Care Home: Harding House

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What the care home does well People are happy living at the home. They are well cared for and are able to make choices about their lives. They learn new skills and have the support they need to follow their interests and meet their needs. The home provides a calm and supportive environment for people who have a hearing impairment. The staff are well supported and have the training and information they need to help them care for the people who live at the home. What has improved since the last inspection? The service has done all the things we asked them to do at the last inspection. They have worked hard to improve the way the service is managed, how things are recorded and the support that people living there get. What the care home could do better: There are good systems for monitoring the quality of the service and the opinions of the people who live there and staff. The manager uses these to help plan for changes which will benefit everyone. Consultation with people who live at the home should continue. We found that the home met the majority of National Minimum Standards with only a small number of concerns. These include recording additional information on medication administration charts and making sure faulty equipment is repaired immediately. We have asked the registered person to do these things because people may be at risk if these problems are not addressed. Key inspection report CARE HOME ADULTS 18-65 Harding House 70 Wandsworth Common Northside London SW18 2QX Lead Inspector Sandy Patrick Key Unannounced Inspection 9th December 2009 10:00 Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 2 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 Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Harding House Address 70 Wandsworth Common Northside London SW18 2QX 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) 020-8870-3653 020 8874 6716 Riverhaven Sharon Angela Smith Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10), Sensory impairment (10) of places Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th January 2009 Brief Description of the Service: Harding House is a care home registered to provide support to ten people with mental health needs and who also have a hearing impairment. The home is situated on a main road within walking distance of the shopping centres of Wandsworth and Clapham Junction and the transport links served by the area. Harding House is a large Victorian house with accommodation provided over three floors with a good size garden to the rear of the home. The fees charged by the home range from £950 to £1100 per week. Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. As part of the inspection we made an unannounced visit to the home on 9th December 2009. We met people who live at the home, staff on duty and visitors. We looked at records, the environment and how people were being cared for and supported. We wrote to people who live at the home, their representatives and staff and asked them to complete surveys about their experiences. We asked the manager to complete a quality self assessment (AQAA). We looked at all the information we had received about the home since the last inspection. Some of the things people told us about Harding House were: ‘They support me when I need it’, ‘they are friendly’ and ‘people are happy here’. What the service 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 Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 6 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. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 People using the 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 have enough information about the home to help them to make a decision about moving there. They have their needs assessed to make sure the home is the right place for them. EVIDENCE: People told us that they had had enough information about the home to help them know if they wanted to move there. They said that they had been able to visit. Everyone who wants to move to the home has their needs assessed to make sure the home can meet these needs. Assessments include information from the person themselves and others who know them well. We saw examples of assessments in people’s care records. We saw that their place at the home had been reviewed shortly after they moved there to make sure they were happy and that the home continued to be the right place for them. No one has moved to the home since the last inspection. Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 People using the 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 have their needs recorded so that the staff know what support they need to give them. They are supported to make decisions about the care they receive and their daily lives. EVIDENCE: People told us that they had the care and support they needed and that they were able to make choices about the things that they did. Everyone has their needs recorded in a care plan. They have been involved in creating this. These plans tell the staff what support they need to give each person to make sure their needs are met. We looked at a sample of these. We saw that care plans were regularly reviewed and information about each person was up to date and accurate. Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 10 We saw that people were supported to take risks and make choices about the things that they did. The staff had made recorded risk assessments where they felt people may be at harm. The assessments looked at how people could be supported to do the things they wanted to do without coming to harm. We saw that these assessments were regularly updated and that the people they were about were involved in discussions about these risks. Everyone who lives at the home has a hearing impairment. All staff are trained to communicate using British Sign Language. All communication in the home includes the use of sign language to make sure everyone feels included and knows what is being said. The staff have regular training to update their skills. We saw that everyone worked hard to make sure they communicated effectively and that information was clear and understood. People who live at the home are involved in reviewing their own care plans. They also meet regularly as a group to discuss plans and changes for the home. Everyone who lives at the home has a key member of staff who coordinates their care and support. Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 11, 12, 13, 14, 15, 16 & 17 People using the 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 are supported to learn and develop skills. They take part in a variety of activities which reflect their interests and needs. They are well fed and given the support they need to plan, shop for and prepare their own food. EVIDENCE: People told us that they did a range of different things which suited their individual needs. They told us that they were supported to learn and develop the skills they needed and wanted. One person said, ‘I like the cooking’. Each person is given individual support to develop the skills that they need and want. People participate in menu planning, shopping, budgeting, managing their own health and medication needs and living together as a group. We saw that individual care plans showed areas where people needed specific support. Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 12 We saw people being supported throughout the day to do some of these activities. Since the last inspection the home has employed an activities coordinator. Her role is to plan the things that each person does and to give them support or arrange for them to have support to do these things. She keeps records of the activities people have participated in. These include meeting social needs, undertaking hobbies and using the local community. We saw that some people attended regular groups, had jobs or went to college. They are also supported to use the shops and other community facilities to meet their leisure needs. The home welcomes visitors and we saw that people were able to receive visitors when they wanted. There is communal and private space available for people to entertain guests. People are supported to plan menus and to prepare food at the home. We saw that meals were balanced and varied. Food is stored appropriately. We saw that the staff were respectful and kind to the people who lived at the home. They communicated clearly with them and took time to understand what people wanted to tell them. We saw people sharing jokes with staff and spending time relaxing with them. Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People using the 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 are given the support they need to stay healthy and have their personal needs met. EVIDENCE: People told us that they had the support and medical care that they needed. Personal, physical and mental health needs are all recorded in care plans. We saw that information was up to date and regularly reviewed. We saw that the staff monitored people’s health needs. Everyone is registered with a local GP and sees other health professionals as needed. The staff work closely with other professionals and we saw that they followed their advice and guidance to make sure people stayed healthy and well. Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 14 There is an appropriate procedure for medication. We saw that medication was securely stored. All staff have had training in medication and there is information on different medicines people use and how to make sure people stayed safe while using these. We saw that medication records were accurate and clear and that people were getting the medication they needed. Some people are supported to manage their own medication. We saw that there was risk assessments and ways to monitor that this is working. The medication administration charts did not record allergies. These or a record of no known allergies need to be recorded, so that this information is clear to anyone administering medication. Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People using the 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 are able to make a complaint and feel confident that this will be investigated appropriately. There are procedures in place to help safeguard people and protect them from harm. EVIDENCE: People told us that they knew how to make a complaint. We saw that there was a complaints procedure and a record of all complaints and how these were investigated and resolved. The organisation has procedures on whistle blowing and protection of vulnerable adults. The home also has a copy of the local authority procedure on safeguarding. All staff have had training in this area and demonstrated that they understood about their responsibilities. There are procedures to help people look after their own money and to make sure this is kept safe. We saw that records of money held on behalf of anyone were accurate and regularly checked. Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People using the 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 live in a safe, clean and well maintained environment. EVIDENCE: People told us that they liked the environment. One person told us, ‘I like my bedroom and the home is very clean’. The building was being decorated at the time of our visit. There were plans for new carpets and furniture in communal areas. There are a number of different communal rooms and everyone has their own bedroom. The building is equipped with special features to support people who have a hearing impairment, such as vibrating bed alarms and lights for indicating the fire alarm being activated. The home was clean and fresh throughout on the day of our visit. Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36 People using the 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 are cared for by well trained, supported and appropriately recruited staff. EVIDENCE: People told us that the staff were kind and supportive. The staff told us that they felt well supported. They said that they had the training and support they needed to do their jobs. Some of the things the staff said were, ‘there is good team work’ and ‘the staff and residents respect each other’. Some of the staff told us that they would like more specific training in supporting people with health care and medication. We saw that the staff had information about their roles and responsibilities and the things that they needed to do. One member of staff said that they would like clearer information about who was responsible for what when the manager was away. Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 18 We looked at a sample of staff files and saw that these staff had been recruited appropriately. The staff had met with people living at the home and had a formal interview. Wes aw that checks on their suitability had been made before they started work. All new staff complete an induction into the home and their work and we saw evidence of this. We saw that staff had regular training and that all staff had been trained in key areas to make sure they knew how to care for people and to keep them safe. All staff have regular team and individual meetings with their manager and we saw evidence of this. We saw that they were well informed and able to contribute their ideas and opinions. There are good systems for communication between staff, including a daily Andover of information, communication book and a diary of events. The staffing levels at the service have increased since the last inspection. This has allowed people to do more things and have the support to pursue more individual activities. Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 People using the 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 live in a service which is well managed and where appropriate checks and monitoring take place to ensure continuous improvement. EVIDENCE: The registered manager has left her job and a manager from another service now works at the home. This person needs to register with CQC. The staff told us that the manager was approachable and worked well. One member of staff told us, ‘the home runs smoothly’. We saw that improvements had taken place since the last inspection and everyone had worked hard to meet the requirements we made. Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 20 The organisation makes regular quality checks at the home and writes a report with actions for the home to achieve. The people who live at the home complete monthly quality satisfaction surveys which are used by the manager to help plan for improvements and changes. We saw that records were well organised, up to date and accurate. We saw that regular checks are made on health and safety, including fire safety. These are recorded and in most cases action has been taken to address any concerns. However we saw that one of the vibrating bed alarms had not been working for over two weeks. This may be the person’s only alert to a fire in the house if they were sleeping. Therefore the alarm must be fixed without delay. There needs to be a procedure and risk assessment, know by all staff and the person concerned, as to what to do in the event of the fire alarm being activated until this piece of equipment is repaired. Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 3 3 X X 2 X Version 5.3 Page 22 Harding House DS0000010193.V378522.R01.S.doc 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 YA20 Regulation 13 Requirement Timescale for action The registered person must 05/01/10 make sure the allergy section on medication administration records is completed. The registered person must 31/01/10 make sure the manager is registered with CQC to manage Harding House. The registered person must 05/01/10 make sure the vibrating bed alarm that was broken is repaired without delay. The registered person must make sure there is a clear 05/01/10 procedure in event of alarm equipment not working and that any risks resulting from faulty equipment are assessed immediately. All staff and people who live at the home who are affected must be made aware of these procedures and assessments. 2. YA37 8 3. YA42 23 4. YA42 13 Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA31 Good Practice Recommendations The manager should make sure all staff have a clear understanding of each others responsibilities and how the house should be run in her absence. The manager should discuss with staff their specific training needs and requests and should make sure relevant training is provided. 2. YA36 Harding House DS0000010193.V378522.R01.S.doc Version 5.3 Page 24 Care Quality Commission Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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