Inspection on 22/08/07 for Haddon House Care Home

This inspection was carried out on 22nd August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Haddon House Care Home 12/06/06

Haddon House Care Home 09/02/06

Haddon House Care Home 07/09/05

Haddon House Care Home 07/03/05

Haddon House Care Home 09/09/04

Haddon House Care Home 25/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Haddon House Care Home 38 Lord Haddon Road Ilkeston Derbyshire DE7 8AW Lead Inspector Janet Morrow Unannounced Inspection 22nd August 2007 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Haddon House Care Home Address 38 Lord Haddon Road Ilkeston Derbyshire DE7 8AW 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) 0115 9441641 0115 9445132 haddon.house@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Rita Flanaghan Care Home 30 Category(ies) of Dementia - over 65 years of age (30) registration, with number of places Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. One MD Place For The Service User Named In The Notice Of Proposal Letter Dated 18 May 2004 to be accommodated at Haddon House Care Home One MD place for the Service User named in the Notice of Proposal dated 06.02.06 to be accommodated at Haddon House Care Home One DE place for a service user named in the notice of proposal letter dated 27th June 2005 to be accommodated at Haddon House Care Home The maximum number of persons to be accommodated at Haddon House Care Home is 30 12th June 2006 Date of last inspection Brief Description of the Service: Haddon House is registered as a home providing nursing care for up to 30 residents with dementia. Built approximately 12 years ago, the accommodation is on two floors with all communal areas being on the ground floor. Bedrooms are located on both floors, with 14 of the places in shared rooms, and a passenger lift is available to ease access within the home. There is a small secure garden at the rear of the home, which is accessed from patio doors from within the lounge. The home is within easy access of the town centre of Ilkeston and all local shops and community facilities. The manager provided information about the fees at the time of this site visit. The fees for Haddon House are between £448.75 and £644.00 per week. The most recent inspection report was on display in the entrance of the home. Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was unannounced and took place over two days for a total of 9.75 hours. Two hours were spent observing the care given to residents in the lounge. The care of three people was looked at in depth when comparisons with the observations were made with the home’s records and the knowledge of the care staff. Care records and staff records were examined. Five members of staff, five of twenty-nine residents currently accommodated, and two relatives were spoken with. A tour of the premises was undertaken. Three residents’ surveys were returned to the Commission for Social Care Inspection prior to the visit; relatives had assisted with their completion. One visiting professional was contacted by telephone following the inspection visit. The home had supplied written information in the form of an annual quality assurance assessment that informed the inspection process. What the service does well: Haddon House provides a comfortable and safe environment for the people who use the service. Residents and families were encouraged to personalise their rooms with their own possessions. All the residents who were able to express their opinion and relatives spoken to were pleased with the service provided. One relative described the home as ‘very good’. The staff team were committed to providing a good standard of care for residents, and were supported to do this through training opportunities and regular supervision. Residents’ care was well planned, and staff have clear guidance to follow to enable them to meet individual residents needs. Comments from relatives stated that the staff were ‘very dedicated and caring’ ‘marvellous’ and ‘lovely’. The observation showed that the majority of communication with residents demonstrated an understanding of individual needs. Residents enjoyed the meals provided by the home. Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 6 Quality assurance systems form an integral part of the management of the home and are used to improve the quality of the care and services provided for people using the services of Haddon House. Feedback from the residents’ surveys was generally positive and one stated that ‘the management and staff are top class’. What has improved since the last inspection? What they could do better: Action must be recorded in the care plans on how identified risks are to be addressed. There must be greater attention paid to risk of falling and pressure sore prevention. More specific details must be recorded in care plans to demonstrate how care needs in relation to dementia are being addressed. The temperature of the medication refrigerator must be within safe limits to ensure medication is stored safely. All staff who record the temperatures of the medication refrigerator must be competent in its use and know when to report any unusual readings. The amount of medication received into the home should be recorded consistently on all medication administration record (MAR) charts. There must be a plan of activities that is suitable for the needs of people with dementia. Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 7 Residents’ bedrooms must not be used for communal purposes, as they are private space and using them for other purposes compromises individual privacy. All staff must have up to date training in health and safety areas, particularly in first aid and infection control. This must be addressed as a matter of priority as it was raised as an issue at the previous inspection in June 2006. Staff recruitment information must include verification of gaps in employment to ensure that the Care Homes Regulations 2001 are complied with and residents are fully safeguarded. 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. Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4. Standard 6 is not applicable as the home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was sufficient admission information to establish that the home was able to meet residents’ needs. EVIDENCE: Three residents’ care records were examined and all had an admission assessment in place and information from external professionals, where applicable. A new assessment tool had been introduced to obtain as much information as possible at the point of admission. Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 10 This information included risk assessments for nutrition and pressure sores as well as a general moving and handling assessment. The information available established that the home was able to meet residents’ needs and relatives interviewed also confirmed that needs were well met. One relative stated that the care was ‘really good’ and a visiting professional spoken with stated that the home was ‘meeting the needs’ of the resident they were involved with. Staff were provided with training specific to the needs of the resident group. Two staff spoken with confirmed that they had been provided with dementia care training, and felt that they had the necessary skills and knowledge to care for the current resident group. Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health care needs were generally met and the care of residents was planned and given in a way that respected individuality. However, lack of attention to privacy and lack of consistency in care planning had the potential for care needs to be missed and dignity to be compromised. EVIDENCE: Three residents’ care records were examined. All had a care plan in place and these were reviewed on a regular basis. However, risks identified in assessment documentation were not always followed through into interventions to minimise the risks. For example, in one file examined, where a tissue viability risk assessment indicated a very high risk of pressure sores, there was no specific care plan in place on how to deal with the risk, although observing for skin changes was noted in the personal hygiene plan. There was Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 12 no information on how to address a high risk of falls on two care plans. Lack of detail in care plans can lead to care needs being missed. Nutritional needs were addressed and monthly weights were recorded on all three files. Two residents had a psychological care plan that covered issues such as aggression and agitation and the third had a social needs document. There was limited social information or details specifically in relation to dementia in two files. The manager stated that the provider had developed a care plan for well-being that was due to be implemented and a detailed dementia care manual was available as a reference document. Access to health care professionals such as opticians, General Practitioners and chiropodists was made available and these visits were recorded. Two of the three residents’ surveys stated that they ‘always’ received the medical support they needed and the third stated that they ‘usually’ did and two stated that they ‘always’ received the care support needed and the third responded that they ‘usually’ did. The home was in the process of devising a storyboard for all residents, which is a brief outline of their unique life history and interests, past and present, to be on display outside their bedrooms. Those storyboards seen contained useful information and the written information supplied by the home stated that they were there to help staff and visitors to see the resident as a whole person, thus enabling more person centred care. The written information provided by the home stated that a named nurse and key worker system was in operation to offer more person centred care. The observation carried out looked specifically for indications of residents’ wellbeing and/or distress, level of engagement with activities or objects and type of staff interaction and observed five residents closely. During the period of observation, there was no evidence of residents’ being distressed and some staff were proactive in engaging with residents in a positive manner, such as offering drinks and having a conversation. Requests for assistance were responded to promptly. However, some staff were less proactive and tended to observe residents’ rather than interact with them. Two of the five people observed spent the majority of the time asleep or were withdrawn. The manager reported that some staff had been nervous of the observation and that this may have affected their work. Feedback on ‘thank you’ cards described the help offered to residents as ‘professional and caring’ and another stated that their relative was cared for ‘very well indeed’. One relative spoken with stated that they ‘couldn’t fault the nursing care’ and another stated that they had ‘no worries at all’ about the care provided. Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 13 The medication administration record (MAR) charts of seven residents were examined to check the accuracy of the recording. This showed that records were accurate, with signatures in place for medicines dispensed. Two people were signing handwritten medication administration record (MAR) charts to ensure they were accurate but the amount of medication received into the home was not recorded consistently on all charts, as one of the seven charts examined had no signature for receipt into the home or quantity of medicine received. Three residents medication administration record (MAR) charts were then examined in more detail and showed that records matched corresponded accurately with the dispensing system. The nurse spoken with stated that Temazepam was stored and administered under controlled conditions and the records of Temazepam corresponded accurately with the stock held. There were no controlled drugs currently in stock. Secure storage facilities were available. A general check on medicine stocks was carried out and found to be satisfactory with no medicines being past their expiry date. Eye drops were stored in the medication refrigerator and labelled with date of opening. The refrigerator temperatures were recorded daily. However, the temperatures recorded were not within the safe limits of 2 – 8 degrees. This had not been reported to the manager and there appeared to be misunderstanding of what the temperature readings meant. This was raised as an issue at the last inspection visit in June 2006. The manager addressed this immediately and removed the thermometer that appeared to be at fault and stated that two other forms of recording the temperature were still being used to ensure temperatures were at a safe level. Discussion with staff, the records and observation supported that staff had a good understanding of how to maintain personal privacy and individuality of the people in their care. Dialogue from staff was polite and respectful, and understanding of individuals difficulties with communication and memory loss. However, staff must not use inappropriate terms to residents; during the observation one resident was called ‘good boy’. Due to refurbishment being undertaken, the ironing room was unavailable on the day of the inspection visit and ironing was taking place in a resident’s bedroom. The manager stated that this was occurring only for one day until the usual ironing room was available. However, this has the potential to compromise individual privacy. One visiting professional spoken with also commented that one resident had had their bedroom changed without being asked first and a member of staff suggested use of a bedroom for an interview. Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The current limitation on activities does not offer residents sufficient occupation, which has the potential to lead to boredom and social withdrawal. Community contacts and meals are well managed, which enhances residents’ quality of life. EVIDENCE: The home was in the process of recruiting an activity co-ordinator. The previous inspection visit in June 2006 had commented favourably on activities for residents but there had been a lack of social stimulation over recent months as a result of a co-ordinator not being in post. One relative spoken with stated that ‘more activity’ would be beneficial and one survey commented that ‘it would be nice if residents were taken out on trips’. The home had also Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 15 previously produced a newsletter but the last edition of this was in July/August 2006. The manager stated that the company had recently increased the number of staff hours for activity from twenty to thirty per week. The observation showed that a limited range of options were available to residents; for example, one member of staff was observed playing a game with a resident but none of the other residents had any engagement with a task outside of the meal time. The observation also showed that the more vocal and active residents were the ones who received most attention. Those who appeared withdrawn were not offered any stimulation during the observation period. The home operates a key worker system so closer relationships can be developed and personal likes/dislikes can be shared and discussed more openly. The manager stated that part of the refurbishment included plans to make a sensory room and to develop a sensory garden. Those relatives spoken with confirmed that they were made to feel welcome at any time and were able to visit when they wished and confirmed that they were kept informed about any change in the condition of their relative. The manager was aware of whom to contact for an advocacy service and there was written information about this in the home’s service user guide. She stated that one person currently had an advocate. Those residents spoken with said they enjoyed their meals and stated that they were offered alternatives if they did not like what was on offer. Staff spoken with were aware of individual likes and dislikes. The serving of the lunchtime meal was observed and demonstrated that individual preferences were taken into account. The dining area was bright and cheerful. The mealtime was unhurried, with appropriate assistance being given to those residents who needed help with eating. Those residents who were on a special diet or who had difficulties swallowing had their dietary needs met. One of the three surveys received responded that the resident ‘always’ liked the meals and the other two responded that they ‘usually’ did. One relative reported that meals were ‘good’ and that they were ‘very nicely cooked and presented’. Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems were in place to ensure that complaints and adult protection issues were responded to appropriately, which ensured that residents were protected and their concerns handled objectively. EVIDENCE: The complaints procedure was examined and this showed that complaints would be responded to within seven days. The written information supplied by the home stated that there had been one complaint received at the home since the last inspection in June 2006. The response to this complaint was seen and was comprehensive. Two relatives spoken with stated that they knew how to complain and were confident of a courteous response. All three surveys received responded that they knew how to make a complaint. Safeguarding adults procedures were in place and the written information supplied by the home stated that staff had attended training in dealing with abuse in September 2006 and April 2007. Those staff interviewed were aware Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 17 of their responsibilities in reporting suspicions of abuse. The home also had the full documentation of Derby and Derbyshire Local Authority Social Services procedures. The manager was familiar with reporting procedures and how to refer to the Protection of Vulnerable Adults (POVA) list and had been involved with one allegation via safeguarding procedures since the last inspection visit in June 2006. Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 18 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, 21, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well maintained, which ensured comfortable and safe accommodation for residents. EVIDENCE: Haddon House was clean and tidy at the time of this site visit. All areas of the home were well maintained and decorated, with evidence to support that ongoing maintenance systems were in place. Residents were able to wander around the building as they wished and had supervised access to a well maintained garden area. Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 19 Bedrooms had been personalised and families encouraged to bring in personal possessions. The written information supplied by the home stated that several bedrooms had been upgraded with new carpet, furniture and soft furnishings. It also stated that ‘plans have been commenced for a total refurbishment of communal areas, bathrooms, and office, including the purchase of a new assisted bathing facility and creating more storage space by converting one of the small bathrooms into a storage area. This includes replacing the flooring and curtains.’ The previous inspection report of June 2006 had recommended that a review of bathing facilities was undertaken due to one bathroom not being used. The home had decided to use this room as a storeroom as there was limited space for storage of wheelchairs, hoists and other equipment. Written agreement from the Commission for Social Care Inspection had been obtained prior to this occurring. The written information supplied by the home stated that all corridors will be themed, providing interesting and stimulating diversion for residents. An example is a sports theme in one corridor, with pictures, sports equipment, memorabilia etc. The written information also stated that a sensory room and sensory garden were also planned as part of the refurbishment. The laundry area was satisfactory and all equipment in good working order. Residents personal clothing was well washed and ironed, and residents looked well presented. Staff spoken with were aware of how to control the spread of infection and confirmed that there was always a plentiful supply of protective equipment such as gloves and aprons. They confirmed that they had received training in this area. Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were sufficient qualified staff deployed, which ensured that residents’ care needs were met. Recruitment procedures were robust, which ensured that residents were protected. EVIDENCE: The staff rota for 20th August 2007 - 2nd September 2007 was examined and showed that four care staff and two nurses were on each day shift and four care staff and one nurse on the afternoon shift. There was one nurse and two care staff on duty at night. There was an additional care staff member on a ‘twilight’ shift from 7pm –11pm. In addition, there were two kitchen staff, two domestic staff, one handyperson and one laundry staff on duty each day, except weekends when there was only one domestic. Staff spoken with thought this was generally sufficient staff to meet current residents’ needs. Although there had been some recent shifts that had been difficult to cover, the manager stated that there were currently no staffing issues and recruitment of new staff was being undertaken. Staff spoken with Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 21 stated that although there were enough staff, there were sometimes problems at weekends. The home was working towards the target of having 50 of the care staff team with a National Vocational Qualification (NVQ) qualification at level 2 or equivalent. Of twelve care staff, three already had an NVQ at level 2 and a further four were undertaking the training. The written information supplied by the home also stated that all staff undertaking NVQ training had completed workbooks on equality and diversity. The staff team was provided with the necessary induction training, so that they had the skills and knowledge to deliver the care that the home offers to provide. Those staff spoken with were knowledgeable on how to deal with people with dementia and confirmed that they had undertaken a two day training course on dementia. Training for qualified staff in 2007 included record keeping, prevention of pressure sores and medication. The written information provided by the home stated that thirteen of the care and trained staff had received training in person centred care, which is applicable to meeting the needs of those with dementia. Not all staff had completed mandatory training in health and safety areas; the training matrix developed by the manager showed that five staff had not completed first aid training and four had not completed infection control training. Courses in these subjects had occurred during 2007 but greater effort must be made to ensure that all staff are updated in these areas. This was raised as an issue at the last inspection in June 2006. Three staff files were examined and showed evidence of good recruitment processes. Most of the documentation required by Schedule 2 of the Care Homes Regulations 2001 was in place, including a Criminal Record Bureau check and Protection of Vulnerable Adults (POVA) check, evidence of identity and qualification and two written references. However, the application form on one file was not completed sufficiently to show gaps in employment and reasons for gaps. Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed and had comprehensive quality assurance systems, which meant it was run in residents’ best interests. EVIDENCE: The manager, who was an experienced nurse, had completed the Registered Managers Award and had several years experience in caring for older people. She was able to demonsttrate in discussion that she was familiar with the conditions associated with ageing. Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 23 Relatives and staff spoken with confirmed that manager approachable and provided support and guidance as required. Staff were encouraged to develop their skills and knowledge. The manager and deputy were responsible for supervision of staff and records seen confirmed that this occurred three monthly with supervision sessions on one staff file being recorded in January, April and July 2007. Quality assurance systems were in place, and the company and the manager were committed to improving the quality of care and services provided at the home. There had been no surveys undertaken since the last inspection in June 2006 but the manager stated that one was due to be done in September 2007. This was confirmed on the annual quality assurance assessment provided prior to the inspection visit. The manager stated that these surveys were sent back to the headquarters of the company and analysed there. An internal audit had been carried out in March and April 2007 that covered areas such as docuementation, activities, training, dementia and catering. This showed that overall there was a 70 quality score and the manager explained that action had to be taken to improve this to 100 . She also stated that the company had recently increased the number of hour for activities from twenty to thirty per week to ensure that all residents’ social needs were addressed. Meetings in the home were another way of obtaining feedback and staff meetings were held regularly with one being recorded in May 2007 and another occurred on the day of the inspection visit. A suggestions box was also available in the entrance area. The manager also stated that a business plan and marketing strategy was devised on an annual basis. The written information supplied by the home stated that residents and relatives meetings were held bi-monthly and the ‘atmosphere was kept informal so residents and relatives feel free to speak freely in the knowledge that their views are valued and any comments or criticisms made will be addressed.’ Written feedback in ‘thank you ‘ cards was seen and one stated that ‘students were positive about their placements’ and another stated that the home provided ‘wonderful care’. Systems were in place for safeguarding residents’ money. The records supported that that all accounts were balanced and all resident money was properly accounted for. A separate account was used for residents’ money. Receipts were availbale for individual purchases. A system was in place to ensure that training in mandatory health and safety areas took place. Staff records confirmed that training in infection control, fire safety, first aid and moving and handling had occurred in 2007 but there were some staff who had not undertaken infection control or first aid training. This Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 24 must be addressed as it was raised as an issue at the last inspection visit iin June 2006. A maintenance person was employed and carried out safety checks and repairs within the home. The written information also stated that regular maintenance of equipment took place that included fire equipment in December 2006, gas safety in June 2007, the emergency call system in December 2006 and hoists in May 2007. A random sample of records at the home showed that water safety had been checked in April 2007 and portable electrical appliances in August 2006. A recent environmental health inspection had given a ‘good’ rating for food safety. Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 25 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 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) Requirement The health and welfare needs of residents must be addressed by having action recorded to address identified risks to ensure health care needs are not missed. The temperature of the medication refrigerator must be between 2 and 8 degrees centigrade to ensure safe storage of medication. This is a previous requirement that has not yet been addressed. Timescale extended. Residents’ private accommodation must not be used for communal purposes as this compromises their privacy. Timescale for action 31/10/07 2. OP9 13(2) 31/10/07 3. OP10 12 (4) (a) 31/10/07 4. OP12 16 (2) (n) There must be a plan of activities 31/10/07 arranged that meets the needs of people with dementia to ensure mental stimulation takes place. Staff recruitment information must have a fully completed DS0000052159.V341046.R01.S.doc 5. OP29 19 (1) (b) (i) & 31/10/07 Haddon House Care Home Version 5.2 Page 27 Schedule 2 application form that accounts for gaps in employment to comply with the Care Homes Regulations 2001 and to ensure residents are fully safeguarded. All staff must receive appropriate 31/10/07 training or instruction in infection control and emergency first aid to meet health and safety requirements. Previous timescale of 31.07.06 not met. Timescale extended. 6. OP30 18(1) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP9 Good Practice Recommendations There should be more information in care plans that related directly to the needs of people with dementia. The amount of medication received into the home should be recorded consistently on all medication administration record (MAR) charts. Staff should receive further instruction on how to use and reset the minimum/maximum thermometer in the medication refrigerator. Staff should not use inappropriate terminology to residents. 3. OP9 4. OP10 Haddon House Care Home DS0000052159.V341046.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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. 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