Care Home: Harbour House

What the care home does well This is a well managed home which is run on behalf of the people living here. People are supported to remain independent for as long as possible and are treated with respect and as valued individuals. Their health and welfare needs are met through appropriate care planning and care delivery. Staff are helped to care for people through good communication and by having appropriate training and support. Care is person centred and tailored to the needs, wishes and preferences of each individual. Staff are described as caring, kind, thoughtful, providing supportive independence. People make choices in their daily lives and say there is just enough routine so that they can organise their lives. Activities are arranged which people enjoy. The home offers a wide selection of different meals which are of a high quality. This includes home baking and fresh fruit and vegetables. Special diets are catered for. People are kept safe from harm through robust recruitment and by ensuring that staff are aware of what abuse is and how to safeguard people. The home is clean, homely and safe throughout. Adaptations are made for those who have mobility problems and this includes ramps, assisted baths and a lift which can accommodate a wheelchair. People say this is their home and that they enjoy their lives. What has improved since the last inspection? Since the last inspection the home has adopted a new care planning system. This has helped staff to record the actions which need to be taken to meet needs. This system has been accompanied by training in care planning which has improved staff knowledge in relation to current good practice. Care plans are reviewed regularly and are up to date. In addition this system includes risk assessments, including risks relating to moving and handling, diabetes, pressure damage and malnutrition. Records have been updated or are in the process of being updated. Staff have received training from district nurses in relation to treating small wounds and the manager continues to source further training as needed. What the care home could do better: This service should continue the work started to ensure that all policies and procedures and training are up to date, to more fully support staff and protect people. Key inspection report Care homes for older people Name: Address: Harbour House George Street West Bay Bridport Dorset DT6 4EY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Teresa Anderson     Date: 2 1 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Harbour House George Street West Bay Bridport Dorset DT6 4EY 01308423277 01308459497 harbourhouse@btopenworld.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: West Bay Housing Society Limited care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Harbour House is owned by West Bay Housing Society Limited, a not for profit organisation. The responsible individual is Mrs Lorna Hill on behalf of the West Bay Housing Society Limited. Day to day management of Harbour House is undertaken by registered manager Mrs Jean Adams. The home is situated close to West Bay harbour, local shops, church and other amenities. Bridport town centre is approximately two miles away. The home is registered to accommodate 33 older people in a combination of 28 single apartments, one double apartment in Harbour House, a double apartment known as Harbour Cottage (situated in the rear garden of Harbour House) and a bedroom alternately used for respite and visiting guests. Apartments are on the ground, first and second floors and level access is achieved by a passenger lift. One flat is at ground floor level and the other is accessed by set of stairs. The home has a large communal lounge and seperate seating ares with views to the central garden. There is a separate dining room on the ground floor and a quiet Care Homes for Older People Page 4 of 28 Over 65 33 0 2 6 0 3 2 0 0 9 Brief description of the care home lounge on the first floor. The home has gardens to the front and side which are attractively planted and well maintained. The current fees range from £448.46 £593.04 per week. Respite care is provided at a cost of £74.28p per night - not including personal care. In addition, relatives can rent guest rooms (which will not include personal care) at a cost of £64.28 per night for a single room and £134.00 for a double room, if booked 3 weeks in advance. Fees do not include personal items such as hairdressing, chiropody, toiletries and newspapers. Further information about this home is available on their website www.westbayhousing.co.uk Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place as part of the normal programme of inspection. It was undertaken by one inspector over one day. During the inspection we spoke with approximately nine people who live here, with four people who work here, with the manager and with one visitor. We looked at records relating to peoples care, medication, training, recruitment, and some policies. We looked around the home and saw some apartments and all of the communal areas. Prior to the visit to the home we sent surveys to eighteen people living here asking for their feedback and comments. Seventeen were returned. We sent eighteen surveys to staff and fourteen were returned. We also sent surveys to health care professionals and twelve were returned. Their feedback and comments are included in the main body of the report. Care Homes for Older People Page 6 of 28 Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 28 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who want to come and live here have their needs assessed and can be sure they will be met. Evidence: Harbour House admits people who have low needs and have a high degree of independence and ability. People tend to independently make an application to the home to move in, although some people are admitted with the help of the Local Authority. Before the home agrees an admission, each person is assessed by the manager and the deputy to determine their needs. A record of this is kept in each persons record. We saw one assessment. This shows that enough detail of needs was taken to ensure that care needs are identified and that those care needs can be met as soon as the person moves into the home. We also saw that there was some doubt about how one persons needs might develop over time. The manager had therefore negotiated a Care Homes for Older People Page 11 of 28 Evidence: longer than normal trial period for this person. This is good practice. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living here benefit from having their care planned and delivered in a way that meets their care needs and which treats them as individuals. Evidence: In surveys people told us they always get the care and support they need and the majority say they always get the medical care they need. We found that each person living at the home has a plan of care which informs staff about how that persons needs are to be met. The home have recently introduced a new system of care planning and are currently in the process of moving to this system. We looked at three care plans. We saw that each care plan contains that persons identified needs and information about how these needs are to be met. These documents also show that peoples needs are monitored and reviewed, and that additional or alternative actions are taken as necessary. Care Homes for Older People Page 13 of 28 Evidence: For example, one care plan demonstrates that this person is becoming more frail and losing weight. The tool to measure risk in relation to malnutrition has been used and shows this person is at high risk. The GP has been contacted and high calorie food supplement drinks have been prescribed. Staff told us how often they give these drinks, and this matches the prescription. They also told us how they use this persons preferred and favourite foods to help encourage them to eat. They told us this person decides where they would like to eat, depending on how they are feeling and that this too encourages them to eat. They told us this person is less likely to eat if presented with a large plate of food, so they offer smaller portions, with snacks in between. The care plan also shows us that this persons risk of developing pressure sores has also been reassessed as they have become less well and have lost weight. This shows that this person is at risk. As a result of this risk, this person now sleeps on a pressure relieving mattress. Staff also contacted the District Nurses for further advice and this is good practice. The care plan also instructs staff to look for signs of pressure sores. We spoke with staff about this. They told us what signs they look for, and where these signs might first show. They also told us that they ask this person if they have any soreness, but as this person has a very high pain threshold, they know that they must be even more vigilant. This is very good practice and shows that care given is very person centred. No one living in this care home has a pressure sore. We looked at another care plan of someone who is more able. This care plan also tells staff about this persons needs and how they are to be met. For example, this person has diabetes, which is controlled by diet. We spoke with the cook who knew about this. She told us that she ensures this person has a well balanced and nutritious diet which includes lots of vegetables and fruit. The care plan also contains information about other areas of care that are important for people with diabetes. This includes regularly seeing the chiropodist and optician, which records show this person does. This person is partially deaf and the care plan describes how best to speak with this person so that they can hear them most effectively. We saw staff using this technique on each occasion that they spoke with this person, and with other people with hearing problems. This is good practice. Another care plan demonstrates that staff monitor peoples health and welfare, and take appropriate actions very quickly. Records show that recently the person this plan relates to had deteriorated mentally and had become very anxious. Staff contacted a doctor to inform them of this. A urine sample was taken which showed this person had an infection. Treatment of this infection has resulted in this person remaining well. Care Homes for Older People Page 14 of 28 Evidence: In surveys staff told us they always have the information they need to care for people. We saw that there is a full handover about residents between each shift and that important information is communicated in written form. This shows that there is a good communication system in place. Feedback from visiting healthcare professionals was very positive. They say that peoples needs are accurately assessed, that needs are monitored and reviewed and that appropriate actions are taken. They say that when advise is given that this is put into action. We looked at how medicines are managed. We saw there is a safe system in place for ordering, receiving, storing and returning unused medicines. The system ensures that medicines are auditable. We looked at records relating to medicines. These are clear, accurate and up to date. People living here are encouraged and supported to manage their own medicines, and this is good practice. To make sure this is as safe as it can be, an assessment of potential risks associated with self medication is carried out by a senior member of staff. The actions to be taken to minimise these risks are then recorded. We note that this system is continually being reviewed and advice is being taken from the community pharmacist to ensure it is as safe as it can be. The home has storage facilities for medicines that need refrigeration and for those which are stored as controlled drugs. Staff who administer medicines have received training. In addition, each member of staff is periodically observed and their competency checked by a senior member of staff. We spoke with one persons relative. They told us the care their relative receives is excellent. They say all needs are met by caring, thoughtful and patient staff. We talked to staff about how they help people to maintain their privacy and dignity. Staff demonstrate an excellent understanding of the importance of treating people as individuals who have a right to be treated with respect. Staff described how, when helping people to wash, that they do this in private and make sure that only those parts of the body being washed are exposed. We observed staff being respectful and helpful. People living here told us that staff are really friendly and yet they understand boundaries. Senior staff told us that this part of care is central to the ethos of this home as it is central to peoples well being. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living here are supported to live the life they choose in a way that suits them. They also benefit from a well balanced, nutritious and varied diet. Evidence: In surveys 14 out of 18 respondents told us that there are always activities that they can take part in, and 4 said there usually are. During our visit to the home we spoke to people about this. They told us there is plenty to do in the home, and that they like their independence to do what they like. They showed us the extensive library of books for people to choice from, and the ongoing word search game that is on a large wipe board for people to add to. They showed us the large screen TV which can be used. This tends to be used for organised showing such as DVDs or favoured documentaries. They also told us that they have a TV, radio and music plays in their bedrooms if they want them. We saw people going out for walks when they pleased and saw people coming to visit the home. Visitors told us they are always welcomed and that there are facilities for them to stay overnight if they wish, and that they can have a meal at the home is they wish. Care Homes for Older People Page 16 of 28 Evidence: We saw that people had developed friendships since coming to the home, and we saw that people already knew people living here and had decided to move in themselves. Staff told us that an activities co-ordinator is about to start work at the home. They also told us that a tradition has developed for three large outings each year. At Christmas people go to the local pantomime, in the summer they go to a musical and they also go to a small farm where they have cream teas. People told us that they dislike the inconvenience of long outings except for these special occasions. In addition residents hold fund raising coffee mornings twice yearly which they organise themselves. Residents meetings are held regularly, and these are also managed and chaired by residents. People told us that they live the life they choose at this home. They told us that there is just enough routine for them to be able to organise their own lives. They say they make all their own choices and that no restrictions are place upon them. They say that staff work hard to accommodate them and their choices. One visitor to the home told us that this home fits around each person and there is never an expectation that the person will fit into the home or around the staff. Although this is a Quaker home, people of all religions are welcome. There is a church near to the home and a quiet time is held each morning at 10am which people can take part in if they wish to. On the day of this inspection a memorial service was being held for one person who had left the home a long time ago, but whom people felt should have their passing commemorated. In surveys people told us they always or usually like the food served. We spoke with the cook who told us that she had recently been introducing new meals. She had an excellent knowledge of peoples needs and preferences. She says that the menu for the week is decided at the beginning of the week, and that there is a lot of flexibility and variety in what is cooked. She told us that if she knows someone does not like something, or if someone tells her they would prefer not to have something, that this is easily accommodated. All food is cooked on the premises. This includes ham for sandwiches, soups and cakes. People we spoke with told us the food is splendid, exceptional and excellent. People told us they choose where they eat, with the majority having breakfast in their apartments, and coming together for lunch and supper. In addition, each person living Care Homes for Older People Page 17 of 28 Evidence: here has a kitchenette in their apartment which includes tea and coffee making facilities. Care Homes for Older People Page 18 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living here are listened to and are safe from abuse. Evidence: In surveys people told us that they know who to speak with if they are not happy and 17 out of 18 say they know how to make a formal complaint. This home has not received any complaints and neither have the commission. People told us they have no complaints and that they feel safe and well cared for. They say that any comments they have are well received and that nothing becomes a complaint because requests are dealt with so easily. We spoke with staff about safeguarding people from abuse. They demonstrate a good knowledge of what abuse is and what to do if they see or suspect abuse. We spoke with the manager about their knowledge of the procedures to be followed. She has in the past had cause to use safeguarding procedures, which she did in a timely and effective way. Since the last inspection training for staff in safeguarding people has been arranged and is due to take place later this month. In addition, the manager has started to review the safeguarding and whistle blowing policies. Whilst this work is ongoing, she has displayed the procedure to be followed if a safeguarding alert were needed, together with the appropriate contact number, in a prominent place in the staff office. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a clean, safe and homely environment. Evidence: In surveys people told us this home is always clean. When we visited this is what we found. It is clean, well maintained and odour free. Furnishings are comfortable and of a good quality. There are maintenance and housekeeping notebooks which people can write in to request work to be done. People told us that any jobs needed, such as putting up shelves, are dealt with quickly and easily. The home is built around a central garden and has gardens to the side. Access to these areas is easy and encouraged. The gardens are well maintained and attract many birds which people living here can enjoy from their apartment balconies or from the sitting areas. Each apartment has a kitchenette area and an ensuite bathroom. Some baths have adaptations to make bathing easier and so that people can maintain their independence. In addition, the home has recently refurbished one bathroom which has an assisted bath and a wet room. Care Homes for Older People Page 20 of 28 Evidence: We looked in areas of the home such as the sluicing area, laundry and toilets, and found that foot operated bins are in place. This helps to prevent the spread of infection. We spoke with staff about how else they control infection. They demonstrate a good knowledge including good hand washing techniques and using protective clothing such as gloves and aprons. The manager told us that infection control training is covered in the National Vocational Qualification (NVQ) which 16 of the 22 care staff hold. She also told us that she is trying to source a trainer for those who do not have this qualification and for updates, but is struggling to find one. We looked in the laundry and saw this is clean and well organised. Washing machines are designed to wash at high temperatures if needed. This room also contains a sluicing facility and hand washing facilities. People living here have washing and drying machines in this room which they can use if they wish. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by well training, competent and caring staff who are recruited using robust methods. Evidence: In surveys people told us that staff are always or usually available when needed. They say staff are kind, caring, compassionate, considerate and helpful. We observed staff interacting with people and saw these qualities. We also saw staff being friendly yet professional, respectful and responsive. We looked at the duty rota and saw that in the morning there are 5 carers on duty, including the head of care. In the afternoon there are 3 carers until 11.45pm and 2 carers overnight. Carers are supported by the manager, administrator, maintenance man, cook, kitchen manager, kitchen assistants, dining assistants and cleaner. The home are also recruiting an activities co-ordinator. The information given to us by the home informs us that 16 of the 22 staff working here have an NVQ in care at level 2. In addition, 3 carers also hold this qualification at level 3 and another at level 4. This exceeds the government target of 50 of care staff holding this qualification. Housekeeping staff are also encouraged to study for, and have achieved, NVQs in their field of work. Care Homes for Older People Page 22 of 28 Evidence: We looked at some staffs records and saw that they have had induction training which is based on Skills for Care Common Induction Standards, and this is good practice. We also saw that apart from NVQ training some staff have received training in caring for people with dementia, care planning, and diversity. Some staff have also received training in the Mental Capacity Act and in Deprivation of Liberty. We looked at two staff recruitment files. We saw that each member of staff completes an application form. This includes their working history, and two referees which includes the most recent employer. References are taken up from these people and an enhanced police check is undertaken before they are allowed to work in the home, as is good practice. We also saw that each member of staff is required to produce photo identification and a health declaration. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a home that supports them to be independent citizens with rights. The home is managed safely. Evidence: This home is managed by Mrs Jean Adams. She has worked at the home as manager for approximately 7 years. She is a Registered Nurse (although cannot practice as a nurse in this setting) and completed the Registered Managers Award in 2004. The home also has a Head of Care who has many designated responsibilities. These two people form the management team within the home. They are supported by senior carers and carers. In addition the home has a management committee made up of Trustees. These people are involved in the decision making relating to the running of the home. The third group of people who are involved in the management of this home are the residents themselves. They arrange, run and chair their own meetings, making certain Care Homes for Older People Page 24 of 28 Evidence: decisions. Non residents can attend these meetings by invitation. People told us this is an exceptionally well run home. They say that different people have different skills and that each person is encouraged and empowered to put those skills into action. They say that they feel that this is their own home where they receive care services, not a care home. They say they live communally and have a community but are treated as individuals capable of making decisions about themselves and their community. They say what they value the most is their independence and that this is therefore what staff value and help them to maintain. Staff told us they feel well supported and they receive the training they need. They say they are treated respectfully by the management team, feel valued and that it is a joy to work in the home. They say the manager is available to them and is friendly, but that she is not afraid to reprimand staff if this is needed. Staff think this helps to keep standards in the home very high. Part of the ethos of this home is to treat people as respected individuals and to promote independence. We have strong evidence that this is being achieved. People say they are involved in the running of the home and decision making, to a degree that suits them. They say their feedback is sought, listened to and acted upon. People told us they are happy to call Harbour House their home and are pleased to have made so many friends. They say they have supported independence. We looked at management systems in the home. We saw that some people like the home to keep their personal allowances and that there is a robust system to do this. All monies are checked by two member of staff and all receipts are kept for auditing. We checked two accounts and found them to be in order. We saw that that staff have training in moving and handling, fire safety, food hygiene and infection control. We also saw that maintenance checks are carried out as needed, that equipment is well maintained and that environmental risk assessments are carried out. The manager of the home keeps the commission informed of any events which affect people living here, including accidents and injuries. We checked about one person who seems to be experiencing a lot of falls. We found that everything is being done to prevent these falls and to minimise the effect of falling. However, this person wants their independence, has capacity to make decisions and would rather fall than have restricted movements. We spoke with this person and they confirmed this. The manager is aware that she needs to review all the policies in the home and plans to do this. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 18 26 38 Work on updating the whistle blowing and safeguarding policies should continue. The manager should continue trying to find training for staff in infection control. The work started to update the policies and procedures within the home should continue. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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