Care Home: Harewood House

What the care home does well Clear and detailed written information is made available to current residents and to people who are considering making Harewood House their home. Detailed needs assessments are carried out before admission and the needs of the residents are continually assessed and reviewed and used to develop an individual plan of care to ensure that the residents individual health and personal care needs can be met. People who are assessed and referred solely for intermediate care are helped to maximise their independence and return home. The medication that is administered by trained staff is stored and handled safely. The principles of respect, dignity and privacy are largely put into practice. In house activities are organised by the staff on a daily basis and the residents can choose whether or not to participate in them. The residents are free to receive visitors at any time they choose and facilities are provided to enable the residents and/or their visitors to make hot drinks and snacks.The residents are offered a choice of meals and a healthy option is always available. Complaints will be taken seriously and dealt with appropriately and policies and procedures are in place to safeguard the residents from the threat of abuse. All of the bedrooms are single rooms so no residents will be expected to share, however arrangements can be made for two residents who want to share a bedroom to do so and use their second room as a private lounge. Suitable locks have been fitted to bedroom, bathroom and toilet doors. This means that the residents privacy will be respected, but that the staff will be able to enter the rooms to provide emergency assistance if they are required to do so. The residents can be confident that the staff are safely recruited, trained, properly supervised and well managed. Harewood House is a pleasant and well-managed residential care home. What has improved since the last inspection? Advice has been taken from the Pharmacist about the use of homely remedies and procedures are in place to ensure that these are used safely. The provision of staff training, including fire safety training, has improved. The quality monitoring system has expanded and improved. General record keeping, including records of needs assessments, has improved. The staff are now being given one to one supervision on a regular basis by the Registered Manager or a Assistant Duty Manager. Electrical appliances are tested at the frequency recommended, which is every five years. CARE HOMES FOR OLDER PEOPLE Harewood House 66 Plymouth Road Tavistock Devon PL19 8BU Lead Inspector Judy Hill Unannounced Inspection 10:00 7th July 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 Harewood House DS0000032457.V367174.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. Harewood House DS0000032457.V367174.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harewood House Address 66 Plymouth Road Tavistock Devon PL19 8BU 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) 01822 613130 neil.mccalley@devon.gov.uk http/www.devon.gov.uk Devon County Council Neil David McCalley Care Home 28 Category(ies) of Dementia (14), Old age, not falling within any registration, with number other category (14), Physical disability (8), of places Physical disability over 65 years of age (14) Harewood House DS0000032457.V367174.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home can accommodate no more than 14 people with a physical disability at any one time. The home can accommodate no more than 14 people with dementia at any one time. Any one with dementia must be 55 years or over. 13th July 2007 Date of last inspection Brief Description of the Service: Harewood House is registered to provide accommodation and care for a maximum of twenty-eight people. The home is divided into four separate units called “Drake”, “Edgecombe”, “Treetops” and “Re-enablement”. “Drake” provides long-term care for up to eight people who have dementia, “Edgecombe” provides long-term care for up to six people who are frail and elderly, “Treetops” provides respite care for up to eight people and “Reenablement” provides short-term care for up to six people who need to restore their skills and confidence following a period of hospitalisation. Harewood House is currently a Local Authority run home, but there are plans to transfer ownership to a private company. The long-term implications of this are not yet known but as admission to the home can only be arranged through Social Service/NHS Care Management assessment, up to date information about this will be made available to people considering using the service and their representatives. The registered manager of Harewood House is Mr Neil McCalley. Harewood House is situated within level walking distance of Tavistock town centre. Tavistock is an attractive market town with a good range of local amenities and public transport links to Plymouth, Exeter and beyond. There is a large park directly opposite the home. There is a day centre on the ground floor of the home, however this is not accessible to the residents. The current fees for long-term and respite care are £570 per week. Intermediate care provided in the “Re-enablement” unit is free at point of use for the people who use it. Harewood House DS0000032457.V367174.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 the people who use this service experience good quality outcomes. This key inspection included a site visit, which was unannounced. The information contained in this report was gained in conversation with the people who use the service, the registered manager and the staff on duty. Information was also taken from the Homes Statement of Purpose and Service User’s Guide, an Annual Quality Assurance Assessment that had been completed by the registered manager and surveys completed and returned to the Commission by residents, relatives and staff. Additional information was gained from a tour of the home and from an inspection of records, including samples of residents needs assessments and care plans and staff recruitment and training records. What the service does well: Clear and detailed written information is made available to current residents and to people who are considering making Harewood House their home. Detailed needs assessments are carried out before admission and the needs of the residents are continually assessed and reviewed and used to develop an individual plan of care to ensure that the residents individual health and personal care needs can be met. People who are assessed and referred solely for intermediate care are helped to maximise their independence and return home. The medication that is administered by trained staff is stored and handled safely. The principles of respect, dignity and privacy are largely put into practice. In house activities are organised by the staff on a daily basis and the residents can choose whether or not to participate in them. The residents are free to receive visitors at any time they choose and facilities are provided to enable the residents and/or their visitors to make hot drinks and snacks. Harewood House DS0000032457.V367174.R01.S.doc Version 5.2 Page 6 The residents are offered a choice of meals and a healthy option is always available. Complaints will be taken seriously and dealt with appropriately and policies and procedures are in place to safeguard the residents from the threat of abuse. All of the bedrooms are single rooms so no residents will be expected to share, however arrangements can be made for two residents who want to share a bedroom to do so and use their second room as a private lounge. Suitable locks have been fitted to bedroom, bathroom and toilet doors. This means that the residents privacy will be respected, but that the staff will be able to enter the rooms to provide emergency assistance if they are required to do so. The residents can be confident that the staff are safely recruited, trained, properly supervised and well managed. Harewood House is a pleasant and well-managed residential care home. What has improved since the last inspection? What they could do better: Daily records should be written up by the staff daily to provide evidence of continuity and as a safeguard against information being missed during the staff handover period. Better use could be made of the risk assessment process to ensure that the residents are encouraged to maintain their independent living skills and to maximise their independence and autonomy. Harewood House DS0000032457.V367174.R01.S.doc Version 5.2 Page 7 Additional staff training could be provided to enable the management and staff to understand behaviour that may be challenging and to consider the causes of it. Although in-house activities are provided, the residents could be given more opportunities to go out for recreation and exercise, with appropriate support from the staff if necessary. The methods of transferring meals from the kitchen to the dining rooms could be improved to ensure that the meals are served at the right temperature. The central heating system should be fitted with individual thermostatic controls to enable the residents to control the temperature of their bedrooms. The bathrooms should not be used to provide additional storage and any items currently stored in them should be stored elsewhere. Access to telephones to enable people to make and receive calls should be seen to be available in each of the units. The office facilities located within one of the units intrude upon the privacy of the residents within their home and should be relocated. Staffing levels should be kept under constant review to ensure that they are maintained at a level that is high enough to meet the assessed needs of the people who live at the home. 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. Harewood House DS0000032457.V367174.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 Harewood House DS0000032457.V367174.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, 3 & 6 Quality in this outcome area is good. The people who use this service and their representatives have the information needed to choose a home that will meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information about the home and the service is provided in a Statement of Purpose. A copy of this document was made available to the Commission on request and it was found to be well presented and up to date. The Service User Guide was also made available to the Commission on request. One of the residents was asked if they had a copy of this and was able to show us that they had. This document refers to individual terms and conditions and contracts that are signed by and agreed with the people who Harewood House DS0000032457.V367174.R01.S.doc Version 5.2 Page 10 use the service. These documents are not included in the Service User Guides but copies will be made available to the people who use the service on request. The Statement of Purpose states that all admissions are subject to the Care Management Process and that no one can be admitted to Harewood House without an assessment and care plan. Assessments and Care Management care plans were seen in a random inspection of records relating to four of the people who use the service. One of the residents spoken with told us that she had chosen to live at Harewood House on a permanent basis because she had attended the day centre on the ground floor and had regularly come into the home for respite care. She said that she felt that she had made the right choice and was happy with the service provided. Harewood House offers intermediate care in partnership with the Primary Care Trust. This is provided for a maximum of six people at any one time and is provided in a unit, comprising of six bedrooms, a lounge, a kitchen and bathroom and toilet facilities that are separate from the long stay and respite accommodation. Specialist services from an occupational therapist and physiotherapist are provided and to provide continuity, care is usually provided by a small number of carers who work exclusively on this unit. Harewood House DS0000032457.V367174.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 & 10 Quality in this outcome area is good. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are largely put into practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A random inspection of the plan of care drawn up by the home for four of the people who use the service was carried out. These were seen to be clearly presented and to include daily records completed by the staff, care plans, evidence of regular reviews and risk assessments. The registered manager said that he had instructed his staff not to complete the daily records daily, but only to do so if they had something to record. It is recommended that the daily records are written up daily and preferably after every shift as this information not only helps with care planning reviews but Harewood House DS0000032457.V367174.R01.S.doc Version 5.2 Page 12 also may be needed to provide evidence if a complaint is made or an accident occurs. Handover meetings are held between shifts to promote continuity of care. The use of risk assessments could be improved to ensure that the residents are encouraged to maintain their independent living skills and maximise their independence and autonomy. Evidence was seen to demonstrate that the physical health of the residents is monitored and that timely referrals are being made to the primary healthcare services. The provision of staff training in health related areas is good and it was observed that a high standard of cleanliness, both in the rooms used or occupied by the residents and in the residents themselves is maintained. Examples of this are in the control of continence, including the prevention of incontinence, and in the provision of staff training in the prevention of infection and the management of infection control. Most of the residents who were spoken with during the inspection said that they were very happy with the care and support provided and the responses to surveys completed and returned to the Commission by some of the people who use the service and their representatives was largely very positive. However, some of the completed surveys indicated that the staffing levels need to be kept under constant review to ensure that there are always enough care staff on duty to care for the residents. The ability of the home to meet the needs of one of the people who used the service was discussed with the registered manager and additional support or staff training could be provided to gain a better insight into why the service user displays behaviour that challenges the staff and if she has any unrecognised and/or unmet needs. Some of residents keep and administer their own medication and the staff keep a discrete check on them to ensure that they are using their medication safely. Most of the medication for the people who have come into the home for long-term care is supplied in blister packs, while the medication for people on short stay (respite and intermediate) care generally arrives in packets. The medication trolleys and storage facilities for the medication, the controlled drug register and storage facilities for controlled drugs and also the homes recording procedures and practices were recently inspected by ‘Boots’ Care Home Services Key Contact and her report, dated 1/7/08 indicates that everything was in good order. The staff were observed to be treating the residents with dignity and respect. The rights of the residents to maintain their privacy is respected and the Harewood House DS0000032457.V367174.R01.S.doc Version 5.2 Page 13 residents who were asked said that they were able to lock their rooms and keep a key with them if they chose to do so. Suitable locks are provided on bathroom and toilet doors. All of the bedrooms are single rooms so none of the residents need to share a bedroom unless two residents choose to share a bedroom and use the second bedroom as a private sitting room. Harewood House DS0000032457.V367174.R01.S.doc Version 5.2 Page 14 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 & 15 Quality in this outcome area is good. The people who use the service are able to make choices about how they live their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some of the people spoken with during the site visit said that they were able to follow their chosen routines about when to get up, when to go to bed and when they wanted to spend time alone in their bedrooms or with other residents in the lounge. Social activities are facilitated in the lounges by the staff on a daily basis and the residents can choose whether or not they wish to take part. Televisions and radios are available for the residents to use in the lounges and many of them have their own televisions and radios in their bedrooms. One of the people spoken with had a workbench and tools in his room so that he could continue to enjoy his hobby of making from wood. He had been Harewood House DS0000032457.V367174.R01.S.doc Version 5.2 Page 15 commissioned by the home to make a caravan and car to be displayed in the entrance hall. The home does not have its own transport facilities although the Statement of Purpose identifies that the Day Centre bus can be used to take groups of residents out during week-ends and bank holidays. The staff said that they sometimes take the residents to the park or to sit outside in the gardens. The Statement of Purpose states that the residents are welcome to receive visitors in their own rooms at any time during the day or evening. Although each of the four units has its own kitchen, the meals for the residents are prepared in the main kitchen on the ground floor, where meals for the day centre and meals on wheels service are also prepared. Menu sheets were seen which showed that the residents are offered a choice of two different set dishes at every mealtime. The cook told us that alternative meals would be prepared if requested. The menu plans are changed to incorporate the resident’s suggestions and/or to include seasonal vegetables. Healthy eating is encouraged and the cook demonstrated that she has a good understanding of the dietary needs of people who are diabetic and of the residents likes and dislikes. Very positive comments were received from the residents about the quality of the food provided, although we were told that the porridge and soup were occasionally a bit cold. Harewood House DS0000032457.V367174.R01.S.doc Version 5.2 Page 16 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 & 18 Quality in this outcome area is good. Complaints will be taken seriously and dealt with appropriately. Policies and procedures are in place to safeguard the residents from the threat of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information about how to make a complaint is included in the Statement of Purpose and the Service User Guides. Some of the residents who completed and returned surveys said that they did not know what the procedures were for making a complaint but there were no indications either in surveys or in conversation with the people who use the service that they had any serious issues that they needed to make a complaint about or that they would have any reservations about raising issues of concern with either the manager or staff. The Annual Quality Assurance Assessment completed by the registered manager identifies that there are policies and procedures in place and kept available to staff regarding safeguarding adults and the prevention of abuse and that the staff receive Safeguarding training on an on-going basis. Regular residents meetings are held and there are plans to include the topic of abuse at one of these meetings in the near future. Harewood House DS0000032457.V367174.R01.S.doc Version 5.2 Page 17 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 & 26 Quality in this outcome area is adequate. The separation of the home into four units works well. The residents live in a clean, reasonably well decorated and comfortably furnished home, but changes could be made to make the units more homely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Harewood House is situated within level walking distance of the town centre and close to local shops. Directly opposite the home there is a large park with a river running through it that makes it attractive to birds and other wildlife. Harewood House is arranged on three floors. The ground floor comprises a day centre, offices, laundry and kitchen facilities. The Kitchen provides for the day Harewood House DS0000032457.V367174.R01.S.doc Version 5.2 Page 18 centre and meals on wheels service as well as the care home. Food is distributed to the home in heated trolleys. The first and second floors are divided into four units. One unit, Edgecombe, provides long term care for a maximum of six people whose main needs relate to frailty due to old age. There are six single bedrooms, a lounge and a kitchen/diner. In addition there are two toilets and a bathroom with facilities to enable people with physical disabilities to access them safely. There is a payphone in Edgecombe Unit but not in the other units. The registered manager said that a mobile phone would be made available on request to residents in the other units but does need to make sure that the residents and their representatives are made aware of this facility. The Intermediate Care (re-enablement) Unit also provides accommodation for up to six people. This unit contains six single bedrooms, a lounge/dining room, a kitchen and toilet and bathroom facilities. This unit provides a service for people who need to rebuild their confidence and skills following an operation, accident or period of ill health. This service is run in conjunction with the Health Service. Intensive support from Occupational Therapists and Physiotherapists is available. “Drake provides accommodation for up to eight people who have a diagnosis of dementia. There are eight single bedrooms, a lounge and a kitchen/diner. In addition there are suitable toilet and bathroom facilities a small laundry. It was observed that one of the bathrooms on ‘Drake’ unit is being used as a storage facility and an alternative storage area should be found ‘Treetops’ provides short term/respite accommodation for up to eight people whose main needs relate to frailty due to their age. There are eight single bedrooms, a lounge, a kitchen/dining room and suitable toilet and bathroom facilities. Harewood is a purpose built residential care home, which, by design, does not lend itself to providing a ‘homely’ environment. However most of the rooms that are used or occupied by residents were seen during the site visit and they were seen to be clean, reasonably decorated and comfortably furnished. The central heating system does not enable the residents to control the heating in their bedrooms and consideration should be given to fitting thermostatic valves to enable them to do so or replacing the radiators, which are rather old fashioned. The offices for the registered manager and assistant duty managers are located just outside the individual units, which makes them assessable without being intrusive. However, the office used by the administrator and the Harewood House DS0000032457.V367174.R01.S.doc Version 5.2 Page 19 physiotherapist and occupational therapist for the re-enabling unit is located in the centre of one of the other units and does impinge of the privacy of the people who live there. The main laundry facilities are on the ground floor and are adequate for the needs of the home. Harewood House DS0000032457.V367174.R01.S.doc Version 5.2 Page 20 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 & 30 Quality in this outcome area is good. The residents can be confident that the staff are safely recruited, trained and well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the staff rota was made available to the Commission on request and this shows that the same group of care workers tend to work on each of the four units to provide continuity and to enable them to develop good working relationships with the people who use the service. Regular use is made of agency staff however the registered manager said that the home only used staff from two agencies and that they tried to use staff who had worked at the home before. Although there are staff in attendance on each of the four unit throughout the day (7.30am or 8am to 10pm), some of the surveys completed by the people who live at the home, their relatives and staff suggest that the staffing levels are not always high enough to meet the needs of the residents. It is therefore recommended that the care staffing level are reviewed and that the social, occupational and recreational needs of the residents, as well of their health and personal care needs are taken into account. Harewood House DS0000032457.V367174.R01.S.doc Version 5.2 Page 21 Dedicated housekeeping and catering staff are employed to keep the home clean, attend to the laundry and prepare meals. All of which are done to a high standard. Some of the care staff were seen and spoken with during the inspection and all of them said that they enjoyed working at Harewood House. Feedback gained verbally from the residents and from surveys completed and returned by residents and members of their family contained many positive comments about the quality of care provided by the care staff, who were described as “wonderful” and “warm, friendly and always helpful”. The recruitment records for two of the most recently appointed care assistants were inspected and safe practices had been used to recruit them. The Annual Quality Assurance Assessment completed by the registered manager shows that fourteen of the thirty care staff employed to work at the home have a National Vocational Qualification in Care at Level 2 and/or Level 3. Newly recruited staff complete a three day induction training course and one of the people who completed and returned a survey to the Commission said that procedural information was covered very well in her induction training. On going training is provided and records showed that this includes Moving and Handling, Fire Safety Training, Safeguarding/the Protection of Vulnerable Adults Training, Infection Control, First Aid and Food Hygiene. Harewood House DS0000032457.V367174.R01.S.doc Version 5.2 Page 22 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 & 38 Quality in this outcome area is good. Harewood House is a well-managed residential care home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection there has been a change of registered manager. The new registered manager is Neil McCalley. Mr McCalley is very experienced in the provision of residential care and demonstrated a good understanding of the needs of the residents and the staff team and a commitment to providing a good quality service. Harewood House DS0000032457.V367174.R01.S.doc Version 5.2 Page 23 Three full-time and one part-time assistant duty managers support the registered manager. The assistant duty managers provide formal one to one supervision for the care staff, while the registered manager provides formal supervision for the assistant duty managers and the ancillary staff. Quality assurance is carried out regularly and the service has gained a Certificate of Registration IS09001:2000 – Quality System 2000. Additional quality monitoring is carried out through residents meetings and surveys. Some of the residents keep small sums of money in a suspense account to cover any personal expenditure they may have. Receipts are kept for any money spent by the home on behalf of the residents and records, which are regularly audited, are kept to show a balance of any money held. The Annual Quality Assurance Assessment completed by the registered manager identifies that regular services are carried out to ensure that the electrical and gas appliances, fire detection and fire fighting equipment and mobility aids are safe and in working order. The AQAA identifies that most of the required and recommended policies and procedures are in place although the dates when they were last reviewed have not always been included so some may need to be updated to reflect changes in legislation and/or good practice guidance. It is recommended that policies and procedures on Physical Intervention and Restraint and Sexuality and Relationships are included in the policies and procedures portfolio. The staff receive a handbook which includes some of the services policies and procedures and have access to those not included. Harewood House DS0000032457.V367174.R01.S.doc Version 5.2 Page 24 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 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 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 2 X X X X X X 3 STAFFING Standard No Score 27 2 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 X X 3 Harewood House DS0000032457.V367174.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations Daily records should be written up daily and preferably after every shift as this information not only helps with care planning reviews but also may be needed to provide evidence if a complaint is made or an accident occurs. The use of risk assessments could be improved to ensure that the residents are encouraged to maintain their independent living skills and maximise their independence and autonomy. Additional support or staff training could be provided to gain a better insight into why service users may displays behaviour that challenges the staff. The residents could be given more opportunities to go out for recreation and exercise with appropriate support from the staff. DS0000032457.V367174.R01.S.doc Version 5.2 Page 26 2. OP7 3. OP8 4. OP12 Harewood House 5. 6. OP19 OP19 Alternative storage arrangements should be found for the items currently being stored in one of the bathrooms. The central heating system does not enable the residents to control the heating in their bedrooms and consideration should be given to fitting thermostatic valves to enable them to do so or replacing the radiators, which are rather old fashioned. Telephones to enable the residents to make and receive calls should be seen to be available in all of the units. The office facilities within one of the units should be relocated as they intrude upon the privacy of the residents who live in that unit. The care staffing level should be reviewed to ensure that staffing levels are maintained at a level that is high enough to meet the residents social, occupational and recreational needs as well as their health and personal care needs. Policies and procedures on Physical Intervention and Restraint and Sexuality and Relationships should be included in the policies and procedures portfolio. 7. 8. OP19 OP19 9. OP27 10. OP38 Harewood House DS0000032457.V367174.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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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