Care Home: Harwood House Nursing Home

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What the care home does well What has improved since the last inspection? What the care home could do better: CARE HOMES FOR OLDER PEOPLE Harwood House Nursing Home Spring Lane Cookham Dean Berkshire SL6 6PW Lead Inspector Helen Dickens Unannounced Inspection 25th March 2008 11:30 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 Harwood House Nursing Home DS0000010987.V359348.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. Harwood House Nursing Home DS0000010987.V359348.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harwood House Nursing Home Address Spring Lane Cookham Dean Berkshire SL6 6PW 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) 01628 478000 01628 478012 Harwood House Limited Ms Morag Forsyth Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (30) of places Harwood House Nursing Home DS0000010987.V359348.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No physically disabled adults under the age of 60 to be admitted. Date of last inspection 27th September 2006 Brief Description of the Service: Harwood House is located approximately three miles from Maidenhead in a rural setting with pleasant views of Windsor and the Thames Valley. The home provides twenty-four hour nursing care for up to 30 residents over the age of sixty years. There is a sitting room and separate sun lounge with French windows leading onto a large patio. The accommodation is on three floors with a small passenger lift available to transport wheelchairs between floors. The house stands in attractive grounds and gardens and has plenty of parking available for staff and visitors. The current scale of charges in March 2008 is between £850 (for a shared room) and £1,100 for a single room. There are additional charges for newspapers, magazines, hairdressing, and chiropody. Harwood House Nursing Home DS0000010987.V359348.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 was unannounced and took place over 6.5 hours. The inspection was carried out by Mrs. Helen Dickens, Regulation Inspector. The Registered Manager, Mrs. Morag Forsyth represented the establishment. A partial tour of the premises took place and a number of files and documents, including resident’s assessments and care plans, staff recruitment files, quality assurance information, and the annual quality assurance assessment (AQAA) were examined as part of the inspection process. A number of questionnaires were sent out to residents and health and social care professionals, and 11 were returned following the inspection. The inspector would like to thank the residents, relatives, staff and the registered manager for their time, assistance and hospitality. What the service does well: The home has good arrangements in place to ensure prospective residents have sufficient information prior to moving in – this now includes a DVD filmed at the home featuring some current residents, and the daily routines at Harwood House. Good arrangements are in place to meet the healthcare needs of residents and some very positive comments were received from healthcare professionals who completed the CSCI surveys prior to this inspection. In answer to the question about what the home does well, one stated that Harwood House ‘Provides an individual with excellent service….an excellent home.’ Staff are respectful to residents and another healthcare professional who had been visiting the home for some years noted on their survey in relation to staff: ‘It has always been my impression that they are caring, respectful and friendly to the residents.’ An activities organiser is employed by the home and good records of resident’s involvement with various activities are kept. One resident noted on their survey to CSCI there are very ‘inventive’ activities arranged at the home, for example a ‘Burns Night’ and recent Easter celebrations. Harwood House Nursing Home DS0000010987.V359348.R01.S.doc Version 5.2 Page 6 Cultural evenings are also arranged where staff from different cultures will get involved in providing food and information about their own country – the manager did a Scottish night which featured haggis, and they have also had Hungarian, Chinese and Indian meal celebrations. The home does well in regard to equal opportunities for example in that they have a good cultural mix of staff. They also have arrangements in place to ensure the home is accessible to those with a mobility impairment, and that there are suitable aids and adaptations fitted in the home to enable residents to be as independent as possible. Meals are very enjoyable at this home with a choice of two dining rooms or the conservatory to have lunch. Many positive comments were received about the food and it was also noted that cooked breakfasts are available throughout the week with around 19 residents per day choosing anything from poached eggs on toast, to a full English breakfast. Harwood House offers a very homely environment, which is well furnished and properly maintained; there are plans for further improvements, including larger rooms for some residents, and a completely level garden. There is a high standard of cleanliness at the home and there were no unpleasant odours in any part of the building; it was noted by the inspector and also commented on by many residents, that there were fresh flowers throughout the home. There are good arrangements in place for staff training and Harwood House exceeds the National Minimum Standard (NMS) on the number of staff with care qualifications. Residents told the inspector that staff were always friendly and helpful, one wrote on their survey: Care and support is ‘Always excellent and always followed up if I need anything.’ A visitor told the inspector that Harwood House is ‘the best nursing home for miles around.’ Good management arrangements are in place and both residents and visitors told the inspector the home was very well run. It was stated that the owner takes a personal interest in the running of the home and that the manager was a very ‘hands on’ matron who always dealt with things ‘personally and promptly.’ What has improved since the last inspection? One Requirement was made in relation to staff supervision at the previous inspection – this has now been met and the relevant NMS exceeded. One Recommendation was made in relation to the safety of the sloping garden. A temporary fence has been fitted though this slope will disappear in the refurbishment programme when the front garden will be completely level. As already mentioned, a DVD has been made about daily life and activities within the home to ensure that all prospective residents can have access to information about the home, even if they are unable to visit. Harwood House Nursing Home DS0000010987.V359348.R01.S.doc Version 5.2 Page 7 Many environmental improvements have been carried out since the last inspection including providing a new luxury bathroom for residents, redecorating and carpeting some resident’s bedrooms, and purchasing a new DVD player, a new TV, and some new lamps and mirrors. The laundry has been upgraded with new machines and some redecoration. A new carpet has been fitted in the conservatory and some nursing equipment has been purchased including a new hoist, some nursing beds, and an air mattress. A water cooler has been installed at the home, and the manager said this is very popular, as are the new staff uniforms chosen by the staff themselves, and their new name badges, which were chosen by residents. What they could do better: 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. Harwood House Nursing Home DS0000010987.V359348.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 Harwood House Nursing Home DS0000010987.V359348.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 and 5 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents benefit by having excellent information about the home prior to moving in, including a DVD about life Harwood House, as well as the opportunity for trial visits. All residents have a pre-admission assessment though this is currently being reviewed to improve the information collected about each resident. EVIDENCE: Prospective residents and their families can refer to the statement of purpose and service user guide for written information about this home prior to moving in. However, the manager has also identified that some prospective residents may be unable to visit the home in advance, usually because of poor health or because they are in hospital. The home has therefore had a DVD made which was filmed professionally at the home, and gives any prospective resident or their family a good idea about daily life at Harwood House. The manager was congratulated on this initiative, which will give any prospective resident the Harwood House Nursing Home DS0000010987.V359348.R01.S.doc Version 5.2 Page 10 chance to view the inside of the home and the residents, without moving from their armchair. All residents in the video gave permission to be filmed. Seven residents returned surveys to CSCI prior to the inspection and all said they had received sufficient information prior to moving in, with one of the newer residents saying they had seen and appreciated the DVD. Assessments are carried out on all prospective residents with two members of staff visiting them and then returning to the home to discuss the initial assessment with the manager. The current assessments used at the home are very basic. However, the manager is working on the project with the Berkshire Care Association whereby a new and improved format for assessments and care plans is being piloted. The home will then adopt this new format for all residents. Trial visits to the home are encouraged and some residents spoken with talked about coming for short stays before moving in permanently. Prospective residents can come to look around the home, come for a meal, or spend the day at Harwood House, before deciding if this is the right home for them. Harwood House Nursing Home DS0000010987.V359348.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 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s benefit by having their personal and healthcare needs set out in an individual plan of care though more work is being done to improve the format and detail of these plans. Residents are protected by the home’s arrangements for administering medication. Residents are treated with dignity and respect at Harwood House. EVIDENCE: Four care plans were sampled and found to contain basic information regarding each resident’s needs. The manager is part of a local project team in Berkshire currently reviewing the format of care plans and she said that Harwood House care plans will be replaced with the new format once the pilot is completed. Current care plans need to contain more information about how residents would like to be supported and the manager said this would be addressed in the new format. Care plans were usually reviewed monthly and a list containing the names of residents and when their care plans were reviewed provided evidence of this. However two new resident’s names had not been Harwood House Nursing Home DS0000010987.V359348.R01.S.doc Version 5.2 Page 12 added to the list and therefore their care plans had not been reviewed; the manager said this was an oversight and would be remedied immediately. Daily notes were kept as well as a record of activities for each resident. Resident’s made some positive comments in regard to their care and support including: ‘Staff are interested and receptive’ ‘Excellent support.’ Care and support is ‘Always excellent and always followed up if I need anything.’ Arrangements for healthcare are good and resident’s care plans contained a record of any interventions by healthcare professionals. Four healthcare professionals returned surveys to CSCI and commented very positively on healthcare and the general care and support for residents. One said they had visited Harwood House over a number of years and ‘always found the staff to be very professional.’ One consultant who has been involved with a few residents said in their experience residents do have their needs met at this home and if there are issues, staff look at ways their new needs can be met.’ This person also said that staff ‘were good at asking for advice if they needed it.’ Another health professional, in answer to the question about what the home does well, stated they ‘Provide an individual with excellent service….an excellent home.’ The home uses the MUST nutritional risk assessment tool for residents and each resident is weighed regularly. Two residents had not been given a risk rating in relation to nutrition and the manager said she would follow this up. Medication arrangements were observed to be well organised and inspection and supervision in relation to medication is provided by the local pharmacy, under contract from the local NHS Trust. The manager said two visits per year are made to the home. The health professional who supervises their arrangements for the administration of medicines noted that ‘Medication arrangements are good and there is no cause for concern.’ Only trained nurses give out medication at this home and the training matrix demonstrated they have all had their training in the administration of medication up-dated within the last year. Medication arrangements were observed to be well organised and the inspection and supervision in relation to medication is provided by the local pharmacy, under contract from the NHS Trust. The manager said two visits per year are made to the home. The health professional who supervises the arrangements for the administration of medicines noted that ‘Medication arrangements are good and there is no cause for concern.’ Only trained nurses give out medication at this home and the training matrix demonstrated they have all had their training in the administration of medication up-dated within the last year. One visitor who was asked about how well they thought the home managed the arrangements for medication, described this home as ‘meticulous to a fault.’ The manager was asked to ensure that clear written guidance is available for staff in relation to any ‘as required medication.’ Harwood House Nursing Home DS0000010987.V359348.R01.S.doc Version 5.2 Page 13 Staff were observed to respect the privacy and dignity of residents. One healthcare professional who had been visiting the home for some years noted on their survey in relation to staff: ‘It has always been my impression that they are caring, respectful and friendly to the residents.’ Personal care was given behind closed doors and there were many instances were residents were seen to be given choices and have their opinions taken into account. For example, each breakfast tray has a note containing resident’s preferred choice of cooked breakfast e.g. ‘2 poached eggs on toast’ which one resident has every morning. Residents at this home have the opportunity to attend resident’s committee meetings, giving them further opportunities to influence the day-to-day life of the home. Harwood House Nursing Home DS0000010987.V359348.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 and 15 People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a very varied programme of activities, and family and friendship links are encouraged. Residents have some opportunity to exercise choice and control in their day-to-day lives, and the arrangements for meals at this home are very good. EVIDENCE: An activities organiser is employed at this home and she was interviewed on the day of the inspection; several staff have also been on activities training courses. There is a regular activities programme in place and good records are kept about the activities enjoyed by each resident, which activities they took part in, and any relevant comments are noted. Residents commented on their surveys that they were either ‘always’ or ‘usually’ satisfied with the activities on offer. One resident said ‘I always enjoy my activities – we always have activities every day.’ Another resident noted the very ‘inventive’ activities arranged at the home, for example a ‘Burns Night’ and Easter celebrations. The manager said one resident belongs to a local tennis club. Harwood House Nursing Home DS0000010987.V359348.R01.S.doc Version 5.2 Page 15 Cultural evenings are arranged where staff from different cultures will get involved in providing food and information about their own country – the manager did a Scottish night which featured haggis, and they have had Hungarian, Chinese and Indian meal celebrations. There is a weekly chair based exercise session though one resident noted they would like the opportunity for more exercises, and this was passed on to the manager. Residents are given the opportunity to enjoy having pets around, and there are currently two cats living at this home; the activities organiser also brings her small dog to the home each day. The manager said some residents go to the cinema and theatre, and the home has obtained permission to use a neighbour’s swimming pool. The Activities co-ordinator is currently in consultation with residents about arranging a trip to the Windsor Races and The Henley Regatta, and they have joined with another local home to organise competitive Domino Tournaments. Residents can have visitors when they choose and are able to receive them in private. Staff were knowledgeable on resident’s family and friendship links and visitors are made welcome. One relative was interviewed on the day of the inspection and spoke highly of the home and its management. This relative has a meal at the home once a week and said the food is ‘excellent’. They also added that staff are ‘always cheerful and positive’, and ‘this is the best nursing home for miles around.’ Residents are encouraged to make decisions about their day-to-day life in the home including having a choice of meals and activities, and the opportunity to voice their opinions at resident’s committee meetings. Bedrooms were personalised with resident’s own items, including resident’s own furniture in some rooms, which adds to the homeliness and comfort for each resident. A new luxury bathroom has been fitted since the last inspection, which includes soft lighting and piped music. Residents can have a choice of music and as we passed the CD player outside the bathroom the manager said she knew which resident had last been in the bathroom by the choice of music disc left in the CD player. The inspector chatted to residents during their lunch and later spoke with several residents individually on this subject. Each main course item was sampled by the inspector and found to be very tasty, including the braised celery casserole, which was the vegetarian option. Comments on the food were very positive from residents and the visitor who was also interviewed. ‘All very well cooked’, ‘Food is excellent’, and ‘Food is good and interesting’ were typical comments. One also said ‘the sweet course is always generous’ There was a choice of three main courses on the day of the inspection and the cook said the majority of food at Harwood House is home-made. Residents have the option of a cooked breakfast each day and the cook said 19 residents currently have a regular order for a cooked breakfast. The dining rooms were very pleasant with linen tablecloths and napkins, and fresh flowers. Residents who Harwood House Nursing Home DS0000010987.V359348.R01.S.doc Version 5.2 Page 16 needed support were given this in a discreet way, and those needing liquidised meals had each item liquidised separately – the cook explained that this maintained the colour and appearance of the food, therefore making it more appetising for residents to eat. Harwood House Nursing Home DS0000010987.V359348.R01.S.doc Version 5.2 Page 17 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 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously at this home and residents are protected from abuse. EVIDENCE: No complaints have been received by the home or by CSCI about this home in the last 12 months. A complaint received more that 12 months ago, but since the previous inspection, was copied to CSCI and dealt with satisfactorily by the home. Resident’s spoken to on the day of the inspection and surveys returned showed that residents felt concerns were taken seriously and their opinions listened to. Where the survey asked if residents knew how to complain, some residents pointed out that there was a resident’s committee, which provided a forum to raise any concerns. One visitor said that the manager was a very ‘hands on’ manager and dealt with any requests or concerns personally and very promptly. They gave an example of a special request regarding the person they visited and how it had been carried out to the letter by staff. The home has a copy of the local multi-agency procedures for safeguarding vulnerable adults and their own in-house policy which mirrors the local arrangements. Both policies were clear about the responsibility to report any alleged incidents to social services. No reports of safeguarding issues have been received about this home in the last 12 months. There is information Harwood House Nursing Home DS0000010987.V359348.R01.S.doc Version 5.2 Page 18 about a local advocacy service on display within the home and all staff have had training on how to safeguard vulnerable adults. Harwood House Nursing Home DS0000010987.V359348.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 and 26 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a homely and comfortable environment, which is clean, pleasant and hygienic throughout. EVIDENCE: A partial tour of the premises took place with the inspector visiting all communal areas and five resident’s bedrooms. Harwood House offers a very homely environment which is comfortably furnished throughout. According to the AQAA, returned to CSCI by the manager prior to this inspection, a number of improvements have been made to the environment since the last inspection. These include providing a new luxury bathroom for residents, redecorating and carpeting some resident’s bedrooms, and purchasing a new DVD, new TV and some new lamps and mirrors. The laundry has been upgraded with new machines and some redecoration. A new carpet has been fitted in the conservatory and some nursing equipment has been purchased Harwood House Nursing Home DS0000010987.V359348.R01.S.doc Version 5.2 Page 20 including a new hoist, some nursing beds, and an air mattress. A temporary garden fence has been built to meet the previous CSCI Requirement regarding the safety of the sloping garden. A water cooler has been installed at the home, and the manager said this is very popular, as are the new staff uniforms chosen by the staff themselves, and their new name badges chosen by residents. Residents appreciated their pleasant environment including several who commented on the fresh flowers in the home, for example: ‘We have fresh flowers in the sitting rooms and in the hall which gives a nice feeling to the place’. Further refurbishment and a new extension is being planned for the home which, whilst it will not increase the numbers of resident’s at the home, it will enable some residents to have larger rooms, and direct access to the new completely level garden. One bedroom needed to have the wall beside the bed repainted, and the sluice has just had some building work completed and now needs the wall to be replastered and the floor recovering. Some health and safety matters raised during the inspector’s tour of the building are discussed under Standard 38 at the end of this report. This home was pleasant and fresh smelling throughout – there were no unpleasant odours anywhere in the home – even the sluice was clean and tidy. Staff have had infection control training and there were good hand-washing facilities throughout with paper towels and individually dispensed soap in all communal areas. The manager removed a cotton hand-towel in one communal bathroom immediately. All seven residents who returned surveys to CSCI ticked ‘Always’ in response to the question ‘Is the home fresh and clean.’ The laundry was clean and tidy though not kept locked – the manager was asked to carry out a risk assessment in this regard and it was completed before the end of the inspection. Harwood House Nursing Home DS0000010987.V359348.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 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents at this home benefit by having their needs met by sufficient numbers of staff, with an appropriate skill mix, and residents are in safe hands. More work needs to be done on recruitment to fully protect residents. Staff are trained and competent to do their jobs. EVIDENCE: There is a staff rota in place and extra staff on at busy periods. Two trained nurses plus the manager are on duty during the daytime, together with 5-6 care workers during the morning, and 3-4 care workers in the afternoon. There is always a trained nurse on duty at night with two care workers. There are sufficient catering and domestic staff on duty to ensure care staff are attending to resident’s care needs, whilst the catering and domestic requirements of the home are well met by other staff. Staff providing personal care to residents are aged at least 18. In addition to the trained nurses, there are 21 care staff employed full or part time at this home. So far 14 of these staff have gained at least an NVQ Level 2 qualification therefore exceeding the NMS recommending at least 50 of care staff have this qualification. The manager said that of the remaining seven staff, four have already started the NVQ qualification. Harwood House Nursing Home DS0000010987.V359348.R01.S.doc Version 5.2 Page 22 Two staff recruitment records were checked. The manager takes responsibility for recruitment and standards were generally good, showing information was kept securely and application forms, references and other relevant recruitment information were kept on file. The manager said she had planned to review recruitment files and how records were kept. One file had a gap in employment history and the manager said she would ensure this staff member completed a full employment history when they came on duty the next day. She said any further unexplained gaps or queries would be followed up. One file had a reference from a family friend – this was discussed and an alternative referee was suggested. There was also a discussion to clarify the issue about whether someone under 18 would need to have a CRB check carried out. Both the Registered Nursing Homes Association and the CRB confirmed to the service that they would need to carry out a CRB check for anyone employed at the home, irrespective of whether they were under 18. A Requirement will be made that the recruitment files are systematically checked to ensure all staff files have all the information set out in Schedule 2 of the Care Home Regulations 2001 (as amended) and a copy of this Schedule was given to the manager. The home has a staff training matrix in place for all mandatory training. This was examined and the majority of staff had done all the mandatory training courses. The manager had identified a few refresher courses, which were overdue, and she had booked the appropriate courses for these staff. Only trained nurses administer medication at this home and they had all had a refresher course in the administration of medication within the last year. The manager said the owner was committed to staff training and there was no problem with getting funding for training. Some additional training courses had been identified which were relevant to the needs of current residents, for example training on Parkinson’s Disease, and some staff had already been sent on this course. Four staff have also been on the specialist training course for activities in care homes. Harwood House Nursing Home DS0000010987.V359348.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 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit by living in a well managed home, with good quality assurance arrangements in place. Resident’s finances are protected by the home’s policies and procedures, and arrangements for staff supervision are excellent. There are procedures in place for promoting the health and safety of residents but more work needs to be done to ensure any shortfalls are identified and dealt with in a timely fashion. EVIDENCE: The manager is a registered nurse and has completed the Registered Managers Award and the Berkshire Leadership programme. The manager has a clear sense of direction and leadership. Residents and staff were complementary about the manager and her management approach. The visitor interviewed Harwood House Nursing Home DS0000010987.V359348.R01.S.doc Version 5.2 Page 24 during the inspection was also complimentary about the manager and owner of the home. He said the owner took a very personal interest in the home and the manager was a very ‘hands on’ matron who always dealt with things ‘personally and promptly.’ Staff morale in the home is good. A deputy manager who is also a registered nurse and a part time administrator supports the manager. There are good systems in place for quality monitoring at this home and the owner has a business development plan to cover the financial aspects of the home’s development. The manager is also developing an annual development plan which will focus more on issues such as reviewing the assessment and care planning format, and reviewing staff files. Policies and procedures have all been reviewed recently and the owner ensures monthly monitoring visits are made to the home. Residents have committee meetings and there are also annual questionnaires and ad hoc opportunities for residents being involved in decision making such as recently choosing new furnishings and colour schemes for the home, and the new name badges for staff. This home does not get involved in managing resident’s finances. Any items, which are in addition to the monthly fees for example hairdressing or daily newspapers, are included on the bill each month to whoever is paying each resident’s fees. There was a Requirement at the last inspection for staff supervision to be carried out at least 6 times a year. The manager keeps a record of all supervisions and all staff were on course for having a minimum of six supervisions in this coming year. Two staff records were checked and one had already had four sessions since Christmas, and another had had five sessions. The manager was commended for the frequency of the supervision and the excellent record keeping in this area. There are arrangements in place for monitoring health and safety within the home and the owner pays a specialist consultant to carry out health and safety risk assessments and act as advisors to the home on health and safety matters. An annual visit is made to the home by the environmental health officer from the local council – at the last visit in November 07 four requirements were made – the manager said three had been completed and the fourth, regarding the ventilation, would be completed with the building works which were starting on 1st May. Some safety records were checked and found to be satisfactory, including checks on the hoists (in February 08) and safety checks on the passenger lift (also February 08). Some shortfalls were noted on the day of the inspection which the manager corrected immediately. A cleaning liquid was left in an unlocked cupboard on the landing – this was removed by the manager; there was no risk assessment for the laundry which was unlocked; and one room upstairs had no window restrictors – the manager had the larger window locked until restrictors could Harwood House Nursing Home DS0000010987.V359348.R01.S.doc Version 5.2 Page 25 be fitted. A Requirement will be made that the monitoring of health and safety be reviewed to ensure any shortfalls are identified and dealt with in a timely fashion. Harwood House Nursing Home DS0000010987.V359348.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 4 X 2 X 3 N/A 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 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 4 X 2 Harwood House Nursing Home DS0000010987.V359348.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19 Schedule 2 Requirement Arrangements for staff recruitment must be reviewed to ensure that all staff files contain the information set out in Schedule 2 of the Care Homes Regulations 2001 (as amended) including a full employment history. Arrangements for monitoring health and safety within the home must be reviewed to ensure any shortfalls are identified and dealt with in a timely fashion. Timescale for action 25/04/08 2. OP38 13(4)(a) (b)(c) 07/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Harwood House Nursing Home DS0000010987.V359348.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Harwood House Nursing Home DS0000010987.V359348.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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