Inspection on 28/06/06 for Robert Harvey House

This inspection was carried out on 28th June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Robert Harvey House 18/03/09

Robert Harvey House 11/04/07

Robert Harvey House 14/03/06

Robert Harvey House 22/07/05

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 West Midlands B20 1AD Lead Inspector Amanda Lyndon Unannounced Inspection 28th June 2006 09:00 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.V300354.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.V300354.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 robertharvey.housecop.org.uk 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) 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.V300354.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 14th March 2006 Brief Description of the Service: Robert Harvey House is a large 2-storey purpose built care home that provides general nursing care for 42 service users aged 65 years and above for reasons of old age and dementia. 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, 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. The home has a communal lounge and dining area. There is a passenger lift for access to the upper level. The home is decorated to a good standard and is well maintained throughout. Assisted bathing facilities and hoisting equipment are available for residents with impaired mobility. The weekly fee to live at Robert Harvey House is £600 Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report reflects the findings of an unannounced field work visit undertaken by two Inspectors when there were thirty nine residents living at the Home. Information was gathered by speaking with residents, visitors and staff, case tracking, examining care and health and safety records and observing the staff perform their duties. A full tour of the Home was undertaken. Prior to the inspection, information was provided on the pre inspection questionnaire record and thirteen completed comment cards were returned, most containing information of a positive nature about the service provided at Robert Harvey House, including: “I have been very impressed with the overall professionalism of all staff and also with the very caring attitude which comes with this”. “My mother is very well looked after by everyone” “Everything is first class here” Negative comments were received about the use of agency staff and the associated lack of continuity of care when agency staff are used and the length of time taken for staff to answer the front door. The Inspectors were assisted throughout the visit by the Assistant Manager and the Nurse in Charge as the Registered Manager was on annual leave. What the service does well: Residents are well supported by the nursing and care staff to meet their health, welfare and personal care needs and are generally cared for in a respectful manner, ensuring that their dignity and self esteem are maintained. One resident said “ The staff help me use the hoist, they are very kind”. The medication management is good and this safeguards residents. Residents and their families are involved in the agreeing and reviewing of care plans and this ensures that the individual’s personal preferences and routines are maintained. There is a wide variety of activities on offer at the Home for the residents to participate in should they choose and this ensures that they are socially stimulated and free to enjoy the activities that they are interested in. Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 6 Residents are supported by the staff to maintain contacts with their friends and family and visitors are made to feel welcome at the Home and this ensures that residents feel comfortable within their home environment. The choice of wholesome and well presented meals meet any special dietary needs of residents for reasons of health or cultural/religious beliefs. Residents are given choice and freedom to make decisions regarding their daily lives and this promotes their independence and individuality. One resident said “ we always have a choice of food here, it’s great”. Robert Harvey provides a homely, comfortable and safe living environment for residents and people living there are encouraged to personalise their bedrooms in order for them to feel secure in their surroundings and to reflect their individual tastes. One resident said “we have a lovely garden, there are birds, squirrels and foxes and the flowers are lovely”. Staff are provided in adequate numbers to meet the needs of the residents. One staff member said “ All of the staff and management are very approachable”. One resident said “ The staff are ever so good here, I get woken up with a cup of tea”. Residents and relatives are invited to regular meetings to discuss the service provided at the Home and this enables individuals to put forward their suggestions for improvements. What has improved since the last inspection? What they could do better: Staff members are available to escort residents to hospital appointments, however a charge to the individual resident for this service may be incurred. Further consideration must be made in respect of the fairness of this in order to meet the health and welfare care needs of residents. Written documentation in respect of the personal, physical health and psychological care needs of residents was poor at times and this may prevent Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 7 the appropriate care from being delivered to individual residents which may put them at risk. The written information in respect of the complaints procedure did not include all of the relevant information and this may potentially prevent residents and their relatives from reporting their concerns to the relevant people. Some staff had poor knowledge of adult protection and moving and handling procedures and this is a risk to residents’ safety. The main lounge did not provide adequate seating for all residents who may choose to use the facility and this may prevent all residents from participating in a particular group activity. Space is limited in the six bedded “ward” area and this does not promote the comfort and dignity of the residents living there. Infection control measures were poor at times and these may result in the spread of infection at the Home and be a risk to residents’ health. 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 DS0000024882.V300354.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 Robert Harvey House DS0000024882.V300354.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, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The admission and assessment processes and information are comprehensive and this enables residents and their families to make an informed choice about whether they would like to live at the Home. Prospective residents know before admission that the Home can meet their care needs. EVIDENCE: A comprehensive statement of purpose had been produced, however this required amending to reflect the current service provided at the Home, to ensure that prospective residents have all the information required to make an informed decision about whether they would like to live there. Residents are issued with a contract of terms and conditions of residency and this identified all services included and excluded from the weekly fee and highlighted the importance of not discriminating against individual residents for reasons of diversity. Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 10 Some information contained within the contract was out of date and the room number to be occupied as agreed with the resident and/or their representative was not identified and this does not safeguard the residents’ right of choice of bedroom as able. The contract stated that staff members were available to escort residents to hospital appointments, however a charge to the individual resident for this service may be incurred. The Home is responsible for promoting and making proper provision for the health and welfare of residents and to charge for this service may not be considered to be appropriate. Senior staff undertake comprehensive pre admission assessments for all prospective residents to assess whether their individual care needs could be met at the Home. Intermediate care is not provided at the Home. Robert Harvey House DS0000024882.V300354.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 adequate. This judgement has been made using available evidence including a visit to this service. Residents’ ongoing health and personal care needs are well met and care delivery is good, however poor documentation in respect of this at times may put residents at risk. Residents and their families are involved in the agreeing and reviewing of care plans and this ensures that their personal preferences and routines are maintained. Medication is administered in a safe manner. Residents are generally cared for in a respectful manner by staff working at the Home and this ensures that their dignity and self esteem are maintained. EVIDENCE: It was evident that the nursing and care staff were providing a good standard of care for the residents living at the Home and there was evidence that the nursing staff refer to the residents’ General Practitioner and other Health Care professionals as required for advice, however, the written documentation in respect of this was poor at times. Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 12 On admission to the Home, comprehensive assessments are undertaken of the individual’s care needs and care plans are derived from these. The nursing assessments included detail of the social, mental health and psychological needs of residents, however, care plans were not derived from this information and care plans had not been written about oral health care needs. Care plans for specific acute medical conditions and nursing care interventions were not always written. Some care plans were hand written and included good detail of actions required in order to meet the residents’ needs, however the majority of care plans were generic and had not been personalised to reflect the individual care needs of each resident therefore did not always identify the actual support required by the staff in order to meet the resident’s holistic care needs. One care plan for diabetes stated “ monitor blood sugar levels and record on blood glucose chart” but did not identify the frequency of recordings required. Care plans were reviewed each month, however these often did not contain any evidence of the monitoring of health care needs. Most care plan evaluations sampled stated “ care as plan.” There was evidence that residents and/or their relatives were involved in the agreeing and reviewing of care plans and this ensures that residents’ wishes and routines are maintained. Some moving and handling assessments were recorded in good detail, however the size of sling to be used and action to be taken should a resident fall were not available in some instances. Daily reports were recorded in good detail and included both clinical and social information. A number of residents were very frail and were being nursed in bed. Regular pressure area care was provided to ensure that their skin did not become sore, however a written record of this was not maintained. Wound care treatment regimes were followed by the nursing staff, however some written documentation in respect of this was poor, the size and depth of wounds were not recorded and care plans had not been updated to reflect a deterioration in the condition of a resident’s skin and as a consequence of this the staff may fail to identify any deterioration in a wound promptly. Personal risk assessments had been undertaken including the risk of falls and pressure area care and these had been agreed by the resident and/or their families. Since the last inspection positive work had been undertaken in respect assessing the nutritional status of residents and referrals to Community Health Care Professionals had been made regarding this as deemed necessary. Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 13 Assessments of the management of continence had not been undertaken and it was planned that advice was to be sought from a Community Health Care Specialist in respect of this. Care plans were written for the use of bed safety rails and consent was available form residents and/or their families as appropriate, however, the risks associated with the use of these was not identified. Residents can retain their own General Practitioner on admission to the Home (if the GP is in agreement). One General Practitioner visits the Home each week and other visits are arranged by the nursing staff as required. A written record in respect of the outcome of these visits was not always available. Residents have access to other visiting Health and Social Care Professionals, including tissue viability, chiropody, opticial services and dental care. On the day of the field work visit, the Community Pharmacist undertook a comprehensive inspection of the management of medication at the Home. The feedback regarding this was that there was a good standard of practice at the Home and a small number of requirements and recommendations were made. Not all prescription creams were labelled, dated when opened or discarded after 28 days which may pose a risk of cross contamination. The preferred term of address was recorded in the care plans and staff were observed greeting residents by their preferred names. Residents appeared to be well groomed and wearing clothing appropriate for the time of year, their age, gender and culture. Residents said that the staff provide support to assist with their care needs in a respectful and kind manner in order for them to live comfortably. One resident said “ The staff help me use the hoist, they are very kind”. Confidential information relating to residents’ personal care needs was left unattended within the first floor corridor area and this does not protect individual residents’ privacy. Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 14 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 & 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 and expectations of residents living at the Home. Residents are supported by the staff to maintain contacts with their friends and family. Residents are given choice and freedom to make decisions regarding their daily lives and this promotes their independence and individuality. The choice of wholesome and well presented meals meet any special dietary needs of residents for reasons of health or cultural/religious beliefs. EVIDENCE: There was a number of activities on offer for the residents to participate in should they choose, including handicrafts, library books, card games, film shows, bingo, entertainers and mobility to music. One resident said that they were disappointed that there were no trips out side of the Home during the summer months. Two part time activities organisers are employed at the Home in order to provide activities for all residents irrespective of their individual interests and abilities. Particular attention is paid to providing social stimulation for those residents who are unable to participate in group activities or for those residents who are nursed in bed. Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 15 A social activities record was maintained for each resident and this included information about whether each activity was enjoyed. The hairdresser visits twice weekly. There were some opportunities for residents to practice their chosen religions. Holy Communion is available each week and a bible study group is held every fortnight, in addition to other visiting clergy. There are currently no opportunities for residents of non Christian faiths to practice, however the management team is exploring this. Residents said that they were made to feel welcome at the Home and there was an open visiting policy. Visitors are able to have a meal at the Home and this ensures that residents maintain links with their families and friends. Residents go outside of the Home with their family and friends as they wish and communication between relatives and staff was good. CSCI received a negative comment from a visitor to the Home in respect of the length of time taken for staff to answer the front door. Residents are able to exercise their choice over their daily lives and there were no rigid rules or routines at the Home. Residents are encouraged to choose their own jewellery and toiletries as able and it was pleasing that a resident’s choice of radio programme was being played. The menus identified a choice of wholesome meals, however despite a four week rolling menu, this continued to be repetitive at times . It was pleasing that breakfast was served at times to suit the residents and a cooked breakfast was available once a week. The Community Pharmacist identified that dietetic advice should be sought in respect of enhancing the nutritional content of the meals served. Fresh fruit was not available for residents during the visit, with the exception of over ripe bananas. Snack meals are available in the evening and during the night. Alternative diets are provided for residents with special dietary requirements due to reasons of health or religious/cultural beliefs and care plans were written in respect of these to ensure that all staff were aware of these and could therefore provide support for the residents in this area. One resident said that mashed potato is served every day for lunch and an alternative like pasta or rice would be a nice change. The lunch time meal was relaxed and unhurried and there were good social interactions amongst the residents. Dining tables were laid attractively, cold drinks were served and the meals were well presented. Adapted feeding Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 16 utensils and plate guards were available for residents deemed to be in need of such equipment following assessment in order to promote their independence. The portions of pureed meals were served separately in keeping with good practice. Hot beverages were served in melamine cups and saucers, however china crockery was also available should a resident prefer this. Most staff were assisting residents in a friendly and respectful manner and it was noted that the majority of staff communicated well with the residents. One care assistant was standing over a resident whilst assisting her with her meal and this is not considered to be dignified for the resident. Weekly menus were distributed to residents in order for them to make choices about what they would like to eat. One resident said “ we always have a choice of food here, it’s great”. Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 17 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 poor. This judgement has been made using available evidence including a visit to this service. The written information in respect of the complaints procedure did not include all of the relevant information and this may potentially prevent residents and their relatives from reporting their concerns to the relevant people. The staff team’s lack of knowledge regarding adult protection procedures may prevent such incidents from being dealt with appropriately. EVIDENCE: The Home had not recorded any complaints since the previous inspection and CSCI had not received any concerns, complaints or allegations about the Home. The complaints procedure was not on display in the Home and the leaflets in the main office in respect of this had not been revised since the last inspection and did not include all relevant information. The adult protection policy did not include local agency guidelines and the knowledge of the staff team on duty in respect of the correct procedure for the reporting of adult protection issues was poor which may put residents at risk. Staff were not aware of the Local Authority’s lead role regarding adult protection and training had not been provided in this area. Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 18 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, 20, 21, 22, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Robert Harvey provides a homely, comfortable and safe living environment for residents and people living there are encouraged to personalise their bedrooms in order for them to feel secure in their surroundings and to reflect their individual tastes. Infection control measures are poor at times and this may pose a risk to residents’ health. The multi-occupancy dormitory does not afford privacy for residents The lack of space within the communal lounge may result in residents having fewer opportunities to socialise. The facilities and equipment available at the Home meet the needs of the residents living there. EVIDENCE: The external grounds of the Home were very attractive and well maintained and suitable for the residents to enjoy. Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 19 One resident said “we have a lovely garden, there are birds, squirrels and foxes and the flowers are lovely”. The internal environment was homely and inviting and decoration was generally of a good standard throughout. Some floor coverings and furniture were old and worn, however a rolling programme of replacing floor coverings, furniture and redecoration was in place. Residents’ bedrooms were clean and spacious and contained personal possessions in order to ensure that residents felt safe and comfortable in their surroundings. Floor coverings were of a hard surface type within the bedrooms. Small lockable safe facilities were provided for residents’ use, however these were situated at floor level and were difficult to access by most residents living at the Home. One resident said “ I like this room and being able to see the lawn”. There is a six bedded “ward” area for more dependent residents living at the Home. The communal space and space for furniture within this area was limited, the overall appearance of this area was institutional in nature and residents’ privacy was limited, however positive comments were received about this area from residents’ families. The “ward” is constantly staffed ensuring the safety of the residents and social stimulation is provided for the residents who are nursed in bed and remain in this area during the day. The future of this area of the Home is being reviewed by the Organisation. There was comfortable seating for up to thirteen residents in the main lounge and additional seating was available in quieter “break out” areas located throughout the Home. All bedrooms had an en suite floor drainage shower facility and there were assisted bathing facilities for residents to use if they preferred a bath instead of a shower. It was noted that the nurse call bell was not working within one of these bathrooms and this may put residents using the facility at risk. Suitable transfer hoists , pressure relieving equipment and other aids to enhance the quality of residents’ lives, maintain residents’ safety and promote their independence were available. The temperature of the hot water delivered to many communal areas of the Home exceeded safe limits posing a risk of residents and staff scalding themselves as a result of this. This was brought to the attention of the Assistant Manager who began to rectify the problem straight away and written confirmation was received following the field work visit to confirm that this had been rectified. Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 20 The Home was found to be generally clean and fresh, with the exception of some areas within the “ward” area, some residents’ bedrooms and the dining room. One visitor met during the inspection said “ The bedroom is lovely here, it is always clean”. An effective and hygienic system for the cleaning of residents’ personal clothing and bed linen was in place and residents’ clothing was labelled to ensure that it was returned to the correct person. There were hygienic hand washing facilities located throughout the Home, with the exception of one of the communal bathrooms and the sluice room. A lidded bin was not available in one of the communal bathrooms, therefore there was no facility to dispose of gloves, aprons and soiled incontinence pads which may cause the spread of infection. It was observed that a member of staff had not changed their apron between affording personal care to a resident and assisting another resident with their meal, posing a risk of cross infection. Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. There is a generally robust system for staff recruitment in place, however lapses in procedures on occasions may fail to afford full protection to residents. Staff have received training to ensure that they perform within their job roles in a competent manner and meet the needs of residents, however further training is required in respect of moving and handling and adult protection in order to safeguard residents. EVIDENCE: Staffing rotas identified that the Home were working within approved staffing levels. Agency staff are used to cover periods of annual leave and sickness to ensure that there are enough staff on duty to care for the residents. However negative comments were received about the lack of continuity of care provided when agency staff are on duty. Laundry and kitchen staff provide ancillary support to the care team and this ensures that any housekeeping needs of residents are taken care of. One resident said “ The staff are ever so good here, I get woken up with a cup of tea”. Staff files examined included the majority of information required by Regulations, evidence of satisfactory criminal records clearance being obtained was not available for all staff working at the Home. However a procedure for maintaining a record of this is being developed at the Home. Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 22 There was no evidence that any gaps in employment histories on prospective staff member’s application forms had been explored and this may put residents at risk. All nursing staff had current registrations and were therefore eligible to work at the Home New staff are issued with a contract of terms and conditions of employment Staff had received training relevant to their job roles including dementia care, tissue viability, managing challenging behaviour, nutrition and cultural awareness. Plans are in place to introduce comprehensive induction training for all staff. “Link nurses” have been trained in respect of infection control, tissue viability, moving and handling, dementia care , continence care and moving and handling in order to provide support and training for staff in these areas and thus improve the standard of care. Further training for staff is required in some of these areas in order to fill knowledge gaps within the staff team. Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 23 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, 32, 33, 35, 36 and 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The Home’s Management team and external Managers ensure that good standards are maintained with the Home being run in the best interests of residents. The systems for resident and staff consultation are good and this ensures that any suggestions about the service provided are put forward. There are systems in place to monitor the quality of service on offer to the residents. Maintenance checks of equipment used at the Home are undertaken to ensure that they are safe to use. Residents are not always supervised in the communal areas of the Home and this may pose a risk to their safety. Staff do not always follow health and safety guidelines and this poses as a serious risk to the safety of residents and staff. EVIDENCE: Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 24 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 this effective management team. One staff member said “ All of the staff and management are very approachable”. The residents’ newsletter was temporarily on hold, however plans were in place to re introduce this at a later date as it had been a very useful method of transmitting information to residents, relatives and staff. Resident/relatives meetings are held regularly and these give opportunity for those people using the service to put their views and suggestions for improvements forward. Staff meetings are also held regularly. Quality monitoring visits are undertaken regularly by external Senior Managers and brief reports are written on the findings of these. A quality assurance system is being piloted in another Home owned by the Organisation and if successful will be implemented at Robert Harvey House. There is currently an internal system of auditing for good practice at the Home. The Home’s staff do not manage the personal finances of any residents. The majority of residents are supported in this area by their families. The system for formal staff supervision was under review as the present system was complicated including both practical observations and one to one opportunities for discussions and was not up to date. There was no evidence that areas of concern or issues raised during supervision sessions were monitored or reviewed and this will not boost staff morale and confidence within their job roles which may have a negative effect on the standard of care provided for residents. Good systems were in place to ensure that an acceptable level of food hygiene was maintained in order to safeguard residents. In order to protect residents, all staff had received initial training in health and safety, food hygiene, first aid and fire safety and a rolling programme of refresher training was in place. A fire drill had been undertaken recently. Health and safety checks of equipment used at the Home are undertaken regularly to ensure that they are safe to use. Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 25 Appropriate moving and handling aids were available and staff had undertaken training in respect of moving and handling, however, it was disappointing to observe a number of unsafe moving and handling techniques being undertaken in the communal lounge area putting both residents and staff at risk of injury. In addition to this, a walking aid had been put out of a resident’s reach as a precautionary measure to prevent the resident from attempting to walk unaided. The nurse in charge confirmed that this action was inappropriate, unsafe and not identified within the resident’s care plan. A resident was being pushed in a wheelchair by a member of staff without using the footrests, putting the resident at risk of physical injury. There were periods of time when residents were unsupervised in the communal lounge. A number of these residents had dementia and their personal safety would be compromised if not supervised. It was noted that the top windows on the first floor landing were not restricted and this may be a risk to residents’ safety. Generic risk assessments were available in respect of the premises and food. Comprehensive risk assessments relating to fire safety were available however these required updating in order to safeguard residents. Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 26 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 2 3 2 X 2 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 X 2 Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 27 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 OP1 Regulation 4 (1)(b) The statement of purpose must be further updated to reflect the current services provided at the Home. The Registered Person must ensure that the Home is conducted so as to promote and make proper provision for the health, welfare and treatment of residents The residents’ contract must be updated and include detail of the room number to be occupied The care planning system must be further developed to include: • information from the assessment such as dietary likes and dislikes, hobbies and interests, social, mental health, oral health and psychological needs must be included care plans must be comprehensive, up to date, specify the nature of the care or nursing need and must specify how the Version 5.2 Page 28 Requirement Timescale for action 31/10/06 2. OP2 12(1) 01/08/06 3. 4. OP2 OP7 5(1)(c ) 15 01/09/06 30/09/06 • Robert Harvey House DS0000024882.V300354.R01.S.doc • • • needs are to be met. generic pre-printed care plans must be tailored to reflect the resident’s individual care needs care plans must be written in respect of specific acute medical conditions Care plans must be evaluated in detail at least once each month and more frequently as required (timescale of 01/06/06 not met) 5. 6. 7. OP7 OP7 OP8 13(5) 12(1) 12(1) The body weights of residents must be monitored, recorded and appropriate action taken as necessary. 8. OP8 12(1)(2)( 3) 13(4)(c) 12(1) 12(1) (timescale of 01/05/06 not met) Bed safety rails consent documentation must include detail of the risks involved in the use of these Continence assessments must be undertaken and reviewed regularly A written record of care interventions, for example pressure area care must be maintained. The outcomes of any visits to residents by doctors must be fully documented in care records. (timescale of 01/06/06 not met) 12. OP9 13 (2) All prescription creams must be labelled, dated on opening and DS0000024882.V300354.R01.S.doc Moving and handling assessments must be recorded in more detail. Wound care plans must include more detail of the monitoring of the condition of the wound. 15/08/06 15/08/06 15/08/06 15/08/06 9. 10. OP8 OP8 31/08/06 15/08/06 11. OP8 12 (1) 15/08/06 01/08/06 Page 29 Robert Harvey House Version 5.2 discarded after 28 days to reduce the risk of microbial contamination and used only by the named resident. (timescale of 15/11/05 not met) 13. OP9 13(2) Remedial action must be taken in respect of the requirements made during the Community Pharmacist’s inspection. Confidential personal care records of residents must be appropriately stored in order to safeguard their privacy. (timescale of 01/06/06 not met) 15. OP15 12(4)(a) Residents must be assisted sensitively and respectfully during mealtimes as required (timescale of 15/05/06 not met) 16. OP16 22 The complaints procedure must be accessible to residents and their visitors and must be updated to state that the complainant can contact CSCI at any stage in the complaint process All staff must receive training about adult protection and the management of challenging behaviour. (timescale of 30/01/06 not met) 18. 19. OP18 OP20 13(6) 23(2)(e) The adult protection policy must be amended to include local multi agency guidelines. The Registered Person must undertake a review of the communal space available to residents in the main lounge and dining areas. The nurse call system must be in DS0000024882.V300354.R01.S.doc 01/08/06 14. OP10 12(4)(a) 17 (1)(b) 01/08/06 01/08/06 01/08/06 17. OP18 13 (6) 30/09/06 31/08/06 15/09/06 20. OP22 13(4) 01/08/06 Page 30 Robert Harvey House Version 5.2 23(2)(c ) 21. OP24 12 (4) (a) good working order in all areas of the Home that residents have access to. The Registered Person must undertake a review of the use of the multi-occupancy “ward” area. (previous timescales not met) 30/09/06 22. OP24 12 (4) (a) The Registered Person must review the sitting of the lockable facilities within the bedrooms to ensure that residents can easily access these. Those rooms identified as being unable to accommodate all the furniture identified in the National Minimum Standards must be reflected in the Statement of Purpose. (timescale of 30/11/05 not met) 30/09/06 23. OP24 16 (2) (c) 30/09/06 24. OP25 13(4) Hot water delivery temperatures in residents’ hand basins, baths and showers must not exceed 43 degrees Centigrade and this must be monitored The Assistant Manager received this in the form of an immediate requirement All areas of the Home must be clean for residents’ use Liquid soap and paper hand towels must be provided in all communal bathrooms and sluice areas (timescale of 30/05/06 not met) 30/06/06 25. 26. OP26 OP26 13(3) 13(3) 01/08/06 01/08/06 27. OP26 13(3) Staff must ensure that they change their protective aprons at the appropriate times in order to prevent the risk of cross infection DS0000024882.V300354.R01.S.doc 01/08/06 Robert Harvey House Version 5.2 Page 31 28. OP26 13(3) 29. 30. OP27 OP28 18(1)(b) 18 (1) (a) (c )(i) Suitable lidded receptacles must be available in all communal bathrooms for the hygienic disposal of clinical waste The use of agency staff must not prevent residents from receiving continuity of care The Registered Person must ensure that a minimum of 50 of care staff are qualified to NVQ level 2 or equivalent. 01/08/06 01/08/06 01/11/06 31. 32. OP29 OP30 13(6) 33. OP33 A record of evidence of criminal 01/08/06 record clearance for staff must be kept at the Home. 18(1)(a)(c A staff training matrix must be 31/08/06 )(i) undertaken in order to identify any knowledge gaps within the staff team and subsequent training must be arranged 24 The Registered Manager must 01/10/06 ensure that effective quality assurance and quality monitoring systems are implemented in the home. 18(2) The Registered Person must ensure that all staff receive formal supervision a minimum of six times a year and written records of this must be kept. Any issues raised within these sessions must be monitored and reviewed (timescales of 30/01/06 and 30/05/06 not met) 31/08/06 34. OP36 35. OP38 13(5) All staff must perform safe moving and handling techniques following the instructions within the resident’s moving and handling assessment. The Assistant Manager received this in the form of an immediate requirement Wheelchairs must be fit for DS0000024882.V300354.R01.S.doc 28/06/06 36. OP38 13(5) 28/06/06 Page 32 Robert Harvey House Version 5.2 purpose The Assistant Manager received this in the form of an immediate requirement Residents must be supervised 01/08/06 within the communal lounge and dining area at all times A risk assessment must be 01/08/06 undertaken in respect of the top windows on the first floor landing that are not restricted and remedial action must be taken as deemed necessary Fire risk assessments must be 15/08/06 updated 37. 38. OP38 OP38 12(1)(a) 13(4) 13(4)(a) 39. OP38 23(4) 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. 2. 3. Refer to Standard OP12 OP13 OP15 Good Practice Recommendations It is recommended that further consideration is made to organising trips out side of the Home more regularly. It is recommended that a review is undertaken of the time taken for staff to answer the front door The menus should be reviewed in order for them to be less repetitive. It is recommended that alternatives to mashed potato are served with the lunch time meal A variety of fresh fruit should be available. Any gaps in employment histories on prospective staff member’s application forms should be explored 4. OP29 Robert Harvey House DS0000024882.V300354.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 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. 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