Inspection on 19/09/05 for

This inspection was carried out on 19th September 2005.

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

Other inspections for this house

03/08/07

27/03/07

04/07/06

07/02/06

28/02/05

05/07/04

22/10/03

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

CARE HOMES FOR OLDER PEOPLE Hartley House Hartley Road Cranbrook Kent TN17 3QN Lead Inspector Gary Bartlett Announced 10 August 2005 09:20 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. Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hartley House Address Hartley Road Cranbrook Kent TN17 3QN 01580 713139 01580 715895 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) Kent Community Housing Trust Mrs Susan Jacqueline Ilott CRH Care Home 44 Category(ies) of Dementia - over 65 (22) registration, with number Old age (22) of places Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14 June 2005 Brief Description of the Service: Hartley House is owned and operated by Kent Community Housing Trust. It is a detached, purpose built premises with accommodation on two levels. The Home is equipped with a platform lift. There are a total of 44 bed-spaces with 30 single and 7 shared rooms. All bedrooms are fitted with a staff call point and many have telephone points. Hartley House is located on a main road on the outskirts of Cranbrook where there are the usual facilities of a small town. There is easy access to public transport with a bus stop near by. Space for car parking is available at the front of the building. There are spacious gardens to the rear of the Home for residents to use. The Home’s senior staffing team comprises the Manager, an Assistant Manager and Team Leaders. The Home employs Care Services Assistants who work a roster that gives 24-hour cover. The Home also employs other staff for activities, catering, domestic, administration and maintenance duties. Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission was represented by Gary Bartlett, Regulatory Inspector, who was in Hartley House from 9.20 a.m. until 4.00 pm. During that time the Inspector spoke with some residents, visitors, a District Nurse and staff. Parts of the Home and some records were inspected. Due to the nature of service offered by Harris and Sackville Units it is difficult to reliably incorporate accurate reflections of those residents’ reflections of the service in the report. Many judgements about the quality of life for residents were made from observation. A relatively large number of comment cards were received prior to the inspection. Residents and their relatives responded that they liked the home, felt well and staff gave good care. Responses from health professionals also indicated good standards of care and good communication, with helpful staff. The Manager and staff gave their full co-operation throughout the inspection. What the service does well: The staff of Hartley House are liked and appreciated by residents, relatives and health care professionals. Comments included: • “I am very pleased indeed with Hartley House.” • “always well cared for and attended to..” • “Very pleased with the care my mother receives” • “excellent care.” Staff were seen to be attentive and responsive to residents’ needs. General health needs were well recognised and managed. People who lived at the Home and their visitors said it was comfortable. The Home maintained close links with residents’ relatives and the local community. Residents enjoyed the meals very much and the choices available. Monies held on behalf of residents were well managed. Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 Page 6 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. Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 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 Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 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) 1 and 2 The Home’s Statement of Purpose and Service Users Guide provided prospective residents with sufficient information to be sure the Home could meet their needs. Residents or their representatives were aware of their role and responsibilities in the Home. EVIDENCE: A copy of the Service Users Guide was given to all residents so they had the information they needed about the Home. A Statement of Purpose, which, the Manager said, was accurately descriptive of the aims, objectives, services and facilities of Hartley House, was also available A copy of the last inspection report was seen to be available for anyone interested. Files seen showed that each resident was provided with a contract to clarify roles and responsibilities and to protect the interests of those concerned. Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 Page 9 Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 Page 10 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 and 11 The care plan format was not comprehensive enough to provide staff with the information needed to meet all the residents’ needs. Residents’ health needs were met with good liaison with relevant health care professionals. Personal care was offered to residents in a way that protected their privacy and dignity and promoted independence as far as was practicable. EVIDENCE: As reported previously, the existing care plans provided limited provision for information about how residents’ care needs were to be met, long and short term goals and for holistic risk assessments. Consequently, residents were potentially at risk. The Manager was anticipating the imminent arrival of an improved care plan format for the Home to use. In the meantime residents’ welfare was better promoted through more consistent recording of care given and the writing of risk assessments. Care plans were regularly reviewed. It was evident that the Home invited placing authorities to attend six monthly Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 Page 11 reviews of care along with the residents and their families. As the placing authority did not always respond, the Home was flexible in the timetabling of reviews in an attempt to involve the relevant Care Managers. Staff were seen to respond very well to an emergency. Residents’ safety was then further protected by the staff’s reflection on the incident and the immediate introduction of safeguards to minimise the risks of a repetition. A senior staff member was seen to dispense medicines in accordance with current guidelines and the Medications Administration Records inspected had been appropriately completed. Residents’ safety had been enhanced through further improvements in the storage of their medications. The temperature of the storage area was now being monitored and the possible requirement to provide ventilation there had been identified. The Manager described how they were changing to a different monitored dosage system and would be shortening the time it took to complete the drugs rounds to better safeguard residents. Residents continued to enjoy access to appropriate health care professionals as and when required. Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 Page 12 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) 15 Dietary needs of resident were well catered for with a balanced and varied selection of food that met their tastes and choices. EVIDENCE: Residents spoke very highly of the meals, said they had plenty to eat and enjoyed the choices available to them. A comment card stated “ Mum is very please with the food supplied.” The meals were well presented and looked appealing. Lunch was taken in a relaxed atmosphere and staff were seen to offer assistance in a discreet and sensitive manner. The Cook demonstrated a commendable understanding of special dietary needs and commitment to catering for residents’ tastes. Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 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 standard(s) 16, 17 and 18 The Home had a satisfactory complaints system and residents and their relatives knew their complaints would be listened to and acted on. Residents’ legal rights were protected and there were systems to ensure they were protected from abuse. EVIDENCE: Residents benefited from the complaints procedure being readily available. A visitor described how they knew of the complaints procedure but had not had cause to use it. A resident said they spoke to staff if they had concerns and “things had always been sorted out nicely”. A comment card stated, “any query or concern I may have would be addressed satisfactorily”. The Manager said that records of complaints were kept and these included details of investigation and action taken and were be used to inform future practice. The Manager described how permanent residents at Hartley House were enabled to be on the electoral role. Postal votes were mostly used although residents would be taken to a polling station should they request it. The Manager confirmed that where residents lacked capacity they were facilitated access to advocacy services. There were procedures for responding to suspicion or evidence of abuse or neglect for the safety and protection of residents. The Manager and other staff spoken with demonstrated a sound understanding of adult protection Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 Page 14 procedures and stated that any allegation of abuse would be investigated promptly and a record kept of all actions taken. Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 Page 15 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, 20, 21, 22, 23, 24, 25 and 26 The standard of the environment within the Home was generally good providing residents with a comfortable place to live. Cleanliness was well maintained but residents were put at potential risk through poor conditions in a sluice room. EVIDENCE: The Home was purpose built and allowed ease of access to all parts for residents with mobility difficulties. A platform lift enabled access to the Harris Unit. Residents said they were comfortable and liked their bedrooms and communal areas. The parts of the Home seen by the Inspector were clean and a visitor said they had always found the Home pleasant. Some residents spoke of having enjoyed using the garden in the recent warm weather. Residents and staff considered the bathing and toilet facilities to be adequate. Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 Page 16 Residents’ privacy had been enhanced by the fitting of new bedroom door locks where required. Residents’ personal toiletries were seen to be well maintained and stored. Some surfaces in the sluice room in Harris Unit were damaged. These must be made good to avoid residents being put at risk through poor infection control. Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 Page 17 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, 28, 29 and 30 Recruitment processes are robust and offer protection to people living at the Home. The Home did not provide evidence to indicate staff were trained as required to ensure the safety and well being of residents. EVIDENCE: Residents, visitors and health care professionals spoke highly of the staff: Statements on comment cards included: • • • “All the staff are very friendly and helpful…” “All the staff seem very kind and considerate…” “ …was very impressed by the carer’s knowledge and friendliness” Staff were seen to be attentive and demonstrated a commitment to meeting residents needs. The Manager explained that in view of the rural location of the Home flexibility was offered to staff to accommodate their individual requirements whilst always ensuring staffing levels were geared to peak times of activity. Residents benefited from a resultant low staff turn over. Some use of agency staff was still necessary to maintain adequate staffing levels. Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 Page 18 Records seen indicated that robust recruitment procedures were used and ensured residents received care only from staff that had been properly vetted. The records of staff training did not give a clear indication that all staff had undertaken mandatory training and updates as required. Residents were potentially at risk through this. Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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, 32, 33, 34, 35, 36, 37 and 38 The Home protected residents’ financial interests. The Home regularly reviewed aspects of its performance through a programme of self-review and consultations, which included the opinions of residents and relatives. The Home could not demonstrate it was able to ensure residents’ safety in that not all staff had supervision or undertaken fire training/regular fire drills or attended food hygiene training/updates. Environmental risk assessments needed to be conducted more thoroughly to identify and address potential hazards to residents. EVIDENCE: Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 Page 20 The Manager was very experienced in residential care for older persons and had obtained appropriate management qualifications. A comment card referred to “A professional senior management team” The Home was regularly audited by the Trust. The records of these audits were also used as Regulation 26 reports to the Commission. The Manager described how an annual survey was conducted when questionnaires were sent to service users and their representatives or relatives. The Manager was the delegated budget holder for the Home with supervision and support being provided by the Trust. The Manager spoke of assessments that were made of required service developments and of the on-going costings to ensure viability of the Home. Business accounts were not inspected on this occasion. A staff member explained that the Home encouraged residents to manage their own financial affairs or to have assistance from their families / representatives. The staff member demonstrated a very sound system of holding and recording residents’ cash, which facilitated ease of monitoring. Residents’ relatives did not express any concerns about the Home’s management of monies or valuables held on the residents’ behalf. During the inspection, areas identified as being in need of repair to ensure residents’ safety were very quickly addressed. Staff were seen to be diligent in minimising risks to residents by carefully placing equipment to avoid obstruction and in ensuring COSHH requirements were adhered to. Records of maintenance and safety checks were seen to be in order. Staff had not had regular supervision which, the Manager said, was due to conflicting administrative priorities. The Manager understood the lack of supervision compromised the Home’s ability to monitor staff performance and provide guidance where necessary to ensure a good service was offered to residents. Assurances were given that staff supervision had been rescheduled. Records seen indicated that some staff had not had fire training or participated in fire drills at the frequency recommended by the Fire Safety Officer. Consequently, residents were potentially at risk in such an emergency. The standard of cleanliness in the kitchen and surrounding area was good and foods were seen to be stored in accordance with guidelines. The Cook had augmented the cleaning schedule provided by the Trust so it was more appropriate to the purposes of the Home. Refrigerator and freezer temperatures were being monitored and records of food kept. Staff had not undertaken food hygiene training or updates within the required timescales. Parts of the fabric of the kitchen needed to be made good to maintain food hygiene standards and protect residents. The fly screen needed to be adjusted Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 Page 21 to close flush with the frame and there was discussion about the need to site the clinical waste bin further away from the food storage areas. These deficits would have been identified through more thorough environmental risk assessments, as would have the poor sluice conditions in Harris Unit. Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 Page 22 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 3 3 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 2 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 2 2 1 Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 Page 23 Yes 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 7 Regulation 17 Schedule 3 Requirement “The registered person shall maintain records as specified in Schedule 3 in that a care plan format that facilitates the full recording of the information required must be used “The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home”, in that the damaged surfaces in the Harris Unit sluice room must be made good “The registered person shall having regard to the size of the care home, the statement of purpose and the number and needs of the service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they perform including structured induction training”. “The registered person shall ensure that persons working at the care home are appropriately supervised”. Timescale for action Action plan to be received by CSCI by 19/09/05 Action plan to be received by CSCI by 19/09/05 2. 26 13(3) 13(4)(c) 16(2)(j) 3. 30 18 4. 36 18(2) Mandatory training courses and updates must be arranged for all staff requiring them by 30/09/05 if not sooner Action plan to be received by CSCI by 19/09/05 Page 24 Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 5. 38 23(4)(e) 6. 38 13(3) 13(4)(c) 16(2)(j) “The registered person shall ensure, by means of fire drills and practices at suitable intervals, that the persons working at the care home and, so far as practicable, service users, are aware of the procedure to be followed in case of fire, including the procedure for saving life” in that fire training must be provided at regular intervals. This refers to all staff, including night staff. “The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home”, in that current food hygiene regulations must be maintained through: 1. All staff involved in the preparation of meals and snacks must undertake food hygiene training/updates within the timescales required by food hygiene regulations 2. The fabric and furnishings of the kitchen must be made good where required to maintain satisfactory standards of hygiene. Action plan to be received by CSCI by 15/06/05 Action plan to be received by CSCI by 15/06/05 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 9 Good Practice Recommendations It is strongly recommended ventilation or similar is provided in the medicines storage area to ensure the recommended storage temperature of medicines is not exceeded. It is strongly recommended the training matrix is amended so as to be more suited to the purposes of the Home H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 Page 25 2. 30 Hartley House 3. 4. 5. 38 38 38 It is strongly recommended the clinical waste bin be resited It is recommended the kitchen cleaning schedule is amended so as to be more suited to the purposes of the Home It is strongly recommended environmental risk assessments be undertaken more comprehensively Hartley House H56-H06 S23958 Hartley House V232458 100805 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection The Oast, Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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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