Care Home: Harefield House

What the care home does well The home provides a very welcoming atmosphere, which actively helps residents to do things they like to do and encourages friends and family to visit regularly. The following extract from the Expert by Experience report demonstrates this: "During my visit I noted photographs of residents doing cooking and flower arranging. On questioning, one resident said flower arranging was her previous occupation and she liked to arrange flowers and showed the others how to do so. Residents enjoyed making bread and cakes, which they ate. Staff were encouraging residents to throw balls and exercise their hands and also were watching a video. One resident had gone out to the hairdresser of her choice (although there is a visiting hairdresser) She also goes down to the local shopping area for coffee with friends. The Roman Catholic priest was visiting and he visits regularly and feels that the Home meets the needs of the residents and is happy place to be. Outings are arranged by the Home to see the lights at Christmas and Spring and Summer outings to parks etc. All the residents I spoke to said they had family who visit and also who take them out on a regular basis. They are able to entertain visitors in their room but mainly prefer to use the "front room" with their visitors." Care plans are now good and include individual activities for residents. Health care is well managed. Staff recruitment, induction, training and supervision are well managed and staff feel supported by the homes management. What has improved since the last inspection? The homes Statement of purpose and statements of terms and conditions for service users have been updated to include details of the fees to be paid by residents or by the commissioning authority, and describe what these fees include. The care planning system and risk assessments have been improved. The home has engaged the services of an Occupational Therapist to carry out an assessment of the homes facilities and this shows safe systems in place for helping residents with moving around the home. The home has improved the recruitment system, carrying out all checks before an appointment for interview is offered. What the care home could do better: The home should include more information in the residents care plans about how residents who have dementia are affected by it, so that staff will know when to offer activities at times best suited to the resident. The home needs to finalise the system for Quality Assurance so that there is an annual development plan showing the plans for continuing improvement at the home. The home should complete the process of ensuring the homes manager is qualified to the required NVQ level 4 in care and management, in order to fully demonstrate that management in the home is well informed. CARE HOMES FOR OLDER PEOPLE Harefield House 47 Harefield Road Brockley London SE4 1LW Lead Inspector Sean Healy Key Unannounced Inspection 09:40 14TH January 2008 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harefield House Address 47 Harefield Road Brockley London SE4 1LW 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) 0208 6926923 maggiestone@tiscali.co.uk Mrs Margaret Rose Stone Mr Raymond Julian Stone Mrs Margaret Rose Stone Care Home 13 Category(ies) of Dementia (2), Old age, not falling within any registration, with number other category (13) of places Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for 13 elderly people of whom up to 2 may have dementia 14th December 2006 Date of last inspection Brief Description of the Service: Harefield House is a privately owned registered care home, located in a quiet residential area of Brockley, South London. The home provides support and care for up to 13 older women, with elderly care needs. The home takes only women, two of who can be suffering from dementia. The home also provides respite care for up to one service user. There is lots of street parking available near the home. The home is comprised of three floors, with bedrooms on the ground floor and first floor. All accommodation is in single rooms, all of which have a sink and one of which has a shower en-suite. There is no lift access between the ground and first floor. The ground floor has four bedrooms, two large living rooms, and a dining room. There is a toilet/bathroom with a hoist, which is wheelchair accessible, and a separate toilet. The first floor has nine bedrooms and one bathroom/toilet with a mobile hoist. The second floor consists only of an office/sleepover room for staff, with toilet facilities. There is a basement, which is used mainly for freezer storage. There is a garden to the rear of the home. Public transport links include a bus service, which stops in Harefield Road, with main line train service and Docklands Light Railway in nearby Lewisham. Lewisham centre is also close by with a selection of shops, cafés and bars. The provider’s email address is: harefieldhouse@tiscali.co.uk Information about the service provided is made available to current and potential service users in the homes Statement of Purpose and Service Users Guide, which are given to all service users. The recent CSCI report is kept in the lobby area of the home open for viewing. A reference is also included in the homes newsletter. At 14th January 2008 the homes fees are £435.62 per week. An additional £10 is charged for some residents with higher support needs. These fees cover all of the homes charges including food. Residents have to pay extra for other personal expenses such as hairdressing, transport, and personal shopping. Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 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 that the people who use this service experience good quality outcomes. The inspection was unannounced and was completed over one day. The inspection ended on the 8/2/08 following receipt of information from the home and from the Expert by Experience. This inspection was conducted by a lead inspector from CSCI and was supported by an Expert by Experience who’s role was to interview residents and relatives about their experiences of living at the home, and to observe staff working with residents. The registered provider and registered care manager facilitated it. Two care staff comments were given to the inspector. Three staff employment files were examined to check that they had been properly recruited, trained and supervised. More than six residents and gave their views on the home to the Expert by Experience who supported the inspector. A number of staff were spoken to by the expert by experience and the inspector. A visiting Catholic priest who visits the home weekly and knows the residents well gave his views on his experience of the home. Three residents files were examined including assessments and care plans. There were three residents’ vacancies. The inspection involved a tour of the premises and examination of a range of management documentation. What the service does well: The home provides a very welcoming atmosphere, which actively helps residents to do things they like to do and encourages friends and family to visit regularly. The following extract from the Expert by Experience report demonstrates this: “During my visit I noted photographs of residents doing cooking and flower arranging. On questioning, one resident said flower arranging was her previous occupation and she liked to arrange flowers and showed the others how to do so. Residents enjoyed making bread and cakes, which they ate. Staff were encouraging residents to throw balls and exercise their hands and also were watching a video. One resident had gone out to the hairdresser of her choice (although there is a visiting hairdresser) She also goes down to the local shopping area for coffee with friends. Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 6 The Roman Catholic priest was visiting and he visits regularly and feels that the Home meets the needs of the residents and is happy place to be. Outings are arranged by the Home to see the lights at Christmas and Spring and Summer outings to parks etc. All the residents I spoke to said they had family who visit and also who take them out on a regular basis. They are able to entertain visitors in their room but mainly prefer to use the “front room” with their visitors.” Care plans are now good and include individual activities for residents. Health care is well managed. Staff recruitment, induction, training and supervision are well managed and staff feel supported by the homes management. What has improved since the last inspection? What they could do better: The home should include more information in the residents care plans about how residents who have dementia are affected by it, so that staff will know when to offer activities at times best suited to the resident. The home needs to finalise the system for Quality Assurance so that there is an annual development plan showing the plans for continuing improvement at the home. The home should complete the process of ensuring the homes manager is qualified to the required NVQ level 4 in care and management, in order to fully demonstrate that management in the home is well informed. Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each resident has a written contract explaining the terms, conditions and costs of living in the home. Their needs are fully assessed and they feel confident that the home can provide a good standard of health care and support. Intermediate care is not provided and therefore this was not inspected. EVIDENCE: There was a requirement at the last inspection for the home to include the fees to be paid by the resident or the commissioning agent in the homes Statement of Purpose, so that potential residents will know the charges made. This has now been done and the Statement of Purpose was revised in August 2007 to show these fees. This document is now typed in larger print so that residents can more easily read it. This document now also describes how the home will consult with residents about the care provided, including monthly reviews of the residents care plans. There are also comments included about how the Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 10 home involves residents in the running of the home and how they will maintain residents independence. Resident’s contracts with the home have now been updated and all residents have a copy of their contract, which shows the service they will receive, and how much it costs. These contracts are very clear and comprehensive, and all residents have been given a copy, which has been signed by them. Three residents files showed that copies were kept by the home for review. The home demonstrates that it only admits new residents on the basis of a full assessment of health and social care needs. Examination of three residents files showed that they were admitted to the home following a complete assessment by the registered manager. These assessments were also supported by a separate social services assessment of need. These assessments are clearly written and include details of health and personal care support as well as food preferences, a brief life history and social and leisure interests. There is clear and well-organised documentation to show all health and social care needs are being fully assessed. It is part of the home’s resettlement policy to offer potential residents the opportunity to come and visit the home before making their decision whether to move in. All residents spoken to said that they had been asked about their needs before moving to the home. The home does not provide for intermediate care. Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s health and social care needs are set out in an individual care plan, and their health care needs are being fully met. They are offered the opportunity to be responsible for their own medication, and are protected by the homes policy and procedures for managing medicines. Residents are treated with respect and their right to privacy is upheld. EVIDENCE: All of the residents are currently women and are supported by an all female staff team. At the last inspection the home had started a new system for care planning and had begun the process of transferring all residents’ plans on to this system. This process has now been completed and all residents care plans are now on this new system. These care plans are easy to read and the type size is large enough for service users to read. The home currently carries out monthly care plan reviews and family and residents are fully involved. There are good records being kept at these reviews and all care plans are being agreed and signed by the residents or their family. Examination of three Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 12 residents files showed that well thought out clearly written plans are on file including monthly review records showing some changes when needed. Residents who spoke with the Expert by Experience said that they are happy with their involvement if their care plans. However it is difficult to always involve all residents fully in care reviews, as the following extract from the Expert by Experience report shows. In these cases the home does involve family members as has been evidenced on the last two inspection visits. Extract: “This was not an easy subject to discuss with the residents as some of them seemed “hazy” about the subject, possibly due to an element of dementia which was noted in several residents. Those who responded appeared to understand the need for care planning and were happy with this.” The three care plans examined were for residents ranging in age from 78 years old to 91 years old, who’s care needs were: Old age, cyclical depression, hypertension and dementia. Personal care support is a feature of support for all residents, and all are supported to have medication, which is being managed, by the home. None of the current residents self medicate, but this is out of choice and their wishes and abilities are assessed at the admission stage. This is recorded on all assessments. Continence support is an issue for the majority of residents and care plans showed that this is fully considered. Currently no residents suffer from pressure sores. All residents now have a weekly activities plan to help ensure that they have an opportunity to take part in exercise and stimulating leisure activity. The Expert by Experience observed this happening and had confirmation from residents that this is a regular pattern of how the home provides support. Extract from Expert by Experience report: “During my visit I noted photographs of residents doing cooking and flower arranging. On questioning, one resident said flower arranging was her previous occupation and she liked to arrange flowers and showed the others how to do so. Residents enjoyed making bread and cakes, which they ate. Staff were encouraging residents to throw balls and exercise their hands and also were watching a video. One resident had gone out to the hairdresser of her choice (although there is a visiting hairdresser) She also goes down to the local shopping area for coffee with friends. The Roman Catholic priest was visiting and he visits regularly and feels that the Home meets the needs of the residents and is happy place to be. Outings are arranged by the Home to see the lights at Christmas and Spring and Summer outings to parks etc.” One resident who suffers from cyclical depression has a description of this and how staff should provide support written in her care plan. Two staff were able to describe how to provide this support without referring to the care plan, which showed a good knowledge of care planning for this resident. Another residents assessment refers to having dementia support needs but this has not Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 13 been fully defined in either a formal assessment, or in specific details about how the dementia affects the resident. The home must seek clarification about this residents diagnosis and include specific details in her care plans about how this affects her ability to take part in exercise and mentally stimulating activities, and how best to offer and provide support. (Refer to Requirement OP7) Risk assessments in care plans included: Bathing, use of hoists, behaviours, bathing, moving around the house, using the garden, and there are written guidance for staff in how to avoid risk when supporting residents. There is a record of these assessments being reviewed monthly, and there is guidance for staff in how to manage risk when it is identified. This is a significant improvement in the management of risk for residents in the home. As at the last inspection there is a range of health care professionals involved in the provision of specialised support for the home. All residents are registered with a GP, dentist, chiropodist and optician, with some receiving support from the district nurse and psychiatry. Records showed flu jabs being offered to those who want it and weekly visits from GPs. Nursing care is not provided at the home but the district nurse provides this support as needed and visits the home weekly or when needed. There have been no hospital admissions since the last inspection and there are no tissue viability issues in the home currently. Continence management is an issue for many residents and there is ongoing involvement from the continence management team via the district nurse. Medication is being well managed by the home. None of the current residents self medicate, but this is out of choice and their wishes and abilities are assessed at the admission stage. This is recorded on all assessments. The home has a medication policy, which was reviewed in November 2007. This adequately shows how medication is managed by the home. Only trained staff have the responsibility to administer medication, and the home uses the boots medication system. The pharmacist visited the home on the 8/11/07 to carry out a 6 monthly inspection visit. The report of this visit showed good standards being maintained. Medication is stored in a locked cupboard and good records of administration are kept. All residents needs support in personal care and examination of three randomly chosen residents files showed that there is a personal care plan on file for each resident. Residents commented very positively about how they are supported in personal care to the Expert by Experience: Extract from Expert by Experience report: “The ladies I spoke to said that they felt safe living at Harefield House because there is always someone here when we want them. Most needed help with washing and dressing but one resident said she sometimes feels energetic enough to do these things for herself and is allowed to do so.” Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 14 Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides for residents individual expectations and preferences regarding social, cultural, religious, and recreational needs. Contact is maintained with family and friends, and residents are supported to exercise choice and control over their lives. The home provides a good diet and meals are served in a flexible manner. EVIDENCE: Staff employed at last inspection as a care activities coordinator. The manager said that this had proved very positive move for the home and had helped to increase activities for residents. However she left employment in August 2007 and since then the registered manager has taken over responsibility for this role. There are activities plans in place for weekly activities for all residents on an individual basis, and details of these are kept on each resident’s individual files. These activities are included in assessments from the time residents move into the home, and include exercise, puzzles, Church interests, family and personal relationships and other hobbies. Residence commented that they have lots of activities and that they have support from staff to attend church regularly. A Catholic priest visits the home weekly and offers have been made Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 16 to encourage other church representatives to visit the home. The priest was visiting on the day of inspection and commented very positively about the sensitive in support of way in which care is provided for residents. The Expert by Experience spoke with many of the residents and her report noted that residents were very happy with the activities offered, and also she observed residents engaged in activities in the home. Residents also told her that they have regular contact with their families who are made welcome in the home. Extract from expert by experience report: “Activities: During my visit I noted photographs of residents doing cooking and flower arranging. On questioning, one resident said flower arranging was her previous occupation and she liked to arrange flowers and showed the others how to do so. Residents enjoyed making bread and cakes, which they ate. Staff were encouraging residents to throw balls and exercise their hands and also were watching a video. One resident had gone out to the hairdresser of her choice (although there is a visiting hairdresser) She also goes down to the local shopping area for coffee with friends. The Roman Catholic priest was visiting and he visits regularly and feels that the Home meets the needs of the residents and is happy place to be. Outings are arranged by the Home to see the lights at Christmas and Spring and Summer outings to parks etc.” Contact with Family and Friends: All the residents I spoke to said they had family who visit and also who take them out on a regular basis. They are able to entertain visitors in their room but mainly prefer to use the “front room” with their visitors.” Residents financial support needs are assessed on admission and support to manage finances is offered when necessary. All of the service users or their family are responsible for their bank accounts and DSS benefits. The home only manages small amounts of cash deposited with them for personal spending such as hairdressing, or small shopping. In these cases receipts and records are being maintained. The home provides a wholesome and nutritious diet for residents and offers a choice of food on a daily basis. Residents who spoke with the Expert By Experience said the food is good and they are offered a choice every day. The report also said that: “The kitchen was very clean and tidy and the food wholesome and well presented. The cook – recently appointed. There were bowls of fruit available for the residents.” The home employs two cooks to provide the food on site and good records of food eaten are maintained as part of the home’s system for monitoring healthy diets. A record is kept in each service user’s own individual file. Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 17 Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and acted on, and all staff are fully trained in and aware of the homes policy for protecting residents from abuse. EVIDENCE: The homes complaints policy was last reviewed in October 2006. This policy adequately shows how complaints are to be managed, and residents have been given a copy. The owner of the home and registered manager are at the home on a daily basis and residents commented that they are available to speak with them whenever they need to. There have been no complaints made since last inspection. The Statement of Purpose includes a summary of complaints policy and all of staff had received training in how to deal with complaints. The complaints policy is included with the resident’s contracts and is also displayed on the notice board in the hallway. The homes Adult Protection Policy was last reviewed in August 2006. All staff have had adequate protection training, which is clearly included in the homes training programme. There have been no adult protection issues reported since last inspection. Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, comfortable, and well-maintained environment, which is clean pleasant and very hygienic. There are suitable toileting and washing facilities at the home. EVIDENCE: Harefield House is a privately owned registered care home, located in a quiet residential area of Brockley, South London. The home provides support and care for up to 13 older women, with elderly care needs. The home takes only women, two of who can be suffering from dementia. The home also provides respite care for up to one service user. There is lots of street parking available near the home. The home is comprised of three floors, with bedrooms on the ground floor and first floor. All accommodation is in single rooms, all of which have a sink and one of which Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 20 has a shower en-suite. There is no lift access between the ground and first floor. The ground floor has four bedrooms, two large living rooms, and a dining room. There is a toilet/bathroom with a hoist, which is wheelchair accessible, and a separate toilet. The first floor has nine bedrooms and one bathroom/toilet with a mobile hoist. The second floor consists only of an office/sleepover room for staff, with toilet facilities. There is a basement, which is used mainly for freezer storage. There is a garden to the rear of the home. There was a recommendation made at the last inspection for the home to write and disability discrimination act policy statement for the home. This has now been done and there is a written policy statement in place. The home does not have stair lifts or a lift to take residents from the ground floor to the first-floor. All residents who live above the ground floor are able to manage the stairs with support, and the home has put in place risk assessments, which are reviewed monthly for each of these residents regarding their ability to safely use the stairs. The Expert by Experience asked residents about the issue of using the stairs and was told that the staff very competently support them, and that they feel safe in using stairs. Extract from Expert by Experience report: “I was shown around the Home. The rooms were all light and airy and well decorated with co-ordinating bed linen and curtains. Everywhere was very clean and smelt “fresh”. The main drawback is the lack of a “lift” but those residents whose rooms are on the first floor say they feel safe going up and down. There are risk assessments every month for these residents.” The home has two bathrooms with a toilet in each. One is located on the ground floor and one on the first-floor. There are also two separate toilets, one on each floor. The bathrooms have hoists facilities and this equipment is well maintained under a contract, and has been examined and approved by a visit in occupational therapist, who was contracted by the home to carry out an assessment. These facilities adequately provided for the needs of the current residents. As part of the development plans for the home the owner plans to refurbish the kitchen and landscape the garden. Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of the staff meets resident’s needs, and they are in safe hands at all times. Residents are supported and protected by the homes recruitment practices. Staff are trained and competent to do their jobs. EVIDENCE: The following is an extract from the homes own Annual Quality Audit Assessment, which was provided to CSCI by the home. Examination of three staff files showed that the extract is accurate and is appropriate to include in this report as follows: “We have the appropriate number staff to provide care and support for our residents. All our staff are fully trained. The home has a recruitment policy and equal opportunities policy, and all newly recruited staff are given a trial period of 28 days, after this time their performance and suitability is reviewed. Our training programme meets NTO training targets. We have 8 full time care staff including a trainee Manager and the proprietor (a qualified nurse). The trainee manager is in the final stages of completing the NVQ 4 course in care and management. 7 of the 8 care staff are qualified to NVQ level 2/3. A cook and two domestic staff are also employed. This staffing Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 22 level offers three staff in the morning, two in the afternoon and two staff at night. The proprietor is available on a daily basis as extra support on each day. As previously mentioned we are thorough in our recruitment process, checking all references, obtaining CRB checks, and ensuring the candidate is appropriate for Harefield House, while upholding our Equal opportunities Policy. POVA checks are done prior to interview, two people are present at the interview, a medical questionnaire is completed before any offer of a position.” The home feels that improvements could be made by: “Offering more comprehensive training to our staff, by meeting NTO training targets, and by taking on new staff with NVQ level 2/3.” (Refer to Recommendations OP30) The home employs eight care staff, one assistant manager and a registered manager to provide the care. In addition to this two cooks and two cleaners are employed. The residents and a visiting clergyman said that the staff communicate well in spite of cultural differences. All of the residents are women and all of the staff support is provided by women. The staff interviewed by the inspector showed a good awareness of the residents care needs and were able to say how they would report complaints or serious concerns to the manager or owner if they needed to. The home has been inducting new staff in accordance with an induction programme which the home has developed which meets the Skills for Care standards. The home is not affiliated to the Skills for Care training standards body and it is recommended that the owner and manager consider doing this to help continuing the provision and development of training for staff. ( Refer to Recommendation OP30) Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35 36 and 38 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The home has an experienced manager but the manager does not hold the required NVQ qualification. The home can now show that it is run in the best interests of residents. Staff are supervised and supported by the management. Resident’s financial interests are safeguarded, and the health, safety and welfare of staff and residents are promoted and protected. EVIDENCE: The home currently has a registered care manager who is also a registered nurse and who has many years of experience in managing the care home. The business footing of the home is that of a sole trader with the registered manager and the responsible person being the owners. The home is well managed in the best interests of the residents and the registered manager is Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 24 present on a daily basis. The responsible person is also present on a daily basis and the accounting and financial procedures of the home are well managed, protecting the financial interests are of the residents. The registered manager and proprietor are competent and experienced. There is also an assistant manager who has been completing an NVQ level 4 in care and management. There was a requirement at the previous three inspections for the registered manager to achieve an NVQ level 4 qualification in management and care. At the last inspection the home had taken the decision for the current manager to step down and for the current provider to apply to become the registered manager. This did not happen as the home has since supported the assistant manager to complete an NVQ 4 in care and support with a view to possibly becoming registered with CSCI. This decision has not yet been formalised but the owner stated that a decision will be reached very soon and an application will be submitted to CSCI by the end of June 2008. On this basis and the fact that the home already has a registered manager, who is present on a daily basis, and who is fully involved in the management and care provision in the home, this requirement is withdrawn, and a recommendation is made for the registered provider to finalise the decision and ensure that the registered manager is qualified to NVQ level 4. (Refer to Recommendation OP31) There was a requirement at the previous four inspections that the home use a recognised quality assurance system based on seeking the views of residents, to include an annual audit and annual development plan. This was partially met at the last inspection, and the home has since developed the quality assurance system and begun the auditing process. This requirement is now met, and further progress will be monitored at the next inspection. The home now conducts surveys of the views of residents’ families, residents themselves and of professionals who visit the home. There is also an annual building audit is carried out to ensure the fabric of the building is well maintained. The manager is now supported by the responsible person to manage a range of systems within the home and this has resulted in improvements in the homes care planning processes and in the overall systems and paperwork in the home. Plans are in place to produce a report on the findings of these surveys, and to include these findings in the home’s development plan. This shows good progress in developing a quality assurance system for the home. The process of finalising the homes first complete audit and development plan is ongoing, and it is expected to be completed in June 2008. There is already evidence of a commitment to this process in the improvements which have taken place in the home over the past three inspections, which have resulted from listening to residents and planning improvements to care planning, risk assessments, staff training and to the fabric and decoration of the home. Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 25 The home has adequate facilities in place for protecting residents’ money and valuables. All residents or their families are responsible for their financial affairs and small amounts of money are left with the provider for purchasing small items on their behalf. Receipts and records are kept of all of these transactions. Examination of three staff files showed that the regularity of recorded staff supervision has improved and staff are having supervision every two months. Staff also have daily contact with the registered manager and owner who monitor their practice and are available to advise and intervene as necessary. The home has an adequate health and safety policy in place, which was reviewed in 2007. There is evidence of a range of health and safety professionals being involved in monitoring health and safety in the home and all documentation examined regarding health and safety, fire safety, electrical and gas equipment and maintenance and risk assessments were up to date and well organised. At the last inspection there was a new Food Standards package being implemented in the home to ensure healthy food is being offered. Since then the home has achieved a four star rating with the government agency for kitchen and food hygiene. The kitchen is maintained to a high level of cleanliness with good methodical daily checks on ‘fridge temperatures and cleanliness. The home carries out a monthly health and safety audit and good records are kept of action taken. Laundry is contracted out to minimise the risk of infection and two cleaners are employed to maintain hygiene standards. There have been no reports under RIDDOR. Health and safety within the home is well managed. Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 28 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 OP3 OP7 Regulation 14.1 a and 15.1 Requirement The home must seek clarification about the residents dementia diagnosis as discussed in this report, Standard 7, and include specific details in her care plans about how this affects her ability to take part in exercise and mentally stimulating activities, and how best to offer and provide support. Timescale for action 31/05/08 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 OP30 Good Practice Recommendations The home should continue to develop the training package for staff to ensure they continue to meet NTO training targets, and consider registering with “Skills for Care” to aid future training and development for staff The registered provider should finalise the decision regarding ensuring that the registered manager is qualified to NVQ level 4 as discussed in this report. 2 OP31 Harefield House DS0000025622.V336068.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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