as to the position of their head, which would have been right up against the curtain. Clothing being returned to service users rooms was not always stored in an appropriate manner but was crammed into the draw space, meaning it would emerge late to be creased. Service users in shared rooms have one wardrobe space between them each person should have their own wardrobe. One resident had a sign over their bed stating “use hoist on transfer”, staff should be familiar with manual handling needs of residents as this fails to respect privacy and dignity. Residents can have a telephone line fitted in their own bedrooms and a public telephone is available. The space within the six bedded high dependency unity is restricted and is further compromised by the practice of two more residents sharing the room during the day. Residents’ agreements with this arrangements and practice should be sought with outcomes recorded indicating who has been consulted. Consideration must be given to health and safety implications as well as issues of privacy, dignity and fulfilment. . Robert Harvey House E54 S24882 Robert Harvey House V236826 070705 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 The home has systems is place to maintain and provide social activities for residents to ensure their needs are being met. Residents are offered a varied and nutritious diet but this is not always presented to them in an appropriate manner that would be appealing leading potentially poor nutritional outcome for some residents. EVIDENCE: Activities ranged from individual to group social events. During the inspection an exercise class was observed to be taking place the downstairs lounge. The home has an open visiting policy and a number of visitors were observed around the home and spoken to during the inspection. A Roman Catholic Priest also visits daily. Care plans sampled did not demonstrate how service users preferences and dislikes were to be accommodated with regards to daily routine. The home had a weekly bath list, which does not demonstrate choice or flexibility. Staff conversed with each other whilst assisting residents with their lunch and failed to make any attempt to communicate with the people they were assisting. Meals are chosen from a weekly menu. Comments from residents in regards to meals included “ food is okay”, “good choice enjoy meals”, “feel satisfied when you leave the table”. Robert Harvey House E54 S24882 Robert Harvey House V236826 070705 Stage 4.doc Version 1.40 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 Written complaints procedure needs to be slightly amended to ensure resident are fully informed about how to make complaints or raise concerns. Staff require training in adult protection to ensure that residents are protected from any forms of abuse. EVIDENCE: The home has received one complaint since the previous inspection and this was dealt with appropriately. The home uses a corporate complaints leaflet, which fails to recognise the Commission. The complaints procedure in the reception area also needs amending to include timescales. Discussions with the Care Manager revealed that they had recently received a copy of the Multi agency guidelines for Birmingham and they would be using this as the Adult Protection policy and procedure. No staff had received training in adult protection or challenging behaviour. Robert Harvey House E54 S24882 Robert Harvey House V236826 070705 Stage 4.doc Version 1.40 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24, 26 Residents’ accommodation is generally well maintained and safe although some issues were noted. Residents own bedrooms are comfortable and personalised to suit the individuals. The home is clean and pleasant. EVIDENCE: The home was built a number of years ago to a high specification. The garden is well maintained and fully accessible to residents who use wheelchairs. On closing the door leading into the garden residents would be unable to get back into the building as the door handle was broken. A lockable facility is available in resident’s bedrooms for deposit valuables and personal items. The bedrooms did not contain all the furniture listed in standard 24 the home will need to discuss with service users and or their representatives as to the provision of this furniture and document this discussion. If rooms cannot accommodate all the furniture listed in standard 24, then the homes statement of purpose must reflect this. No bedrooms were carpeted, laminate flooring was in place. All corridors and communal areas were fully carpeted. Robert Harvey House E54 S24882 Robert Harvey House V236826 070705 Stage 4.doc Version 1.40 Page 14 There are systems in place to minimize the risk of cross infection. A sluice washing machine was in place on the upstairs floor. Robert Harvey House E54 S24882 Robert Harvey House V236826 070705 Stage 4.doc Version 1.40 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 30 Deployment of staff on duty does not ensure that residents’ needs are met at all times. Staff are trained to care for residents physical care needs, mental health care training is needed. EVIDENCE: Staff rotas were seen for the forthcoming month. The rotas demonstrated that two trained nurses rostered during the day and one at night. Seven care staff are rostered for each the morning shift and five for each evening shift. Discussions with care staff revealed that they felt five was not enough two care staff would be allocated to the six bedded unit area leaving three care staff for the remaining residents. Ancillary staff are employed for cooking and cleaning. The home engages agency staff to ensure there are sufficient staff to meet the rostered numbers. The Care Manager demonstrated an understanding of the needs of agency workers within the home to ensure the safety and comfort of residents whilst in their care. Staff have individual training records. No dementia training has taken place for staff, this needs to be addressed as eleven residents have a diagnosis of dementia. Robert Harvey House E54 S24882 Robert Harvey House V236826 070705 Stage 4.doc Version 1.40 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35, 36, 38 The management team have systems and structures in place to ensure and monitor the smooth running of the home. The home does not undertake formal staff supervision and cannot demonstrate how staff are supported to meet residents needs. Health and safety of residents and staff are not always promoted or protected. Residents’ financial interests are safeguarded. EVIDENCE: The Care Manager is a Registered Nurse with many years experience. Two days a week the Care Manager works as a trained nurse within the home providing direct care for residents. She is supported by an assistant manager who concentrates on the administration of the home. The home does not keep any money for residents, they have system where bills are paid subsequently and the resident or their representative is invoiced. No formal staff supervision is taking place however staff do receive an annual appraisal. Robert Harvey House E54 S24882 Robert Harvey House V236826 070705 Stage 4.doc Version 1.40 Page 17 Care plans for residents are stored together and may present problems if access is required. Files were stored securely. Policies and procedures were last reviewed Sep 2003, these should be reviewed more frequently to ensure they are in line with current good practice and recommendations. The kitchen required deep cleaning as debris was noted on the floor, cooker canope and tiles. There was no evidence of a cleaning schedule for the kitchen. The loft area, contained wheelchairs and bed bases. The Care Manager confirmed that staff physically transfer wheelchairs to the lower floor by nurses and care staff for the use during residents outings. This is deemed an unnecessary and unsafe practice and must cease. The home had a number of surplus wheelchairs and these need to be returned to the appropriate department. Fire equipment was observed to be obstructing exits this was rectified by the Care Manager during the inspection. Fire drills and training were taking place. Testing of the emergency lighting system has not taken place monthly and should be taking place. Robert Harvey House E54 S24882 Robert Harvey House V236826 070705 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION 3 x x x x 2 x 2 STAFFING Standard No Score 27 2 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 3 x x x 3 2 x 2 Robert Harvey House E54 S24882 Robert Harvey House V236826 070705 Stage 4.doc Version 1.40 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 3 Regulation 14(1) Requirement The Registered Person must ensure that all residents have a pre admission assessment completed by a competent person and this is retained on their file. The Registered Person must ensure that care planning is based on a comprehensive assessment process and that individual needs are identified along with preferences, likes and dislikes and these are monitored and reviewed regularly with the involvement of residents and/or representative. Care staff must also be fully aware of identified care plan needs. The Registered Person must ensure that multi professional health care visit documentation is comprehensive. The Registered Person must ensure that all service users are given access to a dentist and a record of this must be kept on the residents file. The Registered Person must ensure that medication is safely stored. The Registered Person must Timescale for action 30/12/05 2. 7 15(1)(2) 30/12/05 3. 8 12(1) 30/12/05 4. 8 13(1)(b) 30/01/06 5. 6. 9 9 13(2) 13(2) 15/11/05 15/11/05 Page 20 Robert Harvey House E54 S24882 Robert Harvey House V236826 070705 Stage 4.doc Version 1.40 7. 10 12 8. 10 12(4)(a) 9. 10 12(4) ensure that all prescription creams are dated on opening and discarded after 28 days to reduce the risk of microbial contamination and used only on the named resident. The Registered Person must ensure that residents only enter other residents bedrooms with that residents consent. The Registered Person must ensure that residents clothing is stored seperately and appropriately. The Regisered Person must ensure that care staff are familiar with residents needs and that labels or signs are removed. The Registered Person must ensure that residents are assisted sensitively and individually at meal times. The Registered Person must ensure that the complaints procedure is comprehensive to ensure that complaints are dealt with promptly and effectively. The Registered Person must ensure that staff are trained in adult protection and management of challenging behaviour. The Registered Person must ensure that residents are able to re-enter the home from the garden area by ensuring the door handle works. The Registered Person must discuss with residents the provision of all furniture stated in standard 24 and a record of this discussion is held on their file. Those rooms identified as being unable to accommodate all the furniture must be reflected in the 30/11/05 30/11/05 15/11/05 10. 11. 15 16(2)(i) 15/11/05 12. 16 22 30/11/05 13. 18 13(6) 30/01/06 14. 19 23(n)(o) 30/11/05 15. 24 & 1 16(2)( c) 30/11/05 Robert Harvey House E54 S24882 Robert Harvey House V236826 070705 Stage 4.doc Version 1.40 Page 21 Statement of Purpose. 16. 27 18(1)(a) The Registered Person must carry out an audit of staffing levels considering the deployment patterns as well as numbers on duty mindful of the needs of residents. The Registered Person must audit staff training in relation to dementia and ensure that training in relation to dementia care takes place. The Registered Person must ensure that all staff receive supervision that is recorded and takes place a minimum of six times a year. The Registered Person must ensure that emergency lighting is tested on a monthly basis. The Registered Person must ensure that the kitchen is kept clean at all times and a cleaning schedule is implemented. The Registered Person must ensure that staff are not put at risk from unnecessary manual handling tasks. Manual handling risk assessments must be carried out in relation to any identified lifting procedures. 30/12/05 17. 30 18( c)( i) 30/01/06 18. 36 18(1)( c)(i) 30/01/06 19. 20. 38 38 23(4)(c ) 16(2)(j) 30/11/05 30/11/05 21. 38 18(1) ( c) 30/11/05 22. 23. 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 37 Good Practice Recommendations The Registered Person seperates residents care plans into individual files. Robert Harvey House E54 S24882 Robert Harvey House V236826 070705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 1st Floor, Ladywood House 45-56 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Robert Harvey House E54 S24882 Robert Harvey House V236826 070705 Stage 4.doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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