Inspection on 02/06/05 for Halvergate House

This inspection was carried out on 2nd June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Halvergate House 03/06/08

Halvergate House 23/05/07

Halvergate House 30/11/06

Halvergate House 18/05/06

Halvergate House 25/08/05

Halvergate House 10/03/05

Halvergate House 13/10/04

Halvergate House 16/12/03

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

CARE HOMES FOR OLDER PEOPLE HALVERGATE HOUSE 58 Yarmouth Road North Walsham Norfolk NR28 9AU Lead Inspector Kim Patience Unannounced 02 June 2005 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. HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Halvergate House Address 58 Yarmouth Road, North Walsham, Norfolk, NR28 9AU 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) 01692 5001000 01692 407474 East Anglia Care Homes Limited position vacant Care Home 50 Category(ies) of OP Old age registration, with number of places HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 The home operates only as a Care Home with Nursing. 2 Fifty (50) Older People, not falling into any other catergory, may be accommodated. 3 Two (2) people who are no younger than 45 years of age, are in need of nursing care due to their physical disabilities and are in need of respite care may be accommodated. 4 The maximum number of persons accommodated should not exceed fifty (50). 5 Registration of an appropriately qualified and experienced Manager (RGN). Date of last inspection 10 March 2005 Brief Description of the Service: Halvergate House is a large period residence that has been adapted and extended over the years to provide accommodation to a maximum of 50 older people. The care home is located on the outskirts of North Walsham, standing within its own grounds with off road parking. Up to thirty-five people who have been assessed as requiring nursing care are accommodated and up to fifteen people who have been assessed as requiring residential care can also be accommodated.Qualified nurses are employed to give twenty-four hour cover in the nursing care part of the home.Care staff and additional ancillary staff including chefs and kitchen assistants make up the staff compliment available in the home. HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and commenced at approximately 11.20am taking approximately four hours to complete. There was no manager available and the administrator and head chef were on leave. There was however a nurse in charge who was very helpful in facilitating the process. A cross section of staff were consulted during the inspection and all were very helpful in providing the information required and again in facilitating the process. Several service users and some relatives were spoken to and some records relating to service users were inspected. On the day of inspection there were 40 people living in the home and two nurses and six care workers on duty. There was one chef and two kitchen assistants and four members of the domestic team. What the service does well: What has improved since the last inspection? It was not possible to fully assess the progress made in respect of the requirements and recommendations made at the last inspection due to not being able to access certain records. However, there were improvements in the environment and no odours were detected on this occasion. There was a definite improvement in the way that the inspection was received at the home, without the restrictions experienced previously. HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 Page 6 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. HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 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 HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 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) 1,3,5 This home has produced information that is given to prospective service users to enable them to make an informed decision as to whether this home can meet their needs. All service users have their needs assessed prior to moving into the home. Prospective service users and their relatives are invited to view the home and the private accommodation prior to making a decision to move in. EVIDENCE: The management of the home has produced a brochure that provides clear information about the facilities and the service that is offered. The information is well presented and includes pictures of different parts of the home and its grounds. The file of a service user recently admitted to the home was inspected and found to contain a pre-admission assessment that provided an overview of the individuals care needs. This individual was also interviewed in her room and was able to describe the process prior to entering the home. She had been HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 Page 9 given information about the service but had not been able to visit prior to admission due to her state of health at the time. However, her daughter was able to assess the quality and suitability of the home before a decision was made. This service user was very happy with the service received so far. The inspector also had the opportunity to speak with another service user and her daughter. This lady was admitted to the home one week ago and had experienced a similar pre-admission process. She was able to visit the home and was able to choose her room. Again, she was very happy with the service provided so far and confirmed that her needs had been assessed and were being met to a good standard. HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 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) 8,10 This home is not able to demonstrate that health care needs are being full assessed. Nothing observed during the inspection indicated that the privacy and dignity of service users was not being considered. EVIDENCE: At the last inspection in March 2005 the inspectors made a requirement in respect of the need for nutritional screening on admission. This requirement has not been met and will be carried forward for the second time. See requirements. When discussed with the nurse on duty, she said, she had not been made aware of the need for such screening and would now include it in the admission procedure. A tour of the home was carried out and several service users and members of staff were spoken to. Nothing was heard or seen to indicate that service users rights were not upheld. Members of staff were seen to knock before entering rooms and they were heard to address people in a courteous manner. Service users spoken to described staff as kind and caring and spoke very positively about the carers in general. HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 Page 11 HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 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) 12,13,15 The home is unable to demonstrate that the lifestyle experienced at the home matches peoples expectations in respect of daily life and activity. The home promotes contact with relatives and the local community. It is not possible to say that people living in the home have a wholesome appealing balanced diet. However, the dining areas are pleasant and meals are served at convenient times. EVIDENCE: It is clear that the home provides activities such as bingo and exercise classes that are publicised at various key places in the home. However, when inspecting service users files it was identified that in some cases, the sections relating to peoples social and recreational needs had not been completed. Therefore, it is not possible to ascertain whether needs are being met in this respect when not recorded on admission. See requirements. During the inspection a number of relatives were seen to come and go freely. Those service users and relatives spoken to confirmed that there was no restriction on visiting at reasonable times. HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 Page 13 The Commission has received comments and concerns relating to the quality of food provided at the home and during the inspection further comments were made. The comments mostly relate to the finished product and therefore suggest that the issue lies with the cooking and presentation of the food. It is important that the home provides food that is cooked and presented in a way that is appealing and easy for frail elderly people to manage. See requirements. The inspector observed at least one service user with a plate of food that she was clearly unable to manage and as a result, one hour later most of the food remained. As already highlighted in standard 8, nutritional screening is necessary to identify the limitations people have in respect of food and the levels of assistance required, if any. See requirements. The homes menus were inspected and appear to provide a good range of choice and alternative options if required. Members of staff have the responsibility of visiting each service user to inform them of what is on the menu for the following day and to record their meal choice. When talking to service users in the dining area, one was unable to remember what she was having for lunch and did not know what to expect. There are no menus in the dining room to remind people and therefore does not give people the opportunity to change their mind if they wish for something different on the day. It is recommended that the home consider a menu board for the dining room. See recommendations. The dining areas in both the residential care unit and the nursing unit were clean, tidy and nicely laid out ready for the meal. It was pleasing to see that the issue relating to people’s dignity and the use of plastic aprons to protect clothing had been addressed and one lady was dressed with a nice good quality cloth napkin. See comments also made in respect of staffing(standard 27) HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 N/A EVIDENCE: N/A HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 Page 15 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) 19,22,26 The home provides a safe well-maintained place to live. However, some aspects of the plan of maintenance and renewal are still outstanding. The home is not able to demonstrate that there is sufficient equipment to adequately meet people’s needs. The home is generally clean, tidy and hygienic in appearance. EVIDENCE: A tour of the home was conducted and no obvious issues with the environment were identified. The home employs a maintenance man who completes all the safety checks on equipment and attends to the general maintenance of the home and its grounds. Records of maintenance were seen. The carpets in some areas of the home are still in need of replacing i.e. the top corridor in the nursing unit and some of the bedrooms downstairs where there have been issues with odours. See recommendations. HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 Page 16 Generally, the home is fitted with specialist equipment that helps to maximise people’s independence i.e. grab rails, wheelchairs, assisted baths and facilities designed or adapted for use by older people. However, there is a lack of useable hoists at present due to the breakdown of two electric hoists. The remaining hoists are being shared between the nursing unit and the residential care unit resulting in delays when needing to transfer people. One lady expressed concern that due to a lack of a hoist she had been waiting 4 hours to go to the toilet and this is clearly not acceptable. See requirements. The home employs a team of domestic staff and the head housekeeper was available for consultation. The home was clean and tidy throughout and on this occasion no offensive odours were detected. The housekeeper was trying new products to combat any future problems. HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 Page 17 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 The home is able to show the staffing levels provided, however it is not possible to say whether the levels are adequate in order to meet the various degrees of need in the home. EVIDENCE: The home maintains a staffing roster, a copy of which was provided. The care hours provided were slightly in excess of the minimum required for the number of people living at the home on the day of the inspection. However, the calculations are very basic and do not take peoples individual needs into account. Another method to assess whether staffing levels are adequate would be to look at how well people’s needs are being met and this is where the Commission has concerns and will require the management to investigate further. Some complaints have been raised with the Commission about poor standards of care that could be attributed to the lack of staff, such as, people not being given adequate assistance with food or drinks, Call bells not being answered within reasonable time, people waiting long periods of time to be assisted to the toilet, people being only partly dressed. The inspector observed that one very frail person who was unable to take a drink for him-self was left with his tea and some water in the morning and the cups remained full at lunchtime indicating he had not had a drink during that time. The complaints relate to people with high dependency needs that require a greater level of assistance. HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 Page 18 The management need to review the staff hours to ensure that they are adequate and that the hours are distributed evenly across the week. See requirements. These issues may also relate to training and this standard was not assessed due to the lack of access to these records on the day. The management may also need to identify members of staff that require further training to improve their practice. See recommendations Another influencing factor may relate to the lack of adequate management of the home. See standards 31- 38 for further details. HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 Page 19 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) 31,32, The home is unable to demonstrate that the home is run and managed by a person who is fit to be in charge. It is not possible to say that service users benefit from the ethos, leadership and management of the home. EVIDENCE: The home does not have a manager at present due to the departure of the previous manager in April. The home has been without a registered manager since January 2004 and since that time has had 4 different post holders. The home owner has appointed a quality assurance officer who will oversee the running of the home for two days a week and he intends to spend an increased amount of time at the home and oversee the management on the other days. In addition, he is giving the nurses on duty, increased responsibility for monitoring the work practice of the carers. HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 Page 20 However, as stated on the previous inspection report and as indicated in this report, good quality management is essential to good quality care and therefore the homeowner must recruit, train and register a suitably qualified manager without delay. See requirements. It was noted that the home did not have a copy of the previous inspection report available for staff and service users to see. Staff were not aware of the outcomes from the last inspection and therefore could not take part in the improvement of the service. It is strongly recommended that staff are made aware of the outcomes of inspections and are engaged in the process of improvement. See recommendations. HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 Page 21 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 N/A 3 N/A 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 N/A 8 2 9 N/A 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 N/A 15 2 COMPLAINTS AND PROTECTION 3 N/A N/A 2 N/A N/A N/A 3 STAFFING Standard No Score 27 2 28 N/A 29 N/A 30 N/A MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score N/A N/A N/A 1 1 N/A N/A N/A N/A N/A N/A HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 Page 22 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 17(1)(a) Requirement Timescale for action 30.06.05 2. 12) 3. 15 4. 22 5. 27 6. 31 The registered person must ensure that nutritional screening is undertaken on admission to the home. 16(2)(m.n The registered person must ) ensure that the social and recreational needs of each individual are recorded and arrangement are made for them to be met 16(2)(i) The registered person must provide, in adequate quantities, suitable, wholesome and nutritious food which is properly prepared. 23(2)(n) The registered person must ensure that the home has adequate equipment as may be required. This relates to the need for a sufficient number of hoists. 18(1) The registered person must ensure that at all times suitably qualified, competent and experienced persons are working in the care home in such numbers as are appropriate for the health and welfare of residents. This refers to the need to review staffing levels and training needs. 9(1) The registered person must I55 S15642 Halvergate House V230884 020606 Stage 4.doc 30.07.05 30.06.05 30.06.05 30.06.05 30.08.05 Page 23 HALVERGATE HOUSE Version 1.30 ensure that the home is managed by a person fit to do so. This refers to the need to recruit, train and register a manager. 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. Refer to Standard 15 19 27 33 Good Practice Recommendations It is recommended that the registered person introduces a way of displaying the menu of the day to remind residents of what is on offer. It is recommended that the registered person continues with the plan of maintenance and renewal. This refers to the replacement of carpets. It is recommended that the registered person reviews the training needs of the staff. It is recommended that the registered person makes a copy of the inspection reports available to staff ad service users. HALVERGATE HOUSE I55 S15642 Halvergate House V230884 020606 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 3rd Floor Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 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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