Care Home: Harewood Court Nursing Home

What the care home does well People live in a pleasant, comfortable and clean environment. Visitors are made to feel welcome and can visit anytime. We received some positive feedback about the staff that work at the home. One visitor said, "Care staff are very good, they can handle (name of person) when they are difficult and they can be aggressive. They are very good." Another visitor said, "They`re very helpful with personal care." Staff use appropriate protective clothing when supporting people with personal care. This helps prevent the spread of infection. What the care home could do better: People could have better support to make sure their nutritional needs are met. Any incidences of abuse between people who live at the home could be more accurately recorded and reported so information that is shared is factual and then the correct course of action can be taken. This will help safeguard people. There could be more staff working during the busy times. This will make sure there are enough staff to meet people`s needs in a timely way. Random inspection report Care homes for older people Name: Address: Harewood Court Nursing Home 89 Harehills Lane Leeds Yorkshire LS7 4HA one star adequate service 20/01/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Carol Haj-Najafi Date: 1 6 0 8 2 0 1 0 Information about the care home Name of care home: Address: Harewood Court Nursing Home 89 Harehills Lane Leeds Yorkshire LS7 4HA 01132269380 01132285697 scouserdumont@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: Conditions of registration: Category(ies) : Solutions (Yorkshire) Limited care home 40 Number of places (if applicable): Under 65 Over 65 0 20 dementia old age, not falling within any other category Conditions of registration: 20 0 The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 20 Dementia - Code DE, maximum number of places: 20 Date of last inspection 2 0 0 1 2 0 1 0 Care Homes for Older People Page 2 of 11 Brief description of the care home The home is registered to provide care with nursing for up to forty older people, this includes up to twenty people with dementia. It is situated in a busy residential area of Leeds, which is well served by public transport. There is a range of local amenities nearby. The home is on 3 floors, accommodation is on the first and second floor, and the ancillary services are on the ground floor. All the bedrooms are single rooms with en-suite facilities. Each floor has a separate lounge and dining room, with a kitchenette available for making snacks and drinks. A passenger lift allows access to all floors and the home is accessible to people with disabilities. Information about the services provided by the home in the form of a Statement of Purpose and Service User Guide is available at the home. In January 2010 the weekly fees ranged from £439.42 to £589.42. Additional services such as chiropody and hairdressing are available for an additional charge. Care Homes for Older People Page 3 of 11 What we found: We carried out this random inspection in response to information we received about Harewood Court. Concerns were raised about inadequate staffing levels and the overall standard of care provided to people who live at the home. Before we carried out this inspection we looked at; - Relevant information from other organisations and what other people have told us about the service. - Information we have about how the service has managed any complaints or safeguarding incidents. - What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. - Previous inspections at Harewood Court. Two inspectors carried out two unannounced visits to the home on 12 and 16 August 2010. We spent six hours at the home and spoke to people who live at Harewood Court, visitors, a visiting professional, staff, the manager and the company director. We also looked at some records. At the end of our visit we provided feedback to the manager and the director. At key inspections in February 2007, January 2008 and January 2009 we found that there were not enough staff working at the home and made a requirement that, There must be enough staff available at all times to meet the assessed needs of the people living in the home taking into account the size, the layout and purpose of the home. This is to ensure that peoples health; personal care and social care needs will be met. At the key inspection in January 2010 we again found that there were not always enough staff to meet peoples needs in a timely way. Overall staffing levels were such that some practices did not always promote the health, safety and wellbeing of the people using the service. A new manager was in post and she had identified that staffing levels should increase and had started taking steps to improve the staffing levels. After the key inspection in January 2010, we met with the director and the home manager to discuss staffing levels. They assured us that staffing levels had increased and confirmed this in writing. They said the home would have 10 nursing/care staff on duty each morning when over 36 people were receiving a service. We did not make a requirement following the last inspection because we were assured that the home had the willingness and the capacity to improve staffing and some actions were already underway. We agreed to monitor this. Just before we carried out this random inspection we received information that raised concerns about the staffing levels at the home. When we visited the home on 12 August six care staff and one qualified nurse were on duty. The nurse in charge informed us thirty five people were living at the home at the time of our visit, nineteen people on the first floor and sixteen people on the second floor. Three care staff were based on each Care Homes for Older People Page 4 of 11 floor. The qualified nurse was based on the first floor but administered medication to everyone in the home and was on hand if care staff on the second floor requested any advice and support. On 16 August the nurse and senior carer told us thirty eight people were living at the home. We arrived at the home at 7.50am. Six care staff, including three senior carers, a qualified nurse, the manager who is also a qualified nurse and the director were on duty. Night staff were handing over to day staff and getting ready to go off duty. The manager informed us that another carer was due to start work at 9am. We spoke to visitors who said they are made to feel welcome and can visit at anytime. We received some positive feedback about the staff that work at the home. One visitor said, Care staff are very good, they can handle (name of person) when he is difficult. They are very good. Another visitor said, Theyre very helpful with personal care. We asked visitors and staff about staffing levels.The majority of people said they were concerned about staffing levels and did not think there were enough staff working on each shift, especially at busy periods such as meal times. Staff confirmed that throughout the day the home is generally staffed with three care/senior care staff on each floor and one qualified staff. Rotas showed that the home has regularly operated with this number of staff even on occasions when the home has been providing a service to over thirty six people. Staff said the manager is often busy in the office so does not spend much time on the floor. On our first visit, the manager was on holiday and had been absent for nearly two weeks. The managers absence was not recorded on the rota and she was rostered as 9-5 or supernumerary. We observed practices at the home during our visit and noted that staff were polite and talked to people when they were supporting them. They knew peoples names and how to meet personal care needs, for example which hoist, standing aid to use. Staff wore protective clothing when dealing with personal care. We observed some very nice interaction from staff and everyone was asked what they wanted for lunch. Staff were very busy so interaction was limited and on some occasions they didnt respond to some requests i.e asking for tea, drinks. Staff were answering the telephone throughout our visit and on one unit answered the telephone four times during lunch. One staff was observed answering the telephone while pushing a person in a wheelchair to the dining room. During our visit we were concerned that peoples needs were not being appropriately met because there were insufficient staff. Before lunch, in the dementia unit, care staff and the senior carer were supporting people with personal care in bathrooms and bedrooms and staff were not available in communal areas to make sure people were safe. During this time one person was observed urinating against doors, going into a cupboard and getting out a box of disposable gloves. One relative came through and said someone was in the lounge and attempting to dismantle a radiator. During our visit, several people were heard to ask for drinks. Before lunch one person was constantly asking for a drink for over fifteen minutes, at lunch time two people asked for a cup of tea, one person asked for a cold drink and one person was trying to drink out of an empty glass for forty five minutes. During lunch staff were very busy, and at times staff were feeding two people at the same time. Two people ate only a very small amount of food and one of Care Homes for Older People Page 5 of 11 these people did not have any fluid. One person did not receive support from staff with their meal for 25 minutes. People who were eating their meals in their room did not get them until 1.40pm. We checked the daily records for the two people that had not eaten their lunch but these were not accurate because staff had recorded food and fluids taken well. A staff member confirmed that in the dementia unit six people require a hoist and two staff for transferring. On the first floor unit staff said sixteen people need two staff to help with transfers. Staff were also busy on this unit during our visit although people got more support during lunch because a volunteer and two relatives were supporting people with their meals. We observed drinks being provided mid morning, lunch time and mid afternoon. People were only offered juice. Staff said that people are offered juice mid morning and mid afternoon but are offered a drink of tea at breakfast, lunch, tea and supper. We asked a staff member why people had only been offered juice at lunch and they said this was because it was a hot day. Staff were sharing one standing aid which is used to transfer people. The aid was being used on both floors so at times staff could not transfer people because they did not have the equipment available.The manager and director confirmed during feedback that three standing aids were available and they would look into this. During the visit several people were shouting out. One person was in their bedroom and was shouting for long periods, which could be heard on both floors. Staff said they did not know the reason for this but said it was a regular occurrence. We asked staff about incidents that took place in the home. Staff said some people were aggressive and there were sometimes incidents between people who live at the home. One staff said the day before our visit, one person had hit another person. We asked the nurse on duty about this and she confirmed that an incident had taken place but did not know the details because she was not on duty at the time. She thought an incident form had been completed. We checked the records but could not find any information about a specific incident although we found records that stated the people concerned had been very aggressive. At the last key inspection we made a requirement because we found that safeguarding incidents were not always reported to the relevant agencies. Since the last inspection CQC has received notifications and incidents have been reported to safeguarding, however, at this inspection we received conflicting information so cannot be sure that all incidences are dealt with and reported appropriately. During our visit a church service was being held on the first floor and some people from the second floor attended. We did not see any other activity during our visit. The activity organiser was absent. We spoke to two staff who started working at the home in June. They both confirmed that they had received an induction when they started working at the home. The manager showed us their induction checklist and the director confirmed that she had completed the induction programme with both staff, which included basic training. When we looked around the home it was clean, tidy and well organised. People were walking freely around the home. Some people spent time in the communal areas; others chose to spend time in their room. Care Homes for Older People Page 6 of 11 During feedback the manager and director acknowledged that the inspection had highlighted serious concerns and they said they would take immediate action to address the staffing levels. The director agreed to make sure four care staff were working in both units at key times. The director acknowledged that the concerns were serious but thought there were several contributing factors which included the absence of the manager and activity co-ordinator, and she said there were additional people staying at the home due to unforeseen circumstances. The manager and director said some administrative tasks would be handed over to an administrator who started working at the home two days before our visit, which would reduce office work for the manager. Two days after our visit we received written confirmation that the director and manager had been monitoring the situation and said they observed the daily activity and found that not all issues were about the numbers of staff but also the organisation and preparation for dining, it was evident that the skill mix needs adjustment and more intense supervision is required. They said the shortfalls are being addressed. What the care home does well: 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 set out on page 2. Care Homes for Older People Page 7 of 11 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 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, 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 1 15 12 People must receive support with food and drink that is appropriate to their individual needs. This will make sure their nutritional needs are met. 30/09/2010 2 18 13 Any incidences of abuse 30/09/2010 between people who live at the home must be accurately recorded and reported. This will make sure people are safeguarded. 3 27 18 The staffing arrangements must be reviewed to make sure that there are enough staff to meet the needs of the people living at the home, taking into account the size and layout and purpose of the home. This will make sure peoples needs are met. 30/09/2010 Care Homes for Older People Page 9 of 11 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 Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: 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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