Care Home: Harwood House

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What the care home does well The staff are friendly. They meet each persons needs well. Care plans are clear. Staff will help to arrange health care when this is needed. The bungalow is well looked after. The home is well managed. What has improved since the last inspection? There were no requirements made at the last inspection. The manager still makes regular checks to see everything is going well. What the care home could do better: Staff need to be careful with medicine records. Key inspection report Care homes for adults (18-65 years) Name: Address: Harwood House Birtley Lane Birtley Chester-le-street County Durham DH3 1AX The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lee Bennett Date: 1 2 0 6 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 28 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Harwood House Birtley Lane Birtley Chester-le-street County Durham DH3 1AX 01914923921 01914923892 m.j.mcnestry@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Northumberland, Tyne & Wear NHS Trust care home 5 Number of places (if applicable): Under 65 Over 65 0 2 0 0 2 4 1 1 dementia learning disability physical disability sensory impairment Additional conditions: The two DE(E) places are for current service users only. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 28 A bit about the care home Harwood House is a care home run by the National Health Service. 5 people can live here. It is a large bungalow, set in a big garden. There are no stairs to the home. Bathrooms and toilets are easy to get in and out of. Everyone has there own bedroom. Nobody has to share. There is a car here for people to use. This means people can get out and about. It is near: Bus stops Shops Pubs A swimming pool GP surgeries Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 28 How we did our inspection: This is what the inspector did when they were at the care home The Inspector talked to the people who live at the home. The inspector looked documents that have to be kept. He looked at: Care plans. Staff files. Medicine records. Some of the homes policies and procedures. (Policies are rules about how to do things. Procedures tell people how to follow the rules.) The inspector looked around the home. This was to make sure it was safe and comfortable. What the care home does well The staff are friendly. They meet each persons needs well. Care plans are clear. Staff will help to arrange health care when this is needed. The bungalow is well looked after. The home is well managed. Care Homes for Adults (18-65 years) Page 7 of 28 What has got better from the last inspection What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Lee Bennett St Nicholas Building St Nicholas Street Care Homes for Adults (18-65 years) Page 8 of 28 Newcastle upon Tyne Tyne and Wear NE1 1NB 01912333300 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed assessments of need are in place before a persons admission, and updated regularly, to make sure the home and the staff team can meet peoples identified needs. Evidence: All of the people living here have done so for some time now, with the last person moving here over a year ago. Before these people moved here information was obtained from a social worker to ensure that their needs could be properly met at the home. This is so the manager had sufficient information about each person, and could make a judgment about whether the staff had the right skills and training, and the home was physically suitable for the people concerned. The assessments provided by social workers include information about diversity needs, such as those relating to disability, gender, race and culture. For example, where people have developed a particular disability,these are identified, and measures taken to ensure people are well supported. After a person moves here their needs are periodically reviewed and if necessary reassessed. This is done with the involvement of a social worker, or other care Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: professional, as well. For example, one person has had their needs looked at by dietitian and community nurse. This is to make sure Harwood House remains the right place for people to live, and that staff have clear information to guide their care. It is from these reviews and reassessments that plans of care are developed. These reviews are undertaken at regular intervals or when a persons needs change. Social Workers have reassessed each service users needs, as the Council is reviewing this care home as a whole. There is also clear information available about the home and the terms and conditions about each persons stay. This has been done in an easy read format, that includes picture prompts. This is so people are kept well informed about what it is like to live here. Care Homes for Adults (18-65 years) Page 12 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living here benefit from well planned care. This means that both service users and staff are well informed about what care is to be offered. Evidence: To help guide the care that staff offer to the people living here, a care plan file is compiled. All of the people living here have had one developed. These are all written up, evaluated and reviewed by the manager and a key worker; a member of staff who works with a named service user and takes a lead on the planning and delivery of care. Staff have updated these to make sure they are up to date. The care files contain extensive and detailed information on each persons needs, and are written in a person centered way. The care practice that we observed reflected the guidance in the care plans, for example with eating meals. Where possible, care plans are signed by the people living here to evidence their involvement and agreement with the content. Closely linked to care planning arrangements are risk assessments. Again, these are written up by a key worker when there is an identified area of risk, either to the service user, or to others by that persons behavior or needs. They follow a standardised format, Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: and detail the area of risk, consider the benefits of certain risks being present, and outline how unnecessary risks are to be managed. We found that areas of risk were being documented for relevant aspects, such as eating, behaviours that challenge the service and manual handling. Both care plans and risk assessments are a formal way of documenting decisions about important matters affecting a persons care and lifestyle. There are also occasional group meetings held. The people living here are able to express their views to differing degrees and (sometimes with guidance) come to decisions about the things that affect them. Importantly, there is currently a review of this service being held by Gateshead Council, and the views of the people living here are being taken into account regarding where, and with who they live. Care Homes for Adults (18-65 years) Page 14 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living here are assisted to spend their time in an active and fulfilling way. This can help promote each persons sense of wellbeing. Evidence: On the day of the inspection, the people living here were spending their time at home, relaxing, watching TV, helping in the garden, and participating in activities around the home (such as bingo). The people living here lead a lifestyle reflective of their age, their interests and preferences. They have opportunities to meet up with family and friends and also have their own vehicle to help get further afield. Some of the people living here told us about the things they like to do, the holidays they have been on, and their plans for things to do this year. As well as going out and about or being occupied whilst in the home, contact with friends and relatives can affect the quality of life enjoyed by people. Most people living here have family contact, and visitors are made welcome. As well as having rights to keep up family contacts and to lead a varied and fulfilling lifestyle, the people here retain rights around Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: how they are helped, and what staff do when they put themselves at risk of harm. To help meet these rights there is written guidance for staff in care plans and risk assessments. This information has been developed so that staff can work in a consistent manner with each person, and support them in a safe and considered manner. Furthermore, staff were able to explain to us clearly the individual needs of each person living here, any risks they may face, and how these are managed. Meals form an important part of peoples daily routine and lifestyle, and are normally taken as a group as the people living here usually get on well. This is an important time for people to talk about their day, and share their experiences with staff. The dietary needs of each person are detailed in their care plans, and there is a record kept of meals planned and provided. Each person is regularly weighed. Where help and prompting is needed staff were able to explain the help they offer, with clear guidance also being available in each persons care plan file. This is so staff follow good practice guidelines, as this can often have important health implications for the people living here. We shared a meal with the people living here, and we observed that staff were supportive where necessary, and provided the help consistent with the written guidance they have. Care Homes for Adults (18-65 years) Page 16 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each individuals personal care and healthcare needs are well supported by systems that ensure privacy is respected and that health and welfare is monitored and maintained. Medication recording arrangements are not as accurate as they could be. Evidence: The people living here have their personal and healthcare needs explained within their case files. This is so staff are clear about what support they need to offer. Each persons needs are supported and met, where appropriate, in private. Specialist support and input has been sought and obtained where necessary, and multi-disciplinary input (such as that from the Community Learning Disability team) is made available. As well as making sure healthcare advice is sought, the registered manager, and other staff in the team, help the people living here to access healthcare treatment. This is so people get the help and healthcare they need to keep well. The results of healthcare visits and routine monitoring is recorded within each persons care file. This can help ensure that staff follow any advice and guidance that has been made by the healthcare professional. Linked to these health and personal care arrangements is the support given with medication. Due to their levels of need, service users are not able to administer their own Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: medicines, and designated staff will help in this area. The staff here have had medication administration training (the safer handling of medication course). This has been supplemented by in-house guidance and competency testing. The medicines themselves are stored in a locked cupboard to keep them safe. There is only a small amount of loose stock, the rest being held in a monitored dosage system. This is where tablets are placed into a blister pack system by the pharmacist. Once given out staff write down who has had what medicine on printed administration records. A brief check of the medicines used here was carried out by us. Most of the medicines we looked at were properly accounted for, but some recording errors were found, including missing signatures on administration records and actual stocks differing from those recorded for 2 out of the 4 medicines we looked at. Care Homes for Adults (18-65 years) Page 18 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear systems help protect people from neglect, abuse and self-harm. Evidence: A clear, written complaints procedure is available at the home. There have been no complaints reported to us since the last inspection. Because of peoples communication needs it is not always possible for people to make direct comments on the quality of care they receive. Staff have therefore to be mindful of each persons behaviour, gestures, and body language to gauge how they feel. We observed that the people living here appeared happy, comfortable and at ease with the staff present. The staff here have also received training on adult safeguarding and abuse awareness matters. More training on adult safeguarding is planned. Both the care providers and the local councils adult protection procedures are available here for staff to refer to. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Harwood House provides a homely and comfotable environment that meets peoples current and changing needs. Evidence: Harwood House is a purpose built care home. It is a bungalow, and has various adaptation (such as accessible baths and lifting aids) to help ensure it is suitable for the people living here. There are spacious and accessible gardens, and ample parking space. Overall the home is domestic in style, and each persons bedroom has been personalised to suite their individual tastes. There is a large main lounge, a small, quite lounge and kitchen / diner. This means people can have a choice of who they spend their time with, or be able to spend time on their own. The home is clean throughout and there is good odour control. Harwood House is a comforable home, and the people living here appear relaxed and at ease in their surroundings. Care Homes for Adults (18-65 years) Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living here are supported by a well trained and qualified staff team. Evidence: There have been two new staff member recruited here recently, and three have left since November 2008. We were not able to see the staffing records as these are held elsewhere, however this has been agreed with us, and are periodically checked on a random basis. These checks have found that Northumberland, Tyne and Wear NHS Trust has robust pre-employment checks in place, including checks for criminal convictions, against the Protection of Vulnerable Adults List, and reference checks from previous employers. Overall staffing levels and team members have remained reasonably stable, given that the future of the home is currently under review. At the time of the inspection, 9 out of the 11 support staff were qualified to NVQ level 2 in care [or higher]. The staff here also undertake periodic training on topics relating to safety and care. We found that all staff had received a one day mandatory course, covering topics such as first aid, health and safety, fire safety and moving and handling. Other topics have included infection control, adult safeguarding and conflict and risk. Staff have not received mental health awareness training. Training is one of the topics discussed at each staff members supervision session. These Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: are one to one meetings that are held between a staff member and manager to discuss their performance, training needs, personnel and personal matters. Actions are agreed where necessary. These occur on a regular basis, to allow staff to feel supported and informed about developments at the home. Care Homes for Adults (18-65 years) Page 22 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a well managed home, where quality and health and safety matters are regularly checked. This can help ensure the service remains focused on the needs and safety of the people who live here. Evidence: Harwood House is overseen, on a full time basis, by the registered manager. She is supported by a deputy manager. The registered manager is qualified to NVQ level 4 in care and has also obtained an NVQ in management. The manager was not present at the time of this inspection, however, a deputy manager competently assisted us on this occasion. There are clear lines of accountability in the home, and external oversight by a Locality Manager. As well as ensuring her own knowledge and practice remains up to date, the registered manager undertakes a number of quality checks and audits to ensure the standard of care is up to current good practice levels. More senior managers also carry out periodic inspections, although these are not always carried out on a monthly basis. The views of the people living here are sought on a formal basis at house meetings. This gives people an opportunity to discuss matters affecting the running of the home, menus and planned Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: activities. Just as the quality of the care provided is checked, so are matters affecting health and safety. Therefore regular checks on the building are carried out, water and fridge / freezer temperatures are monitored, and working practices that could present a risk are looked at, and safe ways of working (for instance by the use of lifting aids) introduced. There were no hazards to health and safety observed. Care Homes for Adults (18-65 years) Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 28 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 19 13 The registered manager must ensure that medicine management arrangements are reviewed, to include periodic quality checks, competency testing and full and accurate recording. This is so each service users welfare is promoted by the implementation of safe and robust systems and practice. 27/07/2009 2 39 26 The registered person (or other person delegated by him) must inspect the home on a monthly basis. 27/07/2009 This is so regular checks and oversight are undertaken. Care Homes for Adults (18-65 years) Page 26 of 28 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 35 Staff should receive mental health awareness training. This is so they have a good understanding of each persons needs. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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