Inspection on 18/02/06 for Safe Harbour Nursing Home

This inspection was carried out on 18th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Safe Harbour Nursing Home 02/07/07

Safe Harbour Nursing Home 21/09/05

Safe Harbour Nursing Home 02/11/04

Safe Harbour Nursing Home 05/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Safe Harbour Nursing Home Abbots Drive Bebington Wirral CH63 3BW Lead Inspector Les Smith Unannounced Inspection 18th February 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 Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Safe Harbour Nursing Home Address Abbots Drive Bebington Wirral CH63 3BW 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) 0151 643 1591 francesblackburn@onetel.com Dr Kumar Shyama Singh Frances Blackburne Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47) of places Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Two (2) named female adults under 65 years of age. One (1) named male adult under 65 years of age. Two (2) named residents in category DE (E). Date of last inspection 21st September 2005 Brief Description of the Service: Safe Harbour is a modern, purpose built care home. It is located in a residential area close to shops and other local amenities. It is registered to accommodate 47 elderly persons who require nursing care. The home is on two floors with bedrooms, lounges and dining rooms on both floors. A passenger lift provides full access to all areas of the home. The home provides both single and shared rooms and some rooms are provided with en-suite facilities. Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over a period of seven hours on one day. During the inspection discussion was held with the deputy manager, staff and residents to obtain their views of the home and of the service provided. Records relating to the care of the residents were found to be extremely detailed and informative and provide staff with all the information necessary for the appropriate level of care to be provided. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 6 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 Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 7 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): 1,2,3,4,5 Prospective residents can be assured that the home is able to meet their individual needs due to the detailed pre-admission assessments that are carried out prior to a place at the home being offered. EVIDENCE: The Statement of Purpose and Residents Guide do not fully meet the requirements and need to be updated to include the detailed complaints policy and procedure. Not all residents have a contract or Statement of Terms and Conditions in place. Files examined for recent admissions demonstrated that Statement of Terms and Conditions were in place and that those files with missing documents related to residents who had resided at the home for some time. The inspector was informed that work is currently in progress to make sure that these documents are put in place. Detailed and comprehensive assessments are made on all prospective residents prior to their admission to the home. These assessments are Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 8 undertaken by the manager or care manager who are both first level nurses. Information is gathered from the service user, family members, GP, hospital staff and any other health care professionals that have been involved in their care provision. The assessment identifies specific care needs and provides the opportunity to identify any specialist equipment necessary and to ensure that the equipment can be put in place prior to the residents’ admission. The files inspected were found to contain substantial information including cognitive ability and any behavioural issues gathered during the assessment. The preadmission assessment is used to construct an initial care plan on the day of admission. Individual preferences, care and social needs are identified and recorded. The home benefits from both the manager and deputy holding NVQ4, three staff with NVQ2 and two with NVQ3. Six of the trained staff are trained as assessors and there are currently eleven staff members working towards their NVQ2 qualification. The deputy manager is a registered first level nurse in mental health and provides additional input and advice for residents with cognitive impairment or dementia. The registered manager positively encourages visits by prospective residents or their representatives at any time. Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 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 the following standard(s): 7,8,9,10,11 There is a comprehensive and consistent care planning process in place that supports the residents by providing staff with the information they need to meet the residents identified and changing needs. The policy and procedure for medication management is fully compliant with current good practice requirements and guidelines. EVIDENCE: A random selection of care plans and related documentation was examined as part of the case tracking process. Care plans included biographical, physical and mental health details and risk assessments. Risk assessments are included for pressure sores e.g. Waterlow, Nutrition, Falls, mobility and handling for all residents together with appropriate risk management strategies. Care plans were reviewed on a regular basis and the case tracking process demonstrated that changing needs were reported and acted upon in a timely way. Care plans are numbered and evaluations are cross-referenced to this number, however care needs to be taken that items are not just copied. One file showed that the evaluation did not correspond to the numbered care plan. It was established that a mistake had been made in October 2004 and Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 10 the incorrect care plan numbers had been copied on a repeating basis since then. Daily dairy sheets were completed appropriately and detailed the actual care delivered. Residents have access to all primary healthcare facilities in the community. A separate record within the care plan recorded all visits by health care professionals and records were seen detailing visits by GPs, district nurses, continence specialists etc. The services of physiotherapists, occupational therapist, dieticians and speech and language therapists are sought whenever necessary. Care plans are agreed with residents or their representatives where possible and are signed to indicate the agreement. Agreements are also signed where it is identified that bed rails, or other protection for residents whilst in bed, are identified as necessary. The home has a policy and procedure to be followed in the event of a service user wishing to administer their own medications and this can only be agreed to following a full risk assessment. The home has a policy and a procedure to be followed for the receipt, recording, storage, administration and disposal of medicines. Registered nurses administer medications to all residents. The inspector noted that two medication records commenced on different dates to the rest and it is recommended that steps be taken to synchronise all medications to the same commencement dates. The MAR sheets were overall well completed but it is a concern that two occurrences were found of medications still in the cassettes but signed for as given. The medication system used is time intensive e.g. new medications have to be checked in on a weekly basis; is not conducive to clear record keeping e.g. MAR sheets are A5 rather than the usual A4 size. It is recommended that the home review their medication system. Personal care is given to residents in the privacy of their bedroom or bathroom as appropriate. The home has four double bedrooms and these are provided with screens to ensure that privacy and dignity are protected. Care staff was observed to be polite and courteous when assisting residents. Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 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 the following standard(s): 12,13,14,15 As far as possible residents have choice and flexibility in how they spend their day in the home, and pursue leisure activities according to their choice and preferences thereby allowing independence and individuality for each resident. Meals at Safe Harbour are good, offering choice and variety whilst catering for residents dietary needs or cultural preferences. EVIDENCE: The routines within the home are flexible to meet the needs and preferences of the residents. A large number of activities are provided in both group and individually and staff members respect the views of those residents who choose not to participate. The home employs an activities co-ordinator for 20 hours each week, and these hours are sufficiently flexible to provide both day and evening activities appropriate to the individual residents. Activities available include crafts, music therapy, Board games, pampering and bingo. The home is actively looking at the possibility of obtaining the use of transport to facilitate trips out. Activities are offered both on a group and one to one basis. Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 12 Residents are given every opportunity to choose and develop their own lifestyle within the home. Individual preferences in relation to many aspects of daily life are recorded on care plans and observed by staff members. Residents spoken to confirmed that their individual choices in relation to how they spent their day were respected. The inspector was informed that the activities co-ordinator would be attending an appropriate course for activities and social recreation in the near future. Ministers of religion visit the home on a regular basis. The Church of England minister provides services fortnightly. A local Priest and Nun visit the home and provide weekly services. Visitors are welcome to the home at any time and may meet with residents in the privacy of their bedroom or in one of the communal areas as they wish. Residents are encouraged to bring personal items into the home such as pictures, photographs and other items of memorabilia as evidenced by the high degree of personalisation of some of the rooms seen. Meals are served in the two dining rooms or in the residents own room as they wish. Menus are based on a four-week cycle but are subject to change depending upon seasonal availability and residents preferences. There is always an alternative choice to the menu on offer and the cook will do an additional meal for those residents who wish to have something different. Meals seen were well presented and looked appetising. Special diets are catered for following the advice of the GP or dietician or on the request of the residents. Liquidised meals were seen presented in a bowl with the vegetables liquidised together. The stimulation of colour and different textures is an integral part of food enjoyment and should not be lost because the meal is liquidised and the meal should be presented on a normal plate to facilitate this. The stimulation of colour and different textures is an integral part of food enjoyment and should not be lost because the meal is liquidised. Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 13 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): 16,18 The home has a complaints and adult protection policy and procedure in place to help promote the safety and welfare of residents. EVIDENCE: The home has a complaints policy and procedure in place. There have been no complaints since the last inspection either directly to the home or to the CSCI. The manager, care manager and staff have all undertaken training in the different types of abuse, their recognition and of the action to be taken in the event of abuse being suspected. The home has a whistle blowing procedure whereby staff and any other person can speak confidentially to the manager or care manager in the knowledge that action will be taken. The home has a copy of Wirral Borough Councils Adult Protection procedure and the manager and care manager were able to demonstrate that they were fully aware of the procedure to be followed. Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 14 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): 19,20,21,22,23,24,25,26 Continuing investment continues to benefit the home creating a comfortable and safe environment for the residents and visitors. EVIDENCE: The home was purpose built to provide care for older people and is situated in a residential area close to shops and other amenities. Accommodation and communal areas are provided on two floors, which are fully accessible, by a passenger lift. The home is currently undergoing some significant alterations to provide appropriate accommodation for the elderly with mental health illness on the upper floor. A tour of the home with the deputy manager demonstrated a high standard of cleanliness, furnishings and décor throughout the home. It was obvious that maintenance is ongoing and minor items of required maintenance had been scheduled for rectification. There is an urgent need however to complete the provision of window restrictors and temperature control valves to the hot water Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 15 outlets. The use of bed rails without protective bumpers or using a single bed rail only is not good practice and presents risk to the residents concerned. Externally the home is of a good standard with the exception of a significant number of window frames and woodwork, which exhibit varying degrees of damage and wear. The large rear garden has had a large area of decking installed as part of a substantial development and will be a major enhancement to the homes facilities when completed. The home has policies and procedures to prevent the spread of infection with appropriate arrangements and contracts in place for the disposal of general and clinical waste. The laundry has a washing machine with sluicing facilities with an Ozone machine to ensure that all germs are killed. Resident’s personal clothing was laundered to a high standard. Resident’s clothes are labelled and some items are laundered in mesh bags for protection. The Environmental health officer inspected the home in September 2005 and made requirements, which have not been met in their entirety. Whilst a cleaning schedule was available it had not been completed for some time and did not meet the requirements as detailed in the inspectors report. Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 16 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): 27,28,29,30 There are sufficient staff employed to meet the assessed needs of the residents but compliance with recruitment policies has not always been present potentially placing residents at risk. EVIDENCE: The home employs qualified nurses at all times, supported by care staff to provide care, supervision and support to the residents. Staff members are deployed in sufficient numbers and skill mix to meet the assessed and changing needs of the residents. Staff training continues to take place with a number of care staff currently working towards attaining NVQ at level 2. As the staff members who are currently working towards their NVQ2 qualify in the near future the home will exceed the 50 target of NVQ qualified staff. Policies and procedures are in place for recruitment to support and protect residents however examination of a random selection of staff files showed that these policies are not always adhered to. One member of staff commenced duty at the home on 13 February but the PovaFirst clearance was not obtained until 17th February. A second member of staff commenced on 24th January but the CRB was not obtained until 24th January and no PovaFirst clearance was present. This file also contained only one reference. Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 17 All new staff are required to complete a comprehensive, three month, induction training programme which includes fire lectures, fire drills, first aid, basic food hygiene and manual handling. One staff file did not have a record of induction and it was established that the induction had not taken place. Training is ongoing for both care and trained staff. Training includes specialist areas such as tissue viability and resuscitation and training in 2006 has included infection control, health and safety, first aid, challenging behaviour, manual handling, food hygiene and adult protection and abuse. Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 18 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): 31,32,33,35,36,37,38 The manager has a good understanding of the areas in which the home needs to improve. Planning was in place and set out how this improvement was going to be resourced and managed. EVIDENCE: The manager, and the care manager, are both qualified nurses and have gained an NVQ in management at level 4. Evidence of on-going training was seen to demonstrate that they continue to update and improve their knowledge, skills and understanding. The deputy manager stated that the home has an open door policy and either the manager or she is available for staff and residents at all times. Staff spoken to confirmed that the manager is approachable and that the home has an open and positive atmosphere. Staff also commented on the substantial Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 19 improvements that have taken place within the home since the current management team were appointed. Considerable improvements have been made to the care plan and the manner in which the care provision is recorded. The views of residents and their families are gathered from one to one discussions and at meetings held with family members. The home is currently working towards attaining Investors in People accreditation. The manager does not deal with any of the resident finances. insured and the certificate is displayed as required. The home is Formal staff supervision has as yet is not in place but the inspector was informed that this will be starting in the near future. The manager and maintenance staff addresses any issues of health and safety although all staff have been given training in health and safety and are aware of their role and responsibilities relating to these. Checks on fire detection equipment are undertaken as required and recorded. Fire drills are held and training is given to all staff regularly to update and reinforce the procedures. Safety, inspection and service certificates were checked for the fire alarm and extinguishers; clinical and general waste disposal, lift; emergency lighting system and the periodic electrical certificates. Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 20 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 3 4 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 3 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 3 3 Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 Requirement The registered person must ensure that the Statement of Purpose includes all of the required information as detailed in schedule 1 The registered person must ensure that all parts of the home to which residents have access are so far as reasonably practicable free from hazards to their safety (Refer to temperature control valves and window restrictors) The registered person must ensure that the home is kept in a good state of repair externally (Refer to window frames and external woodwork) The registered person must ensure that bed rails are properly protected and used in accordance with best practice guidelines. The registered person must ensure that the requirements as detailed in the Environmental Health inspectors report dated September 2005 are met in full. Timescale for action 31/03/06 2 OP19 13(2)(a) 30/06/06 3 OP19 23(2)(b) 30/09/06 4 OP22 23(2)(n) 31/03/06 5 OP26 16(2)(j) 31/03/06 Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 22 6 OP29 19(1)(b) 7 OP36 18(2) 8 OP38 13(4)(a)(c) The registered person must ensure that the documents specified in schedule 2 are obtained before allowing a person to work at the home The registered person must ensure that persons working at the home are appropriately supervised. The registered person must arrange for a gas safety check to be carried out and forward a copy of the relevant certificate to the CSCI. 31/03/06 31/03/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP15 Good Practice Recommendations It is recommended that the registered manager review the system for medications. It is strongly recommended that liquidised meals be presented in a manner that is attractive and appealing. Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Safe Harbour Nursing Home DS0000039379.V283962.R01.S.doc Version 5.1 Page 24 - 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. 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