Care Home: Howgate House

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What the care home does well What has improved since the last inspection? All the requirements from last inspection have been dealt with and the home has worked hard to make improvements in all areas of the service. The home has produced an admission pack, which provides clear and concise information to help people decide if the home is suitable for them. The care planning has improved and people are involved in drawing up and reviewing their care plans. This means care can be delivered in a way that takes account of people`s wishes and abilities. Work is in progress on improving the environment to make sure that it continues to provide a pleasant and comfortable place for people to live. What the care home could do better: There are no requirements following this visit. The home is providing a good service and that they know what further improvements they need to make. CARE HOMES FOR OLDER PEOPLE Howgate House Howgate Idle Bradford BD10 9RD Lead Inspector Mary Bentley Key Unannounced Inspection 7th May 2008 09:15 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 Howgate House DS0000068594.V364780.R02.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. Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Howgate House Address Howgate Idle Bradford BD10 9RD 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) 01274 618010 01274 610727 HHouse4@schealthcare.co.uk CC Care Ltd Mrs Shelley Melinda Lobley Care Home 63 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Old age, not falling within any of places other category (63) Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old, age not falling within any other category - Code OP, Mental Disorder - Code MD The maximum number of service users who can be accommodated is: 63 15th May 2007 2. Date of last inspection Brief Description of the Service: The home has been operating since 1989 but was registered as a new service in December 2006 when it was taken over by Southern Cross. The home provides personal and nursing care for up to sixty-three people. The majority of people living in the home are over the age of 65. Howgate House is a modern purpose built property situated in the village of Idle. It is close to local bus routes and within easy reach of the main road to Leeds and Bradford. Accommodation is provided on 3 floors and many bedrooms have en-suite facilities. There are 8 double rooms. There are communal rooms on the ground and first floors. The ground floor has a separate dining room and lounge and the first floor has a combined lounge and dining room. There is a designated smoking room for people living in the home. There are no gardens, but there is a small patio with outdoor seating. There is some off road parking. In May 2008 the weekly fees ranged from £351.19 to £612.01. Services such as hairdressing and chiropody are available for an additional charge. Copies of inspection reports are available in the home. Howgate House DS0000068594.V364780.R02.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 stars. This means the people who use this service experience good quality outcomes. The inspection process included looking at the information we have received about the home since the last key inspection in May 2007. We have not received any complaints or concerns about the home since then. The purpose of this inspection was to look at how the needs of people living in the home are being met. We did this unannounced visit in one day; one inspector visited the home between the hours of 9.15am and 5.15pm. During the visit we spoke to people living in the home, visitors, staff and management. We looked at various records including care records and looked at parts of the building. Before the visit we sent surveys to people living in the home, their relatives, and health care professionals involved with the home. In total 19 surveys were returned. We sent a self-assessment form to the home and it was returned to us in good time, it was clear and contained all the information we asked for. Information from the surveys and the self-assessment form are included in this report. As part of this inspection we carried out a thematic probe. This is where we look at additional information on a particular theme and in this case we looked at how vulnerable adults are protected from abuse. This information is taken from all the homes visited in the country between May 6 and 16, 2008. The findings of this thematic probe will be used as part of a wider investigation that we are doing, about the quality of care that people experience. This report will be published later in 2008. Further information on this, and thematic inspections can be found on our website www.csci.org.uk What the service does well: These are some of the things people told us about Howgate House: • • • “Promotes good quality care in a pleasant environment” “Staff are approachable and are happy to answer any questions” “Everything to support the residents family” DS0000068594.V364780.R02.S.doc Version 5.2 Page 6 Howgate House • • “A very good place for care” “From my observations residents are treat with respect and dignity” The home has been awarded a 5 star rating (the highest) by Environmental Health for its standards of food hygiene and safety. People are protected by the home’s systems for employing new staff, all the required checks are done before they start work to make sure they are suitable to work with vulnerable adults. There is a good training programme, which means that staff are supported in developing the skills, and knowledge they need to meet people’s needs. Health and safety are managed well which means that the home is a safe place for people to live. What has improved since the last inspection? 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. Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 7 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 Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. Standard 6 does not apply to this service. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are given the information they need to help them decide if the home if the right one for them and their needs are assessed before they move in. EVIDENCE: The majority of the 13 people living in the home who completed our surveys said they had been given enough information before moving in and said they have contracts. In response to concerns raised last year that people were not getting enough information about the service the home has introduced an admission pack. This is a simplified version of the Statement of Purpose and Service User guide and is given to people when they contact the home. Information about the home is also available on audiotape and CD if people need it. Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 9 Pre-admission assessments are done before people move in. Staff said they get information about new people before they move in so they have some understanding of what their care needs will be at the time of admission. The home encourages people and/or their relatives to visit before making a decision about moving in. Some people told us they had visited, others said they had not been able to because they had needed to move in immediately. Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 10 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 and 11. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s care needs are met in a way that takes account of their preferences and abilities and respects their privacy and dignity. EVIDENCE: Everyone living in the home has a care plan. The care plans are detailed and have information on people’s personal, health and social care needs. People living in the home and/or their relatives are involved in drawing up the care plans and are kept informed about changes. We saw evidence of this in the 3 care plans looked at. The care plans we saw were up to date. The manager and area manager check them regularly to make sure they are kept up date. People living in the home told us they usually get the care and support they need. One person told us they are “very happy” and “well looked after”, they said they can always get to see their GP if they need to. Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 11 Another person living in the home said, “The girls work well and are good to us. I dont like the idea of the nurse in charge coming into the room when visiting GP; I think it is private between GP and me”. Relatives told us they feel people are well cared for and said they are kept informed. These are some of the comments made by relatives: • “ They give good care to my mother who had a severe stroke 3 ½ years ago”. • “They always advise me if problems have arisen and what was done to solve the problem”. One person said their relative tended to slump in the chair and they would like staff to pay more attention to helping them sit upright. The care plans show that people have access to a range of NHS services. Healthcare professionals who completed our surveys did not raise any concerns about the home. One said, “From my perspective as a GP clients needs are well met”. Medicines are managed safely in the home. One person said they thought the breakfast and lunchtime medicines were too close together, they said they would prefer them to be spaced out so that they didn’t clash. The home provides care for people with terminal illnesses and uses the Liverpool Care Pathway. This is a recognised model of good practice for palliative care and helps to make sure that the needs of the dying person and their family/friends are dealt with in a sensitive and consistent way. Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s individual needs are met and they are involved in planning the programme of social and leisure activities. People are supported in keeping in touch with family and friends. EVIDENCE: Daily routines are flexible, for example people can get up and go to bed when they choose and can stay in their rooms if they choose not to use the communal areas. The home has an activities organiser who works approximately 25 hours a week. Most people living in the home told us they are satisfied that there are activities for them to take part in if they want to. On the day we visited a number of people went out for lunch to a local pub. This is a regular event and different people are given the opportunity to go. One person said he enjoys being able to walk to the local pub whenever he wants. Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 13 The home has access to a minibus and uses disabled access taxis so that people can go out. Information about social events is advertised in the home and in the newsletter. Information about people’s social care needs and preferences is included in the care plans. Visitors are welcome at any time. Relatives told us the home meets people’s different needs, one person said “they seem to cater for everybody in the home” and another said they have always found the staff to be “very caring” not just to their relative but to other people as well. People’s spiritual needs are identified and representatives from local Christian churches visit people in home. The majority of people told us they like the food. Two people felt it could be better, one said “ Very bland, no taste, could do better” and the other said “The meals are ok but they could do more choice”. We observed the lunchtime meal on the first floor. The tables were nicely set with tablecloths, napkins, and condiments. People were offered a cold drink with their meal and a hot drink afterwards. The meal was nicely presented and looked appetising. There was a choice of 2 hot meals and one person had a salad. Staff were available to help or prompt people and this was done discreetly. Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 14 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 quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Complaints are taken seriously and acted on and people are protected from abuse. EVIDENCE: Information about the complaints procedure is displayed in the home. The majority of the 13 people living in the home who completed our survey said they know who to speak to if they are not happy. One person said, “I can speak to any one of the carers or nurses”. One person said they only know how to make a verbal complaint. One relative said they were not aware of the complaints procedures, however they said, “if I have raised concerns they seem to have been acted upon”. The home told us they have had 10 complaints since our last inspection. All of them were dealt with within 28 days. The home records details of all complaints and a senior manager reviews them every month. The home has detailed policies and procedures on the protection of vulnerable adults, (safeguarding). At the time of the visit 85 of staff had received training on safeguarding. A number of new staff were doing induction training, which includes safeguarding. The company requires all staff to update this training annually. Staff we spoke to had a good understanding of their Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 15 responsibilities to protect people and know what to do if they have any concerns about people’s welfare. Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 16 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 quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live in a clean, comfortable and pleasant environment, which is well equipped to meet their needs. EVIDENCE: The home was clean, tidy and odour free when we visited. People living in the home said it is usually clean and fresh. Two people said they thought there were not always enough housekeeping staff. It was evident that a lot of improvements have been made since our last visit and there is an ongoing programme of refurbishment. The majority of the bathrooms have been upgraded making them a more pleasant place for people to use. The kitchen areas on the first and ground floor have been upgraded; they are now more domestic in style. Parts of the Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 17 home have been redecorated and new furniture has been provided in some of the lounges. There is a decked patio outside the dining room on the ground floor and this provides a pleasant and safe place for people to sit outside. In the bedrooms we looked at people had lots of their personal belongings. People told us they are consulted about the decoration of their rooms. One person said that before she moved in she was asked what colour scheme she would like for her bedroom. The home is well equipped to meet the needs of people with physical disabilities, there is a passenger lift to all floors, and the corridors are wide. There are assisted bathing facilities, disabled access toilets and there are hoists to help people with moving and handling. The home told us they have been working to improve the laundry service. Only one person mentioned the laundry service to us and that was to say they thought more care could be taken putting people’s clothing away tidily. The majority of staff (83 ) have done training on the prevention of cross infection. Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 18 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 quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There are usually enough staff to meet people’s needs and people are protected because all the required checks are done before staff start work. There is a very good training programme, which supports staff in gaining the knowledge and skills they need to care for people properly. EVIDENCE: People living in the home said staff are usually available when they need them. Two people said they thought the home was a bit short of staff sometimes. One person said they are “a bit slow sometimes, they do their best” and another person said they sometimes have to wait if staff are busy with other people. Most people spoke positively about the staff describing them as “caring” and “lovely”. One person said the night staff are very kind. Another person “Some staff are very helpful”. Most people said that staff listen to them and take notice of what they say. We observed staff being kind and respectful to people. Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 19 There were 55 people living in the home when we visited. There are usually 2 nurses on duty all day with 9 care assistants in the morning (until 2pm) and between 6 and 7 care assistants until 8.00pm when the night staff start. There are usually a total of 6 staff overnight, this includes 2 nurses. There is an activities organiser who works about 25 hours a week. The deputy manager has some supernumerary time and the manager is fully supernumerary. The home employs separate staff for housekeeping, catering, administration, and maintenance. We looked at the files of 3 newly appointed staff and they showed that all the required checks were completed before they started work. Staff told us they had not been allowed to start work until the home had done all the checks, which included 2 written references, PoVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) checks. All new staff are given induction training and have a mentor to support them while they are learning the job. Over 50 of care staff have achieved an NVQ (National Vocational Qualification) at level 2 or above. The home provides a lot of staff training on safe working practices as well on subjects related to the needs of people living in the home. There are annual updates on subjects related to safe working practices such as fire, moving and handling and food safety. In addition the majority of staff have done training on customer service, nutrition, the care of people with dementia, challenging behaviour, care planning and the safe management of medicines. The training records are good and information on training is readily available. One person said, “They (staff) seem to be well trained and appear to carry out their duties” and another said, “Staff appear trained and knowledgeable”. Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 20 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, 32, 33, 35 and 38. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is well managed; people are given the opportunity to share their views of the service and kept informed about changes. The environment is safe for people and staff because appropriate health and safety practices are carried out. EVIDENCE: The manager is a nurse with twenty-five years relevant experience. She regularly attends training to keep up to date with current good practice in both care and management. Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 21 The company has systems in place to support the home manager in her role, for example there is a central personnel department, and an area manager visits the home at least once a month. During that visit various aspects of the service are checked and if necessary areas for improvement are identified. The company sends questionnaires to people who use the service at least once a year. The replies go to the company’s head office where they are analysed. The area manager then discusses the findings with the home manager and an action plan is put in place to deal with any issues that have been identified. Last year some people told us they did not feel they were kept informed and expressed a lack of confidence in the management team. The home has worked hard to address these concerns and people raised no such concerns this year. One person told us they thought the home had become “more efficient” in the last year and another said it is “much better with the new owners”. The home continues to promote an open culture that encourages people to express their views of the service. For example the newsletter has information on how to contact the manager and on the “managers surgery” which is held every month. The home holds small amounts of money for some people. When we looked at the records last year they were clear and up to date. All transactions were listed, and receipts were available for money spent on people’s behalf. The maintenance records we looked at were up to date and showed that equipment is maintained and serviced at the required intervals. There is system in place for recording and monitoring accidents. The home has a health and safety group that meets every 3 months. Part of this group’s responsibility is to review all accidents and look at how they can reduce the risk of similar incidents happening again. Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 23 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. Refer to Standard Good Practice Recommendations Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Howgate House DS0000068594.V364780.R02.S.doc Version 5.2 Page 25 - 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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