Random inspection report
Care homes for adults (18-65 years)
Name: Address: Havelock Court Nursing Home 6-10 Wynne Road Havelock Court Stockwell London SW9 0BB one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sonia McKay Date: 2 0 0 7 2 0 1 0 Information about the care home
Name of care home: Address: Havelock Court Nursing Home 6-10 Wynne Road Havelock Court Stockwell London SW9 0BB 02079249236 02077386914 enquiries@havelock.ansple.co.uk www.bupacarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) BUPA Care Homes Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 60 Number of places (if applicable): Under 65 Over 65 0 0 0 dementia mental disorder, excluding learning disability or dementia physical disability Conditions of registration: 0 0 0 if the number of service users in the category of MD rise above 30, staffing ratios for each shift should be maintained in accordance with the Staffing Notice dated 15 March 2002 for the top floor of the home MD(E) up to 5 services in this category PD(E) and DE(E) when the current service users in this category vacate there are to no further admissions into these categories service users who are liable to be detained under the Mental Health Act l983, including
Care Homes for Adults (18-65 years) Page 2 of 12 Sections 2 and 3, must not be admitted until the relevant Sections are discharged Date of last inspection Brief description of the care home Havelock Court is a nursing home owned and managed by a care provider called ANS. ANS became a subsidiary of BUPA in August 2005. The home provides nursing care for 60 residents in a purpose built home in the middle of a mixed business and residential area, a few minutes walk from a major shopping centre that has full transport and community facilities. It is set in a no-through road in its own grounds, with a gate entrance and its own parking facilities. The ground floor has the reception area, offices and communal facilities and bedrooms are located on the first and second floors. The ground floor has an activities room, 2 separate lounges, 2 conservatories, one of which is for smoking, 2 dining rooms, and a back garden. There is a passenger lift to all floors, and a keypad system for all communal doors to ensure the safety of residents who may wander. A copy of the most recent Commission inspection report is available in reception. A residents guide to the home is being reviewed and can be requested from the home. Fees range from GBP995.00 to GBP1,334.00 per week and depend on the individual care needs of each resident. Care Homes for Adults (18-65 years) Page 3 of 12 What we found:
This random inspection was carried out to check compliance to requirements made at the last inspection and to look at safety of the administration of prescribed medicines as there had been a serious covert medication error resulting in a resident being taken to hospital with an overdose. The inspection was carried out over the course of one day by the lead compliance inspector, a pharmacist inspector and a Commission manager. What the care home does well:
As required in the previous inspection report, the statement of purpose and service users guide to the service have been revised. These documents now contain more information about placement fees and local services. As required in the previous inspection report staff now keep better records of the meals that are actually served and the wide variety of cultural meal options, which were always available, have now been added to the main menu options presented to residents. We were not able to observe a communal meal in a ground floor dining room during this inspection as there was an event on the ground floor and residents chose to eat their meals in small lounges on the first and second floors or in their bedrooms instead. The registered manager updated us about improvements made to mealtimes and advised that a ground floor dining room has been reorganised to make it easier for staff to support residents who need assistance to eat their meals or use wheelchairs and walking aids. Some staff have received specialist training in supporting residents to safely swallow and eat and how to ensure that residents are in a good seating position to eat their meals comfortably. The trained staff have cascade this information to other staff. Additional jugs have been purchased to make sure that adequate supplies of drink are available during mealtimes. During this inspection we observed residents spending time in their bedrooms and in cosy communal lounges on the first and second floors. Some were watching television and others were playing music. At the last inspection a few of the less physically able residents did not have access to wheelchairs to move about the building. This meant that they were confined to their bedrooms. We issued a requirement for the provider to ensure that residents have the correct aids available. Transit wheelchairs have been purchased and are now available when needed. The pharmacy inspector looked at how medications are being handled in the home. The 2 requirements, 4 and 5, and the 3 recommendations, 11, 12 and 13, made at the last inspection, have been met. Appropriate action has been taken following a safeguarding
Care Homes for Adults (18-65 years) Page 4 of 12 incident on covert administration, so people are now receiving their medicines safely and as prescribed. The manager said that nurses no longer leave floors unattended to give medication on another floor as at the last inspection and there is a protected medication round so staff are not disturbed. Special medication tabards have been ordered for nurses to wear during the rounds. The GP has been changed and the GP attends the home twice weekly on regular days.The deputy manager accompanies the GP on their rounds. The home uses the same pharmacy supplier as before as they provide a good service including staff training, audits and fast delivery of emergency prescriptions. The manager said she meets regularly with the GP and with the supplying pharmacists quarterly to sort out any issues with medication and prescriptions and she is satisfied with the service provided. Only one resident is currently having medication given covertly. There were two at the last inspection. The other resident is still at the home but is now taking medication without having to use covert administration. The provider has updated their covert medication policy after the recent safeguarding incident. The policy is still in draft but a copy was provided to us for review at this inspection. Medication training about safe covert administration was provided in June 2010 for nurses and carers. I interviewed one nurse on the 2nd Floor about the process for covert administration. The nurse was aware of the policy and had recently attended refresher training on covert administration. The nurse said only one person was now on covert administration. The person was admitted to the home on covert administration. Their care plan had been reviewed in April 2010 following the safeguarding incident. A Monthly review of the care plan takes place, and there is a twice a year review by the supporting multidisciplinary team, including the GP. The nurse said that different coloured crockery is now used to distinguish when medication has been added to food. She said if medication in food is refused, it is taken back to the nurse and disposed of in the clinical waste bin outside the home and that medicines are only added to food once the person starts eating to avoid wasting the dose. I inspected the care plan, it contained more detail than the previous plan, including what to do if the person refuses medications in food. The home is now managing covert administration safely. I inspected blood glucose monitoring sheets for the past 3 months for 3 people who needed their blood glucose levels monitored three times a day, once a day, or weekly.
Care Homes for Adults (18-65 years) Page 5 of 12 Monitoring is being done according to the agreed schedule, so this requirement has been met. I inspected medication administration sheets for all people on both floors, no medications were out of stock, and there were no gaps in recording on medication administration records (MAR charts). Staff record when all medicines are given, including food supplements and creams. There is evidence people are receiving their medicines as prescribed at the correct times. All changes to MAR charts have been initialled by staff or by the GP and it is clear who has made the change so the recommendation from the last inspection has been met. Receipts of all medicines have been recorded, and there is a disposal record for medicines to be taken away by the clinical waste contractor for disposal. This provides an audit trail for all medicines received into the home.I carried out a stock check on a small sample of medicines and this tallied with the MAR charts. All medicines were stored securely. Keys are kept by the nurse in charge only. I observed medicines being given on one floor and this was done safely with MAR charts completed at the time. The deputy manager said that only nurses give medicines, however carers have also had training about medication. New clinical refrigerators have been ordered since the last inspection and staff monitor the temperature of both the clinical fridges and the clinical room where medicines are kept. I inspected these records and found all medicines are being stored at appropriate temperatures so the recommendation from the last inspection has been met. There is a new Controlled Drugs(CD)register. I checked the stocks of Controlled Drugs and this tallied with the entries in the register. There are now clear entries in the register with no missing information so the recommendation from the last inspection has been met. The is clear information on the allergy status of residents on the covering sheet with each MAR chart. Protocols are in place for all medicines given on an as required basis, including whether the person is able to request their medicines or whether staff have to make an assessment of whether the person needs it. For pain relieving medicines, staff complete a pain assessment to record the severity of the pain and whether the pain relieving medicines have been effective. The due date for injections given every two weeks is being recorded to help to ensure these are given on time. I inspected records of injections given and these are being given as prescribed. For one person on an anticoagulant, warfarin, the anticoagulant book is kept with the MAR chart. They are having regular blood tests and the dose being given tallies with the most recent dose in the book and on the MAR chart.
Care Homes for Adults (18-65 years) Page 6 of 12 There is a GP communication log where staff add the names of residents who need to be reviewed by the GP or who need prescriptions to be ordered for them. The GP ticks the names off as he carries out each review. There is also a separate log where the GP records any interventions. These records show that people are receiving good access to the GP. Only one resident partially self administers his own medicines. He has a lockable storage space available in his room so that he can store the medicines safely, however at present staff keep his medicines and bring them to him to take himself. This has been risk assessed. There are information leaflets available for all medicines kept at the home. These are kept in each residents file in a section about their medical conditions. I spoke with one carer on the 1st floor who says she is aware of what medicines people are on even if she does not know what they are for. She said notifies the nurses of any changes in a persons condition at daily handover meetings between shift changes. She said she had attended medication training. At the last inspection we made four requirements about improvements needed to the physical environment of the home. These requirements have all been addressed and met. Fire doors have all been checked for safe operation and any gaps around the doors have been reduced to avoid smoke travelling through the building so easily. Window opening restrictors have all been checked and the maintenance officer maintains a record of periodic checks to ensure safe operation. The maintenance officer said that staff have been reminded to let him know straight away if they notice any defective devices. The provider has reviewed the use of close circuit television within the building and this has been stopped. Cameras now only record external views of the building and reception for security purposes. Bathrooms and shower rooms have been decorated and improved and are now all in working operation, a persistent plumbing problem in one shower room having been resolved. During a tour of the premises we noted that there were no unpleasant odours. The home environment continues to improve and vacant bedrooms have been decorated and furnished to a high standard. There are further improvements to the attractive communal garden and various seating areas. As recommended in the last report, there are now plans to develop a rehabilitative kitchen for residents to use and an occupational therapist has assessed the home to see what changes can be made to make it more accessible for residents with a physical disability. The manager advised us that the assessment report is pending. As recommended in the last report, residents have been consulted about their choice of window coverings and net curtains have been purchased for those people who wanted
Care Homes for Adults (18-65 years) Page 7 of 12 them. Some of the bedrooms are overlooked so this has improved the privacy of those rooms. We looked at a sample of seven staff recruitment files for staff who had been appointed in the last 10 months. We identified that the recording of staff recruitment had improved with individual information being retained in indexed files. These files were easy to read and follow and provided evidence that full recruitment details had been obtained about each applicant. The recommendation given at the key inspection of 20 July 2009, to make sure that staff references linked to the previous employment of applicants, had been complied with. The recruitment records were clear and well organised in this area and provided an easy to follow audit trail for references. Overall, a good standard in this area had been achieved. One of the inspectors spoke with a visiting relative. Feedback on the whole was positive, with the homes administrative team particularly praised. The manager and staff were viewed as working hard to provide a reliable service for residents. At the last inspection there were concerns that the residential floors of the home did not have enough staff on duty and trained nurses were sometimes absent if they were administering medication in communal areas on the ground floor. We issued a requirement for appropriate numbers of correctly trained staff to be available at all time. The providers improvement plan indicates that staffing levels were reviewed and arrangements put in place if a nurse was absent from the floor. The home manager and deputy manager are both trained nurses and are available to work hands on as required. The improvement plan says that staffing ratios and skill mix is reviewed by the homes management on a daily basis and in line with the number of residents and their dependency. There is a trained nurse and small team of carers working on both the first and second floors of the home. Residents who require additional assistance may have a one to one carer for periods of the day and a record is kept of who is on duty at all times. An additional trained nurse is on duty on at least two early shifts each week o each floor of the home. This is so that a nursed can liaise with the GP when he does his regular home surgeries and also with other health and social care professionals. The requirement we issued in regards to staffing levels and skills mix is therefore met. Staff morale appeared to have improved and some staff commented that although they were still very busy they had now got better at planning their time to link with professionals. A new member of the care team spoke enthusiastically about the home and joining the team and also showed great understanding of feelings of anxiety experienced by a resident she had accompanied to a health appointment that morning, and how she had tried to reduce this anxiety by gentle encouragement and thoughtful communication. Residents we spoke with spoke positively about the staff and the home and some were
Care Homes for Adults (18-65 years) Page 8 of 12 observed to have good relationships and share a joke with the staff on duty. The home manager has registered with the Commission and has been in post for over a year. The manager is experienced and qualified. Staff gave positive feedback about her management style and drive for making improvements to the service. All of the requirements we made at the last inspection have been addressed and met and the manager is working with input from the BUPA quality assurance teams in a system of on going audit and diagnostic review that results in action plans for improvement. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 9 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 10 of 12 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 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 20 Controlled Drug (CD) patches are being used, and these patches are disposed of by placing in the sharps bin. It is recommended that these patches be placed in the CD denaturing kit. Care Homes for Adults (18-65 years) Page 11 of 12 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 12 of 12 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
