Inspection on 28/01/10 for Haversham House

This is the latest available inspection report for this service, carried out on 28th January 2010.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Haversham House 11/03/08

Haversham House 24/04/07

Haversham House 20/04/06

Haversham House 09/09/05

Haversham House 21/04/05

Haversham House 01/10/04

Haversham House 05/04/04

Similar services:

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Key inspection report Care homes for older people Name: Address: Haversham House 327 Bromsgrove Road Redditch Worcestershire B97 4NH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Andrew Spearing-Brown     Date: 3 1 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Haversham House 327 Bromsgrove Road Redditch Worcestershire B97 4NH 01527542061 01527544732 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Springlea Limited care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Age: Physical disability - Code PD age 55 and above. Dementia - Code DE age 55 and above. The maximum number of service users who can be accommodated is: 16 The registered person may provide the following category of service only: Care Home Only (Code PC) 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 (OP) 16 Physical disability (PD) 16 Dementia (DE) 16 Date of last inspection Brief description of the care home Haversham House is a small home, which provides a service for 16 older people who may have a physical disability and/or a dementia type illness. The home is situated close to Redditch town centre. There is a local bus service available. Car parking is available for visitors and staff. The home is an adapted town house, which has Care Homes for Older People Page 4 of 33 Over 65 0 16 0 16 0 16 2 5 0 2 2 0 0 9 Brief description of the care home accommodation on two floors; the first floor is accessed by a stair lift. Enquiries about fees charged by Haversham House should be made by contacting the home. The inspection report is available in the home. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, the commission completed the last inspection at Haversham House during February 2009. This inspection was unannounced and was carried out by one inspector. As part of this inspection, in addition to visiting the home, we also took into account other information we had received. Prior to the inspection we requested an Annual Quality Assurance Assessment (AQAA) from the registered manager. The AQAA is a self assessment document that focuses on how well the service believes it is doing regarding outcomes for people living there and where they believe they could improve in the future. The AQAA also provides us with certain data which we need to know. The AQAA was completed by the manager and returned to us Care Homes for Older People Page 6 of 33 We posted out some surveys to the service for residents, their relatives and staff to complete. We also posted surveys to some professionals who visit the service. The information from these sources helps us understand how well the home is meeting the needs of people using the service. Some of these comments have been included within this report. During our time at the service we spoke to the manager, some members of staff, residents and some visitors including relatives and professionals. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? 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 on page 4. Care Homes for Older People Page 8 of 33 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to help people make a choice about whether they would like to live at Haversham House. The care needs of people who may use the service are assessed so that individuals and their relatives can be assured that staff will be able to meet these. Evidence: In our survey we asked whether people had received enough information about the home before moving in. Most people who returned a survey to us responded that they had. Some people were not sure whether they had or not. Information about the service provided at Haversham House is available. We saw a copy of the homes Statement of Purpose on display in the hallway. We were given a copy of the homes Service Users Guide. We were told that a copy of this document is given to people when they have a look around the service. Care Homes for Older People Page 11 of 33 Evidence: The guide contains some useful information which could assist people in their decision making process about whether the home is suitable. The guide does not contain all the information listed within the National Minimum Standards such as the views of residents and is not available in any other format such as large print or audio. One resident confirmed that her family had visited the home and that they had seen the bedroom she now occupies. We are aware that some people had a look around the home on the day of our visit on behalf of a relative. Within our previous inspection report we highlighted a shortfall in the homes assessment process and the transferring of information into a care plan. The AQAA stated that a comprehensive admissions assessment is now in place. We saw an assessment carried out on behalf of the home. The assessment contained brief details of care needs under a range of different headings although some parts were blank. The information was however sufficient to draw up an initial care plan so that staff were able to meet individual care needs. We saw a document from the local authority saying that the team had experience of working with Haversham House and that they believed the placement to be appropriate. We saw a statement of terms and conditions signed by the manager and the persons representative detailing charges. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have an individual care plan. They can not however be fully confident that their plan will give staff clear guidance about their current care and health care needs and how people should be supported to remain safe. The recording and storage of medication is not always well managed and needs to be improved to ensure that people always receive the medicine. Evidence: As part of this inspection we viewed a sample number of care plans, daily records and risk assessments. A care plan is a document designed to guide staff about the level of care required so that individual needs are met and people receive the support they require. Care plans need to be reviewed or amended on at least a monthly basis to ensure they are up to date and are accurate. We found that care plans were generally reviewed however this had not happened during January 2010. During the inspection itself and upon the AQAA the registered manager told us that she is wanting the home to become more person centred. Person centred care concentrates on what people are able to do and how staff can assist to meet Care Homes for Older People Page 13 of 33 Evidence: remaining care needs. We found some areas of concern within each of the care plans we viewed as each of them had gaps in the information available to staff. Fluid charts are in place for some people. We saw that staff generally complete these. However as care plans did not reflect these charts staff were not given any guidance as to how much fluid people needed to take or what action to take if a certain amount was not taken. The daily records of one resident showed a tendency to close curtains in the communal areas of the home during the early afternoon. It was evident that at times other people found this frustrating. The care plan made no reference to this matter or give any strategies as to how this could be avoided or managed to stop potential confrontation. We saw daily records showing concern for one person indicating that a chiropodist was needed. The daily records made reference to this health care need for over a month before the matter was attended to. On another record we saw evidence that medical advise was sorted however no follow up information was available and people were unable to tell us what the outcome was. Records showed that staff were applying over the counter creams to people without seeking advice beforehand. It was evident on a couple of occasions that staff had used cream prescribed for one resident on another. This must not happen as prescribed items are the property of the person for whom they were intended. Other records showed that health care professionals are contacted and their advice obtained. During the inspection nobody raised any concerns regarding seeking medical attention and one person told us that the staff call the doctor as needed. No concerns were raised within our questionnaires about medical care. Risk assessments were seen to be in place with the care records regarding pressure sore prevention and moving and handling. Risk assessments were seen to be revised from time to time. As part of the inspection we assessed the management of medication within the home. Medication is stored within the front office in a lockable trolley. Facilities for the storage of control medication are provided. We did not view the storage facilities for items requiring refrigeration. Care Homes for Older People Page 14 of 33 Evidence: We viewed the majority of the current months MAR (Medication Administration Record) sheets as we noted shortfalls at an early stage of this part of the inspection. As the current months sheets had only recently commenced we also viewed the previous months sheets. In most cases medication was signed as given satisfactorily. However we noticed a number of areas that gave cause for concern. We heard staff make reference to one resident who had not received her inhalers and the fact that staff needed to administer them. However, on checking the MAR sheet they were already signed as given when they were not. We found gaps on the MAR sheet whereby staff had failed to either sign for medication administered or enter a code detailing why it was omitted. We also saw occasions when staff had signed the MAR sheet indicating that the item was administered then signed over the top of the original signature to say that the item was refused. This could indicate that staff are signing for medication prior to administering. We audited some medication to check the number of signatures against the number of tablets dispensed. In most cases these balanced correctly however sometimes this could only be done by assuming medication was given if a gap appeared on the MAR sheet. With one antibiotic we counted too many signatures as opposed to the number of tablets dispensed. It was evident that one person had not received a tablet the day beforehand as it was still in the blister pack and the MAR sheet was not signed. The time on the MAR sheet was incorrect and the tablets held did not balance with the number carried forward. We discussed these areas with the manager who agreed that medication was not given but was unable to give us a reason for this. We found some conflicting information within the MAR records regarding allergies. We saw some MAR sheets of one person showing an allergy while others did not. This could present a risk to an individual if this information was not picked up by a medic while prescribing additional medication. Medication was usually booked in correctly. On most occasions handwritten entries were signed by another person to verify that the entry was checked for accuracy. Medication dispensed within a bottle or a box did not have the date of open recorded upon the container. The home had a limited stock of house hold remedies. We Care Homes for Older People Page 15 of 33 Evidence: checked the balance of some painkillers and found them to be short by 2 tablets. We saw one person administering medication. This was done with care and compassion. People were offered a suitable drink in order to take their tablets. In order to try and move towards normalisation the trolley is usually not taken into the lounge or dining room. We did, however, witness the blister packs containing medication left unattended and unsecured while medication was being administered. This practice is unsafe and could lead to unauthorized people accessing prescribed medication. We also saw a tube of cream on a window ledge within the office. A list of staff able to administer medication was held with the MAR sheets. The sheet was not signed by all those involved, we were told that one person is currently off sick. The information showed that some staff needed to have somebody else with them as they had not received full training to enable them to administer medication on their own. Medication was listed within the care plans seen however creams were not included and the information did not demonstrate why the medication was prescribed or detail any possible side effects. We discussed the above shortfalls with the registered manager at the time of the inspection who was unable to account for the shortfalls. The manager agreed that action needs to be taken within the home to improve systems and therefore ensuring that records are correct and people receive what they are prescribed at the right time. During our inspection we saw staff being kind, courteous and caring towards people. Staff were seen to be up holding peoples privacy and dignity. One relative wrote in relation to her relative that staff care for her with respect, as if she was related to them. We observed that residents were suitably attired taking into account gender, culture and weather conditions. On most occasions staff were seen knocking bedroom doors before entering. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to engage in some in house activities. Meal times are relaxed and people generally like the food available to them. Evidence: The atmosphere in the home is welcoming, friendly and relaxed. Visitors are made welcome at the home and we saw that they have a good relationship with the staff. The AQAA completed by the registered manager told us that she intends to encourage families to participate more in the daily running of the home as well as the social side. The Service Users Guide states There is a strong emphasis on structuring leisure time, our Activities Organiser will advise on how individual residents can pursue their own hobbies and interests and participate in group activities. The manager confirmed that Haversham House does not have a dedicate activities organiser however one of the carers does have a lead role in this area. Therefore it is the responsibility of carers to provide social activities as part of their daily routine. We were told that an activities schedule was previously in place showing events such as Care Homes for Older People Page 17 of 33 Evidence: bingo however this schedule is now not done. We received some comments from people about activities within our surveys: ** gets bored. Theres not much to keep them amused/occupied. I would like to help prepare vegetables for dinner and make cakes or scones. In response to our question on whether the home arranges activities the most common response was always although we did receive other answers. Some people believed the home could improve by offering trips out to places such as garden centres. During our time within the home we saw staff interacting very well with residents but we did not see any structured activity. Although the manager spoke about having meaningful stimulation within the home we did not see anything taking place. One member of staff wrote on a survey that residents help with the cleaning of their bedrooms. The manager told us that she intends to contact NAPA (National Association for the Provision of Activities) as a means to improve activities within the home. One resident said that she would like to be involved in tasks such as folding towels. A television is provided within both lounges. We saw a small number of DVDs in one of the lounges. During breakfast time a DVD of classical music was playing in the background. We saw a member of staff turn the volume up without asking any of the residents. We also witnessed a television being turned off because it was lunch time without consulting residents. The manager told us that she had made a number of attempts, without success, to have a local clergy visit the home in order to address the religious needs of people using the service. We were told that a vicar from a neighboring Parish had visited and had agreed to visit occasionally until more permanent arrangements could be made. Haversham House has a cat who appeared to have free access to all areas of the home. One resident was seen carrying the cat around the home and told us how much she liked having a cat. Within the AQAA, it was stated that Fresh fruit and snacks are readily available and on show at all times and offered at all meal times. During our visit we did see some fruit in the lounge, however, this was not peeled and therefore may not encourage people to help themselves. We saw no other snacks available to people. Care Homes for Older People Page 18 of 33 Evidence: The days menu is on display. On the day we visited the menu consisted of lamb liver and onions or roast beef with mashed potato and mixed vegetables. This was followed by apricot semolina or fruit cocktail. Tea consisted of home made chicken soup, chicken or salmon sandwiches or poached egg on toast and fruit cake. The main meal was plated up in the kitchen and served to residents. The meal looked well presented and residents told us that they enjoyed it. Before lunch we heard a visitor commenting that the dinner smelt nice. The AQAA stated that service users are encouraged to serve themselves to a degree and within their capabilities.This was not our finding during our visit. We discussed with the manager the possibility of engaging residents more with the serving of lunch rather than plated meals. We saw the cook assisting one resident with her breakfast. The cook was heard offering people a choice such as a sandwich or toast. Throughout the day staff were heard offering residents a drink. Cold drinks were available throughout the day although we did not see any resident help themselves to this. Redditch Borough Council rated the food safety within the home to be good during August 2009. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that staff will take notice if they have concerns and that suitable action will be taken to put things right. Staff know that they have a duty to protect people from abuse however some systems need improvement to safeguard people fully. Evidence: The majority of staff confirmed within the questionnaire that they know what to do if somebody has a concern about the home. Relatives and residents, in their questionnaires, also told us that they know how to make a complaint about the service. Information was displayed about complaints in the entrance hall. The procedure made no reference to the Care Quality Commission. A copy of the homes Statement of Purpose was available in the home. We were told that people receive a copy of the homes Service Users Guide. Within both of these documents was information about complaints. The information did refer to us. However they need to be reviewed to ensure the information supplied is consistent and accurate regarding peoples rights to raise concerns with the commission at any stage. During our visit some people we spoke to were able to tell us that they would speak to the manager if they had any complaints. People told us that they were confident that their concerns would be listened to. We saw the manager engaging with people Care Homes for Older People Page 20 of 33 Evidence: throughout our visit, therefore, giving people the opportunity to raise any concerns if they existed. The commission did receive some information about the service provided at Haversham House during May 2009. We wrote to the registered provider about these matters and we received a suitable response. A copy of the Worcestershire multi agency guidelines in relation to safeguarding was in the managers office on the second floor. As these guidelines were within this area this would limit its availability to other members of staff. We saw no other information supplied by the local authority to guide and inform staff about the importance of adult protection. We spoke to staff members during our inspection about the action they would take in the event of them having any concerns or suspicions about actual or potential abuse taking place within the home. People told us that they would inform the registered manager. The training matrix from 2009 did not include safeguarding. The manager confirmed that no training took place during the year. The manager recognized the importance of having up to date training and agreed that there is a need for this to take place. The manager has a good understanding of her responsibilities in relation to the Deprivation of Liberty safeguards(DOLs)and the Mental Capacity Act. Information upon DOLs was in her office and she had recently made a referral under these safeguards to the local authority. During this inspection we looked at the recruitment of three recently appointed members of staff and found that robust processes are not always carried out. Further information regarding recruitment is included later within this report. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable environment. Attention is required to some areas to ensure that people are safeguarded against potential risk. Evidence: Haversham House can accommodate up to 16 people. Bedrooms are located on the first and second floor. A stair lift is provided to enable people to gain access to all areas of the home. The lift is in two parts. Therefore, people need to transfer from one to another on a small landing. Some signage is in place within the home to help assist people with a dementia type illness orientate themselves. A large clock in the lounge was showing the correct time. Information regarding the days menu was on display. We saw a number of bedrooms and found them to be personalized by the individual concerned. A call system is fitted and we were assured that the call lead are accessible to people when in bed. Wardrobes are secured to the wall to prevent accidental toppling. Communal facilities consist of a lounge with a dining room off in a conservatory and a smaller lounge with a dining area. A small seating area is provided along a corridor on the first floor. The lounge areas were warm and pleasant. Lighting in these areas is Care Homes for Older People Page 22 of 33 Evidence: domestic and sufficiently bright. A fuse box in the small dining room was open and needed to be closed to prevent any unauthorized access. Some areas of the home require redecoration. The carpet on both stair cases is very worn and in place thread bear or patched. Some steps have tape upon them. We were told that the carpet is due to be replaced. In the meantime close observation of this area must be in place as it could represent a serious health and safety concern. Bathing facilities consist of a shower on the ground floor and a bath on the ground and first floor. The shower has a step into it which may prove difficult for people with mobility difficulties. The bath on the ground floor has a seat within it which can be lowered into the bath. The upstairs bathroom contains no aids to assist people. Continence aids were clearly visible in the ground floor bathroom which could demonstrate a lack of regard for up holding dignity. Communal toilets are provided. The toilets were clean although the frame around one was rusty. A toilet on the first floor has no floor covering. At the time of our inspection the home had no domestic staff. As a result carers were having to carry out these duties as well as prepare the afternoon tea. These duties are on top of meeting the care needs of residents. Although the home was generally tidy we did notice area where it was dusty or had cobwebs. A washing machine is provided in a small lockable room on the ground floor. Drying facilities are provided on the second floor. It is therefore necessary for staff to carry wet washing up two flights of stairs. Although containers are provided to carry items in no risk assessment is in place regarding the lifting and transferring of washing. People told us that they are happy with the laundry service provided. Disposable gloves and aprons were available for staff to use. We also saw a hand gel dispenser near to the front door and saw that staff were carrying hand gel on their person. These measures help to reduce the risk of cross infection within the home. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive appropriate care and support from staff members. People can not however have full confidence that staff are suitable because not all recruitment checks are done. Training is provided however, not everybody has received all that is necessary to ensure that staff have the skills and knowledge they need to carry out their job. Evidence: We asked staff on our survey whether there are enough people on duty to meet the needs of residents. Most staff stated usually. We asked residents whether staff are available when needed. The response to this question was mixed but most replied either always or usually. Throughout our inspection we observed carers to be kind and considerate. Residents confirmed our findings. Haversham House is registered to care for up to 16 people. We were told by staff that 3 carers are on duty throughout the day and 2 at night. A cook is employed six days a week between 7.30am and 2.30pm. Haversham House currently has no domestic staff therefore carers have to carry out cleaning and laundry duties. We looked at the files of two recently appointed members of staff and found shortfalls within both. On one file we could not find any written reference. The manager assured us that these were obtained but she could not find them. In addition gaps in Care Homes for Older People Page 24 of 33 Evidence: employment history were not followed up and we noted that dates of employment did not match between a CV and the application form. It was however evident that a PoVA first (Protection of Vulnerable People) and a CRB (Criminal Records Bureau) disclosure were obtained as necessary. On the other file we could only find one reference. We later discovered that the home had employed a new night carer. The person was named on a rota in the office but no hours were recorded. On looking at the time sheets it was evident that the person had worked a total of 46.75 hours that week. Another person was named as having worked on the rota but the time sheet showed that she had not worked. Although a PoVA and CRB were obtained for the carer the home did not have any written references. Not having the necessary recruitment checks in place could potentially place residents at risk of unsuitable people gaining employment. The rota needs to be an accurate record of the people who have worked within the home. The AQAA stated that all staff have or are working towards NVQ (National Vocational Qualification) level 2 or 3. During this inspection we established that currently 5 out of the 12 carers have a level 2 NVQ. A total of 3 carers are working towards their NVQ. Therefore 4 carers do not have and are not currently working towards this award. The AQAA also stated that All staff have received dementia training, dignity in care training as well as mandatory training.We looked at a training matrix regarding training completed during 2009. Although the majority of staff have received training in Dignity and Care, Fire Safety and Moving and Handling others have not. We were informed that only the cook and one carer hold a basic food hygiene certificate. There was a notice in the office informing staff about some forthcoming person centred care training. Other training needed includes First Aid, Infection Control and Safeguarding. These findings regarding training do not therefore match the statement within the AQAA. We saw the induction pack for two of the newly appointed members of staff. We saw that they were filled in although not completed. The dates when induction had taken place were not recorded. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People generally get the support they need from the care home because the manager works alongside carers. People are not, however, always safeguarded to the extent that they should be because essential management tasks are not carried out fully enough. Evidence: Mrs Margaret Phillips is the registered manager of the service. She is experienced in the care sector and holds the Registered Managers Award (RMA) qualification. The RMA is a level 4 NVQ (National Vocational Qualification) in management. The manager does not hold a NVQ level 4 in care however she had a very hands on approach to care delivery. During this inspection we saw the manager administering medication as well as assisting residents with other care needs. We found the manager to be caring and compassionate whilst carrying out her work. During our inspection people spoke highly of the manager. On the questionnaires from staff members there was a mixed responses as to whether the manager provides enough support and meets with staff to discuss how they are working. Care Homes for Older People Page 26 of 33 Evidence: We are aware of some forthcoming changes in the management structure at Haversham House. As a result of these changes it is planned to introduce a part time administrator to assist with some of the paperwork. These duties are important because they help to provide some of the safeguards for people using the service for example staff recruitment. A newly appointed Operations Manager recently carried out a visit to the home and wrote a report following her visit as required under Regulation 26. The report highlights some areas where improvement is needed such as the stair carpet and attention to some radiators and the boiler. Reports from other recent visits undertaken by the registered provider were not available during this inspection. The AQAA (Annual Quality Assurance Assessment) was returned to us although this was after the date stipulated within our request. The detail within the document was in most areas scant and it did not give a full reflection of where the service believes it is doing well. The Service Users Guide states At Haversham House we are committed to maintaining and improving the quality of our service. We have developed quality assurance policies and procedures, which are reviewed on a regular basis. An important part of our approach to quality assurance is to obtain the views of all those who have contact with our service, particularly those of residents, relatives and their representatives. The manager showed us some returned questionnaires however these were done some time ago. These documents were not dated and the results were not collated to establish overall findings. The manager told us that no resident meetings have taken place although one relatives meeting was held. The manager was not aware of any other quality assurance systems in place within the home. We were informed that the home holds small amounts of money on behalf of people using the service. We viewed the records and checked the balance held for two people. The records were clear and balanced correctly. We asked to see the records regarding fire safety. Within the office was a sheet whereby staff record that they have carried out a daily fire safety check. Between the 7th January and 29th January 2010 this record was not completed on 13 occasions. Throughout the time we were in the home we saw a hoist partly blocking one fire door and a table blocking another. The daily check list had not picked up on this as a fire safety concern. Care Homes for Older People Page 27 of 33 Evidence: We were assured that the fire alarm is tested weekly however at the time of the inspection the last recorded test was on the 30th December 2009. The alarm is at times tested in sequential order although this was found not to be always the case. The manager assured us that the alarm is tested weekly but no other records could be found when we were at the home. Since the inspection the manager has informed us that a record of testing was subsequently found. Guidance from the Health and Safety Executive (HSE) regarding the servicing of hoisting equipment states that The Lifting Operations and Lifting Equipment Regulations 1998 require that personal lifting equipment (hoists for lifting people) are thoroughly examined every six months unless a separate thorough examination scheme is devised by a competent person. Haversham House has a stair lift, a portable hoist and a seat that can be lowered down into a long bath. The portable hoist was reported as new however this is mentioned within a letter from the provider dated June 2009 therefore it is at least 7 months old. We were told that the manager is waiting for confirmation that the person who carried out a service is competent to do so. We saw evidence that the stair lift was serviced during January 2010. The manager was unable to find any documentation regarding the servicing of the equipment within a bathroom. It was confirmed that this equipment is used regularly therefore it is vital that it receives the necessary servicing to ensure the health and safety of residents. Windows are restricted by means of a chain. The windows on the second floor do not have any means of restricting. Although this area is used by the manager and is not as such an area used by residents people could potentially access this area. The home has no system in place for the routine checking that restrictors are in place and in good working order. Records were maintained following the checking of hot water temperatures delivered to bedrooms. The checks did not include baths. We were told that this is because staff check the temperature when bathing people. However this would be once staff had cooled the water down and did not take into account the possibility of residents running a bath themselves. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 Plans of care must be developed and implemented once a risk, potential risk or need is identified through assessment. This is to ensure that peoples needs are met and their safety and wellbeing is protected. 31/03/2009 Care Homes for Older People Page 29 of 33 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, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Regulation 15 (2) All people living in the care home must have a care plan which is reviewed and up dated so that it accurately reflects their health and welfare needs and provides clear guidance for staff to follow. This is so staff have the relevant details available to them in order to meet identified care needs. 05/03/2010 2 9 13 Regulation 13 (2) The service must ensure that Medication Aministration Records are completly accurately following people recieving their prescribed medicines. 26/02/2010 Care Homes for Older People Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This so safeguard people and so that they received medication as prescribed by a medical practitioner. 3 9 13 Regulation 13 (2) Medication must be kept securely at all times. To ensure people are safeguarding against receiving incorrect medicines. 4 19 13 13 (4) All part of the home must be free from hazards which may course injury. This is to ensure that people are safe within the home. 5 29 19 Procedures within the home 26/02/2010 must ensure that the recruitment of staff includes obtaining written references. This is so that only suitable people are employed in the care home. 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 26/02/2010 26/03/2010 Care Homes for Older People Page 31 of 33 Care Homes for Older People Page 32 of 33 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. Copyright © (2009) Care Quality Commission (CQC). 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