CARE HOMES FOR OLDER PEOPLE
Haddon House Care Home 38 Lord Haddon Road Ilkeston Derbyshire DE7 8AW Lead Inspector
Brian Marks Unannounced 7 September 2005 9.00am 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 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 C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Haddon House Care Home Address 38 Lord Haddon Road Ilkeston DerbyshirE DE7 8AW 0115 944 4222 0115 944 4110 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Tamaris Healthcare (England) Ltd (wholly owned subsidiary of Four Sasons Health) Rita Flanaghan CRH N - Care Home with nursing 30 Category(ies) of 30 places - DE(E) Dementia - over 65 registration, with number of places Haddon House Care Home C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One MD Place For The Service User Named iIn The Notice oOf Proposal Letter Dated 18 May 2004. Date of last inspection 7 March 2005 Brief Description of the Service: Haddon House is registered as a home providing nursing care for up to 30 residents with Dementia. Built approxiomately 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. A passenger lift is available in 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. Haddon House Care Home C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced visit that took place at the home over a morning. Additionally, time was spent in preparation for the visit, looking at previous reports and other documents. At the home, apart from examining the home’s documents, care files and records, time was spent looking around the building and speaking to staff who were on duty at the time. Because of the nature of their medical condition, the majority of the residents were not able to give a clear opinion of their life at the home. However one was spoken to and he was able to speak out for himself. Staff were observed throughout the visit, looking after and dealing with residents and visitors and the manager was present throughout the inspection visit. After the inspection verbal reports, about their experiences of the home, were received by telephone from 3 care managers of the local Social Services Department. What the service does well:
The home occupies a specialist position in local care services to older people, in that all residents have been assessed as suffering from dementia illnesses and are highly dependent on staff support for their day-to-day needs. Additional health care needs are well managed and care records indicate success with the management of complex problems. The activities of staff at the home are supported by a good range of documents and records, which allow them to work safely and consistently. Social life at the home is supported by the appointment of an activities coordinator, and family members and friend are actively encouraged to visit and participate in the life of the home. Relationships between residents and staff were observed to be warm and supportive and the staff spoken are committed to their work at the home and the residents they care for. A professional-looking Newsletter that is produced in-house keeps everyone involved with the home in contact. A good number of bedrooms have been redecorated in individual bright colour schemes and the housekeeping and laundry staff maintain good standards of cleanliness. Staff have continued in a good programme of training and development which has helped them to work safely and professionally and allowed them to stay committed to the task of caring. Haddon House Care Home C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Haddon House Care Home C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Haddon House Care Home C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 and 6 People do not come to live at the home without their needs being assessed and the services they need from the home being identified. This makes sure that the care provided is right when they move in. They are also given clear contracts that outline the rights and responsibilities related to their stay at the time. EVIDENCE: All residents are given a range of information documents about the home at the time of their admission, and these have been updated since the last inspection to meet the requirements of the law. In particular all residents have been given terms and conditions that apply to their stay at the home, and contract arrangements have been completed with the parent company for both privately funded and state-sponsored residents. From the files looked at, all the people who have come to live at the home have had there needs looked at the time they came to the home; this identified the type of care required and was included within the Admission Assessment document. Those residents who are sponsored by Social Services also had assessments completed by outside professionals that confirmed the
Haddon House Care Home C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 9 suitability of the home and indicated the degree of mental ill health needs the person may have. All of the assessment records have been completed to the same standard and included some formal assessment documents that looked at quality of skin health (Waterlow) and any wounds, nutrition, mobility, and continence. From these a detailed care plan has been developed (see next section) that indicated how staff would provide help consistently and safely on a day-to-day basis. The records have been developed by the parent company in an easy-to-follow style that ensures all areas of care needed by each individual are described, and the care staff spoken to described how they used the documentation, particularly when they had been informed by nursing staff about any changes with individual circumstances. They kept up to date in this way. The home does not provide an intermediate care service so Standard 6 does not apply. Haddon House Care Home C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 11 The care of all residents, including health care, is planned and given in a professional way that respects individuality and the differing needs of residents. Some work still needs to be done to make the management of medicines completely safe. EVIDENCE: The records of 3 residents were looked at closely and staff caring for these people were also spoken to during the inspection. The care plans include a comprehensive description about how staff care for individuals, divided into a number of important areas to reflect personal and health needs. Additionally, some of the assessments, referred to previously, identified areas of risk affecting the residents’ lives, and these created a practical guide for staff to care for residents consistently and safely. On one file however the mobility needs of the resident, which are substantial, hadn’t been subject to this ‘risk assessment’ approach and the programme for helping him is not explicit. On another file the use of cot sides had not been fully looked at with appropriate consents being given. This may lead to potentially unsafe care activities being carried out. All the care plans examined had been looked at and evaluated regularly, and revised where necessary, so that the actions of staff are based on up-to-date information.
Haddon House Care Home C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 11 Good contact with local health care services is indicated in the records, as is the management of non-routine health care situations. For example the treatment of pressure sores, sudden weight loss and acute mental health problems were well documented in the care records examined, and positive or stabilised outcomes had been achieved. Additionally, the involvement of outside professionals has been properly coordinated to the benefit of all concerned. The records examined indicated that none of the residents looked after their own medicines and this is managed by the home on their behalf. Areas of concern, identified at the last inspection had been dealt with, although an issue around safe recording on the record sheets is still occurring in isolated instances, and a more careful approach to the use of ‘occasional’ medicines was identified. The management of equipment, documents and facilities within the clinic room is satisfactory, although a recommendation is made for complete safety in storing medicines in the refrigerator. As required at the last inspection all files examined now indicate the funeral wishes of residents or their representatives and matter this had been sensitively handled. Haddon House Care Home C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were not specifically looked at at this inspection. Haddon House Care Home C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were not specifically looked at at this inspection. Haddon House Care Home C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 24, and 26 The home is clean and hygienic, and offers good standards of comfort to residents in the bedroom, garden and communal areas. However, the provision of assisted bathing facilities needs urgent review so that sufficient facilities are available to residents. EVIDENCE: Observations made during the visit indicated that the home had been well maintained, decorated and equipped; the small lounge had been redecorated since the last inspection. The majority of residents are accommodated in single rooms but en-suite facilities are not provided. The garden area at the rear of the building is well maintained and offers additional safe facilities for residents to enjoy. In order to assist residents to orientate themselves around the building, bright colour schemes have been employed and all bedroom doors had a large photograph of the occupant attached to them. Bedrooms have also undergone a programme of redecoration and personalisation and again bright colour schemes have been employed, where that is the preference of the resident.
Haddon House Care Home C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 15 A problem still remains over the availability of bathrooms around the home. One is equipped with a ‘Parker’ bath and is well used but another one upstairs is shared with the hairdresser‘s facilities and is the only one where a mobile hoist can be properly used. A third one upstairs is small and not easily accessible for staff to offer assisted bathing facilities and the floor of the downstairs shower room has not been fitted and this remains unusable. The manager reported that the builders were due to complete this in the week following the inspection. The rooms visited as part of a tour of the building indicated adequate fixtures and furniture and the availability of lockable storage within wardrobes. Family representatives have been asked whether they wish for their relative to hold a key, in the interest of privacy; these issues were all required at the last inspection. The home was very clean and tidy, and free from odours at the time of this inspection. The members of staff responsible for laundry and housekeeping described the systems they worked to and presented an organised picture for maintaining standards at the home; all residents observed in the home wore clean and well-presented clothing. Haddon House Care Home C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 28 Levels of care staff at the home continue to present difficulties for the maintenance of a safe and consistent service to residents. EVIDENCE: On the day of the inspection the morning shift was 1 carer below the required level, which the manager reported was due to late-reported sickness and no staff being available to cover. The manager and staff spoken to reported that this is a periodic occurrence and has been an issue for some weeks, following a period of settled staffing; the previous rotas supported this. Staff spoken to were unanimous in their observations that the situation of being 1 staff down has a direct impact on the care they offer and dilutes the quality of service to residents; they also stated that key aspects of their care activities are always dealt with, but routine tasks take a little longer to achieve. The CSCI had, earlier this year, agreed to vary previously set arrangements for staffing to accommodate the work pressures at the home but these changes have not been effective in resolving this longstanding problem. Dependencies of residents, by the nature of the home, have continued to be high and routinely place high demands on staff. Examination of staff training records indicated that 3 staff had qualified at NVQ level 2 which is not up to the level that is required by law to make sure that residents are cared for by suitably qualified staff. Haddon House Care Home C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 and 36 The home is well managed with a good system of administration and records, which includes the management of resident finances. However the formal supervision and monitoring of staff is not carried out to the standard required by the law. EVIDENCE: Following an urgent requirement issued at the last inspection the parent company of the home has overhauled and renewed the system of managing resident finances and this is now in operation at the home. Examination of records kept at the home indicated that all accounts were balanced and all resident money was properly accounted for. Examination of staffing records indicated that the level of formal 1-to-1 meetings between the manager and care staff has improved since the last inspection but is still below the level of regularity required by law. A system of
Haddon House Care Home C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 18 this sort allows for individual and confidential support being given to staff as well as allowing for their to be monitored as well. Haddon House Care Home C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 3 x 2 x x 3 x 3 STAFFING Standard No Score 27 2 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x 3 2 x x Haddon House Care Home C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 20 Yes Are there any outstanding requirements from the last inspection? 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 8 Regulation 13 (4, 5) Requirement The registered person must ensure that all residents have their care needs fully assesed and that any areas of specific concern are further assessed under a comprehensive system of risk assessment. This specifically applies to moving and handling needs of residents and the use of cot sides. If the Medication Administration Record is handwritten or altered by a member of staff this must be signed and dated by them. This must then be checked, signed and dated by a second member of staff. (Previous timescale of 30.04.05 not met). The instructions for the use of and recording of occasional (PRN) medicines, specifically haloperidol, must made explicit in the care plans of residents and revised if its use changes. The shower room floor must be replaced. (Previous timescale of 31.01.05 not met). The broken fan in the ground floor toilet must be repaired or replaced. (Previous timescale of 31.12.04 not met). Timescale for action 31.10.05 2. 9 13(2), 17(1) Schedule 3 31.10.05 3. 9 13(2) 31.10.05 4. 5. 21 21 16 13(4), 23(2) 30.09.05 30.09.05 Haddon House Care Home C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 21 6. 21 23(2) 7. 27 18(1) 8. 28 18 9. 36 18 The registered person must urgently review and adapt the provision of assited bathing facilities so that variety of provision is availble and the numbers required by the standard is met. Staffing must be maintained in accordance with the proposal from the Provider accepted by the Commission for Social Care Inspection on 03.05.05. (Further correspondence on this subject will take place separately from this inspection). The registered person must achieve the target of 50 of care staff having achieved at least NVQ level 2 by the due date. Formal supervision must be given to staff at least 6 times annually and records of this maintained and signed by the staff member and supervisor. (Previous timescale of 31.12.04 not met). 31.12.05 31.09.05 31.12.05 31.10.05 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. 3. 4. 5. Refer to Standard 2 9 10 12 14 Good Practice Recommendations The registered person should ensure that the contracts of all privately funded residents are sigend on their behalf by appropriate representatives. The registered person should provide a thermometer that reads maximum and minimum tempertures for the refrigerator in the clinic room. All residents should be routinely assessed as to their ability to hold the keys to their own rooms. The font size of the newsletter should be available in large print format for those residents with visual impairment. Residents must be given information regarding their right
C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 22 Haddon House Care Home 6. 17 to access care records in an appropriate format. The Provider should ensure a procedure is in place to ensure postal voting papers are protected and cannot be used by persons other than those to whom they are addressed. Haddon House Care Home C52-C02 S52159 Haddon House V247921 070905 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection South Point Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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