Inspection on 23/05/07 for Halvergate House

This inspection was carried out on 23rd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 30/11/06

Halvergate House 18/05/06

Halvergate House 25/08/05

Halvergate House 02/06/05

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 Nursing & Residential Home 58 Yarmouth Road North Walsham Norfolk NR28 9AU Lead Inspector Kim Patience Unannounced Inspection 23rd May 2007 09:10 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 Halvergate House DS0000015642.V341413.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. Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Halvergate House Address Nursing & Residential Home 58 Yarmouth Road North Walsham Norfolk NR28 9AU 01692 500100 01692 407474 halvergate@eachltd.co.uk www.eachltd.co.uk East Anglia Care Homes Limited 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) Position Vacant Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50), Physical disability (2) of places Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home operates only as a Care Home with Nursing. Fifty (50) Older People, not falling into any other category, may be accommodated. 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. The maximum number of persons accommodated should not exceed fifty (50). Registration of an appropriately qualified and experienced Manager (RGN). 30th November 2006 4. 5. Date of last inspection 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 who require either nursing or residential care. The care home is located on the outskirts of North Walsham, standing within its own grounds with off road parking. 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 DS0000015642.V341413.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on the homes first key inspection in 2007. It includes information provided by the home, information gathered in relation to the home since the last inspection and a site visit that took approximately 9 hours to complete. It also includes information provided by the management of the home since the inspection in May 2007 and correspondence with the home since the previous inspection in November 2006. Comment cards were not sent to the residents but several residents and their relatives were spoken to during the course of the site visit. Their views are reflected in the report. Three inspectors, including the Commission’s pharmacist inspector, conducted the site visit. The findings of the pharmacy inspection are included in this report. During the site visit, a tour of the premises was completed. Records relating to residents, staff and the business were inspected. Staff were also interviwed and their comments are also reflected in this report. The acting manager and the company director were present throughout the day and provided with brief feedback at the close of the inspection. They also summarised their notes made at the feedback and provided a copy to the Inspectors commenting where changes had already taken place. What the service does well: What has improved since the last inspection? • • The Company have appointed a permanent manager. The home has introduced a new pre-admissions assessment. DS0000015642.V341413.R01.S.doc Version 5.2 Page 6 Halvergate House • • • • • • • • • Residents’ records have been reorganised and relevant information is now easily accessible to care staff. Care plans have been improved and there is evidence of regular review. New assessments and evaluations have been introduced for pressure care and nutritional needs. New systems have been introduced to monitor continence, fluid and dietary intake. Menus are now displayed in the dining room. There was no evidence of communal toiletries in use. Staff are now being offered one to one supervision. Staff morale has increased and systems have been introduced to improve their efficiency. New induction standards have been introduced. What they could do better: • • • • • • • • The home needs to ensure continuity in record keeping. Assessments must reflect people’s preferences and choices. People’s social and emotional needs must be properly assessed and met. The role of the activities/training coordinator must be reviewed and adequate time allocated to each role. Medication arrangements must safeguard the health and welfare of residents. The home must safeguard the health and welfare of residents ensuring needs are met at all times. Staffing must be available in sufficient numbers to meet the needs of residents at all times. Retain the manager and reduce staff turnover ensuring there is a trained and competent team of staff. Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 7 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. Halvergate House DS0000015642.V341413.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 Halvergate House DS0000015642.V341413.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 Quality in this outcome area is adequate. The home now has a fairly robust admissions procedure so that people who use the service can be assured their needs will be assessed and met accordingly. However, consistency is needed before this outcome area can be once again rated as good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a policy and procedure for the admission of new residents. People are provided with an information pack containing details of the facilities and services available. The pack contains a copy of the service users guide, which has been updated. However, one copy still contained the details of the previous manager and needs to be replaced with an updated version. This was discussed with the proprietor and manager at the feedback session and the Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 10 Commission have received written confirmation since the site visit that this has been corrected. Since an incident in February 2007, the pre-admission assessment has been updated and the new format prompts the assessor to ask for more detailed person centred information. This is good practice as it has the potential to avoid problems as needs should be more robustly assessed. The file relating to one new resident admitted in March 07 was inspected. On the day of the inspection visit it did not contain a pre-admission assessment and there was no evidence of it being completed. However, there was an admission’s assessment that provided an overview of the resident’s needs on admission and a first night report had been written. Care plans and associated records had been completed within 24 hours of admission to the home in accordance with the improved practice. The management of the home did subsequently produce notes relating to the pre-admission assessment visit but these did not constitute a thorough assessment of need. The management of the home do write to people confirming that they are able to meet need, however and this is seen as good practice. See requirements. On inspection of other files relating to people who were admitted in the last year, each contained a pre-admissions assessment. The home do not offer intermediate care in the sense that they offer a rehabilitative service so this standard has not been assessed. They do offer short term care to people from time to time. Halvergate House DS0000015642.V341413.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. The management of the home have worked hard to improve the systems in place to ensure that people who use the service have their needs assessed and met in a way that promotes their health and welfare. However, there is still evidence that at times the administration of medication is not safe. This is of concern as this has been the case for over two years and this adversely affects the overall outcome judgement in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The last inspection in November 2006 showed that the home had made improvements in this outcome area. This inspection shows that improvements to care plans and associated assessments have been sustained and further improvement can be seen. Since the new manager joined the home in March 2007, a number of improvements have been made. Records have been reorganised and all Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 12 relevant and essential care plans and risk assessments are now kept in the resident’s rooms. Whereas previously some were in the residents’ rooms and others were held at the workstations. This change of practice enables care assistants to easily access relevant information in relation to people’s health and care needs. Care assistants spoken with said the reorganisation of records had made a difference to the quality of care they provide and has increased the efficiency of the care team. The records relating to five residents were inspected. The care plans were generally well written and there is evidence of regular review. The home should continue to make improvements here, for instance, care plans need to include peoples preferences and choices. See recommendations. Observations of those residents were also made and showed that needs were being met in accordance with the care plans. Discussions with residents also confirmed they were satisfied with the care provided. However, one resident said that her preferences in terms of rising in the morning were not always taken into account. One comment made by a resident said that they were “very happy with the care”. Other assessments, such as risk assessments and assessments relating to health care needs were written. But again these need to be further developed to ensure assessments are written in all cases. In discussion with the Proprietor and manager at the end of the site visit, it was agreed that all information about dietary needs and preferences would be included in the records kept in the residents’ rooms as well as in the kitchen. The Malnutrition Universal Screening Tool (MUST) is also to be introduced once staff have been trained to use it. This will improve how people’s nutritional needs are assessed and met. See requirements. Improvements have been made to assessments relating to pressure care. Where people were assessed as at risk of developing pressure sores, care plans had been written and evaluations were being completed at regular intervals. New systems have been introduced to improve record keeping in relation to diet, fluid intake and continence. These records are kept in the nurse’s office and following any assistance given in these areas, care staff are required to update the records. Staff spoken with felt that the system was much improved and resulted in much better monitoring of peoples health and care needs. Care plan summaries contain more information and now include regular checks of pressure care equipment to ensure any failures are identified immediately. The summaries, although clear and succinct, are still very task focussed and do not always include peoples choices and preferences. This represents a deterioration in the standard seen on previous occasions, when staff had included detail about preferences of daily routines. However, the care plan summaries do now start at the point of admission and are updated and Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 13 changed in accordance with the knowledge gained about each individual’s needs. This action was implemented following an incident in February. See recommendations. Comments made by the residents during the day were as follows: “We are not bad off, but it is all wait, wait, wait”, “Staff are respectful, there are so many new ones”. One relative said staff , “ Always protect Mum’s dignity, cover her legs when using the hoist”. The inspection of the medication standard was undertaken at the same time by pharmacist inspector Mr M Andrews to assess the current medicine management practices at the home. This inspection follows a total of seven similar inspections undertaken at the home since early 2006. The findings of this inspection were discussed with Ms Kalnins during verbal feedback. Since previous pharmacy inspections the home has put in place a 28-day monitored dosage system (MDS) in which most medicines are supplied. It was noted, however, that the MDS was not synchronised with corresponding 28-day MAR charts with the risk of confusion and error when nursing staff select medicines for administration. There was found to be improved flexibility and timing of medicine doses particularly those prescribed for multiple-dosing. For example, four times daily antibiotics are administered with suitable intervals between doses and so are given at times other than medicine round times. At the time of arrival for inspection (09.30am) the morning medicine round had almost been completed. A full inspection of medication administration was not undertaken at the November 2006 inspection. However, after this inspection the home carried out an investigation into the administration of psychoactive (and sedative) medications for one particular resident. This investigation demonstrated that there had been errors in the administration of the medicines and the Commission concluded that there had been a failure to promote the health and welfare of this particular resident. There has been a general reduction in the number of residents prescribed psychoactive (and sedative) medicines for the management of psychological agitation since the last inspection. There were no residents prescribed these medicines for discretionary administration by nursing staff. For the one resident previously mentioned two such medicines were no longer in use. This area of medicine management shows an improved outcome for the residents at the time of this inspection. On conducting an audit of current and most recent medication records, the inspector found several omissions in records for the administration of medicines and some inadequacies in records for the disposal of medicines. Omissions in records for the administration of medicines included prescribed creams for topical application, eye and ear preparations and medicines for oral administration. Accordingly, the use of these medicines could not be accounted for. In addition, a sample audit of medicines against current Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 14 medication records identified a total of 7 discrepancies where medicines could not be accounted for in full. This remains of concern because for these medicines records cannot confirm that medicines have been administered in line with their prescribed instructions. Ms Kalnins reported that she had been conducting similar audits on an approximately weekly basis and had found no discrepancies. However, more recently, audits conducted by Lucy Trevarthen (Quality Assurance Manager) had identified similar discrepancies. The inspector also looked at records for the non-administration of medicines. Some were found to be unclear because where the records indicated that they have been refused by residents, medicines had been removed for disposal from containers and did not remain as expected. Inaccurate record-keeping for the non-administration of medicines prescribed for regular administration places the health and welfare of residents at risk- see requirements. The Commission have since received confirmation that the management of the home have adopted a recommendation by the Pharmacist Inspector for improving their recording of this aspect of their performance. Ms Kalnins reported that a visit by the Primary Care Trust clinical pharmacist had been arranged during the week following the time of inspection to undertake medication reviews on behalf of prescribers. There was documented evidence on medication records where prescribers had authorised changes to medication regimes. However, on case tracking medical interventions for a resident, the inspector found that the GP involvement leading to only two out of three recently prescribed courses of antibiotic were recorded in the resident’s care notes. The home’s records of prescriber interventions were incomplete in this case –see recommendations. The arrangements for the storage of most medicines including refrigerated medicines and controlled drugs were found satisfactory. However, when the inspector visited the room of a resident self-administering his medicines they were found not to be secure. This caused some concern to the Pharmacy Inspector as there were a number of oral medicines (including medicines for cardio vascular disorders and paracetamol) in or on a non lockable container which was not within easy reach of the resident. This places other residents at risk by unauthorised access to the medicines. The Commission recognises the right of individuals to administer their own medication, but steps must be taken to ensure that the medication of one resident does not pose a potential problem to others if they can gain unauthorised access to it. The Commission acknowledge that the resident in question chooses to remain in their room but the location of the medications needs to ensure that no-one can have unauthorised access to it.–see requirements. In addition, the recorded risk assessment in place for this resident had most recently been written in October 2006. This is of concern because the resident self-manages many medicines including inhaled medicines and painkillers.. see requirements and recommendations. Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 15 Although there have been improvements in medicine administration, the Commission has conducted many pharmacy inspections over a short period of time and each has highlighted repeated shortfalls, some of which have the potential to put people at risk. The Commission acknowledges that the management of the home have taken steps to address the poor practice in this aspect of its operation, including investing in a Monitored Dosage system. However, until the requirements and recommendations have been addressed and improvements sustained the Commission considers that the outcome for residents in relation to the management of medication remains at poor. A further random visit will be made to the home to inspect this area of operation of the care delivery. Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 16 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. The home continues to make some improvements in this outcome area. However, progress is slow in relation to the provision of person centred activities and the home needs to invest resources in this area before the outcome can be rated as good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The last inspection in November 2006 showed that the home had made some improvements to activities. This inspection confirms that the improvements have been sustained, however, there has been little further development of person centred activities. The activities coordinator still has the dual role of activities and training. This still results in some difficulties allocating sufficient time to both roles. For instance, on the week of the site visit, four new staff had commenced their induction and her role as training organiser meant she needed to devote her time to the new staff, leaving no time for activities. On the day of inspection, no activity was seen and the home was very quiet in the afternoon. There was Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 17 to have been an activity led by a volunteer, but he was not able to come to the home that afternoon, but staff did not organise an alternative activity. The Commission had made recommendations previously about the combining of the role, but at the November 2006 inspection following discussion with the person in post, it was agreed that this role could not effectively be combined. A requirement to consider employing a second person to take on part of this role was made at the last inspection. The home did consider this within their improvement plan and the other home owned by the company were to provide assistance. The company are urged to revisit these arrangements to ensure that they are working to the benefit of the residents. Care plans still do not address people’s social and emotional needs fully. Some documents, such as the activities of daily living, include some good information in respect of people’s hobbies and interests while two of the five looked at do not. The form for recording hobbies and interest is good and would be informative for care staff if routinely completed. See requirements. The activities coordinator was interviewed and discussions showed that she is working hard to arrange group activities and develop areas of the home that people can use for activity, such as, a garden which has been redeveloped to include raised beds, hanging baskets and a propagator. Some residents have already been involved in growing tomato plants and making hanging baskets and this is good. The area also has a bench so that residents can sit outside. The home now has a plan of group activities that is advertised around the home. In the coming week some residents were going on a trip to Cromer pier and in September there is a trip to the broads. The activities coordinator is aware that there are a number of residents who cannot or do not want to engage in group activities and therefore she is now concentrating on developing plans of one to one activity for those people. Some staff spoken with said due to the low number of residents at present they were able to spend more time with people and on occasions found the opportunity to play cards or sit and chat. Records of any activity people engage in are maintained. However, there was little evidence of meaningful activity for some people. During the site visit several visitors were seen and some were spoken with. The home does not impose restrictions on visiting at any reasonable time and encourages contact with friends and family. Meals and mealtimes were assessed. Since the last inspection the home has appointed a new cook. All residents spoken with, apart from one, were happy with the quality and choice of the food available. People are offered two choices of main meal and various choices at teatime. Menus are now displayed on the tables in the dining rooms and act as a reminder of what is on offer. Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 18 One resident was unhappy with the meals offered and she was spoken with with her daughter. Due to a swallowing problem she requires softened food and often she states that the meals are not suitable. She said that alternatives are offered, but generally the same ones. She likes to have porridge for breakfast and the home is able to accommodate her request, which is good practice. However, she states the porridge is often lumpy and she is not able to swallow it. This resident, with the support of a relative, has raised concerns about the food, but this appears to be an ongoing difficulty. It is recommended that the manager endeavours to document the actions the home takes to resolve the issues. The Commission has received written confirmation from the manager since the inspection that she has met with those concerned and discussed the issues with them. See recommendations. At lunchtime the dining room was nicely prepared and tables were set with placemats, cutlery, and condiments. The range of cutlery seen showed that individual physical needs are taken into account and that in cases where people find it difficult to manage usual cutlery, specially designed cutlery is provided to aid independence and this is good. Observations of the lunchtime period showed that people’s needs were met, choices were being offered such as a choice of clothing protector. Staff were seen to provide sensitive support with dining and communicated well with residents. On the day of inspection it was, however, noted that some people in the older part of the building were taken to a lounge near one of the dining rooms and sat there for some 25 minutes. During that time there were no staff in the room and nothing to stimulate people. Lunch was delayed due to a problem that had arisen with getting people ready for lunch especially people who needed assistance with moving. Similarly , staff moved people to the same lounge after lunch and this appeared to be caused by staff going for their lunch leaving one member of staff on duty in the nursing area for most of the mealtime. This has been raised as an issue at previous inspections and was raised with the management of the home at the feedback session after this inspection. The new manager was unaware that this had been a common practice in the home previously and had arisen largely due to a problem with staff deployment, which meant that if too many staff were working long days they were all due for a break at or around lunchtime, thus causing there to be a staff shortage “on the floor”. Lunch in the newer wing proceeded smoothly. Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 19 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. The home has systems in place to protect the health and welfare of people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the home has not received any complaints. The home has a complaints procedure that is publicised in the service users guide and posted around the home. The new manager has an open door policy and prefers to have good communication with residents and relatives in order to deal with any issues promptly. Quality assurance mechanisms are now in place and residents are consulted about the quality of various aspects of the service. This also helps to ensure that people are provided with the opportunity to express a view about areas that need improvement. The home also has systems in place for the protection of vulnerable adults. Recruitment procedures are now robust and all staff are trained in adult protection. In December 2006 an adult protection issue was identified by the home, which involved a member of staff striking a resident. The home took appropriate Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 20 immediate action in line with the adult protection procedures and the member of staff was dismissed and referred to the protection of vulnerable adults (POVA) team for inclusion on the POVA register. In February 2007 a complaint was made to the Commission regarding the care of a person who stayed at the home for a ten-day period of respite care. The complaint was forwarded to the adult protection team for investigation. The Proprietor co-operated with the subsequent investigation and the following action points were agreed with him via the Adult Protection Process. • Pre-admission process assessments to include MUST tool, pressure sore assessment, carer involvement, other agencies, up to date medicines and a prescription if possible. Daily summary of care to start from day one of stay, basic care plans within 24 hours Pressure relieving equipment checked and signed for daily Concerns around hours of staffing at weekends still lower than during week. • • • These action points have been commented on in the relevant outcome areas of the report. No further action has been taken by the Adult Protection team. Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 21 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 and 26 Quality in this outcome area is good. People who use the service can be assured that the home provides a good standard of accommodation with systems in place to ensure that the standards are maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was completed and all areas were found to be clean, tidy and free of offensive odours. In general, the home is well maintained, and the décor, furnishings and fittings are of a good standard. Residents spoken with were happy with the standard of their accommodation and said it was always clean and tidy. Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 22 The gardens are also well maintained and as mentioned in standard 12 the once unused courtyard has been redeveloped to create an a safe outdoor space where people can sit or engage in gardening activities. During the tour of the premises a number of unsecured areas were identified, such as an unlocked room containing potentially hazardous substances. This was discussed at the feedback and the management of the home agreed to take this up with those concerned. It is recommended that the home ensures all areas that should be secured or risk assessed if this is not practical and action taken to make minimise risks to the residents. See recommendations Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 23 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 adequate. The home is able to demonstrate that employment practices promote best outcomes for the people who use the service. However, the home cannot fully demonstrate that the number of staff deployed on each shift is sufficient to meet peoples holistic needs at all times, therefore, this outcome area cannot be rated as good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection the home was accommodating only 27 residents, 8 of whom were assessed as having residential care needs and 19 of whom were assessed as having nursing needs. The management’s target staffing levels for this number of residents are 2 nurses and 5 Care assistants in the morning and 1 nurse and 4 care staff during the afternoon. The night shift should comprise one nurse and 3 care staff. The manager said the number of care staff would be increased by one in the morning and afternoon when the number of residents reached 30. This is in addition to other ancillary staff who support the overall care delivery. Copies of the staffing rotas for the two weeks preceding the inspection were taken and later analysed. The rotas showed that of the 28 day shifts, 5 did not Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 24 meet the home’s own target for the current number of residents. (This represents 17 ). The rosters submitted show that: o one shift a nurse had been replaced by a care assistant o in the four other instances the shift operated with a carer short (all of these instances were at a weekend). During the inspection, there appeared to be an adequate number of staff available and peoples’ needs were being met. However, at lunchtime the number of staff was reduced due to staff on long shifts taking their breaks at the same time. This resulted in one member of staff being available in each dining room, leaving one other to assist five people with their meals in their rooms. This has been highlighted as an issue at previous inspections and appears as an action point for the manager on the home’s own Improvement Plan. The Improvement Plan suggest that actions to resolve the issue should have been taken by 31 January 2007. However, this is clearly an ongoing issue and needs careful monitoring especially at weekends when, according to the four weeks of staff rosters submitted, two of the shifts each weekend day are covered by staff working long days. See requirements. At the last inspection it was reported that the home had introduced a twilight shift to provide additional cover in the early evening and provide residents with more choice in terms of activity and bedtimes. This shift has now been withdrawn. There has been a significant staff turnover since the last inspection. 46 members of staff are employed in total and since November 2007, 30 members of staff have left the home and 23 new staff have been appointed. At this inspection staff reported however, that staff morale was good and said that staff group was now more stable. The activities/training coordinator has continued with her dual role and despite a requirement made at the last inspection to consider appointing another person to take on one of the roles, there has been no change. (See standards 12-15 for more information). As mentioned in standard 12 there was little activity or stimulation for people during the inspection. Neither the Activities Person nor the staff felt able to offer some activity for the residents in the absence of the volunteer scheduled to run the session planned. See requirements. A number of staff were spoken with and said that it was much easier to manage with a lower number of residents and felt they were better able to meet people’s needs. There was more time available to spend chatting to people and engaging in one to one activity. However, one member of staff also said, at times it was more difficult due to the residents being spread out in various parts of the home. Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 25 Residents and relatives spoken with felt that on the whole people’s needs were met and that staff were caring, kind and friendly. No one expressed any concern about staffing. Comments made by the residents included: “Staff are happy”, “I have had to wait 50 minutes for the bell to be answered”, In answer to a question ‘Can you stay up late?’ the response given was “Well you have to wait until they come and get you” The Commission consider that the standard relating to staffing is almost met because of the continuing issues of staff deployment and the failure to progress the person centred activities in a more robust way. Training is progressing well and the home has a training plan for 2007. A new induction programme, which meets the skills for care standards, has been introduced and it is now expected that all new staff will progress to their NVQ 2 in care. 8 staff are currently completing an NVQ and 2 have already completed. This out of a care staff complement of 46. The files relating to three new members of staff were inspected and found to be in good order. In all cases the files were kept in accordance with the regulations and appropriate pre-employment checks had been conducted. Since the last inspection the home has introduced a system where all new staff commencing with a POVA check are allocated a named worker on each shift and this is documented in their file. It was noted that a Criminal records check relating to an overseas worker had not been translated into English and it is recommended that the home ensure they always obtain a translation so they can verify the check is clear. This check will refer to the period prior to entering this country and management of the home will need to know that this is clear so will need to understand what has been written. The CRB applied for in this country will only refer to the period of residence in this country. See recommendations. Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 26 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 adequate. The home has systems in place that promote best outcomes for people who use the service. However, the home must be managed by a person who has been assessed and registered as fit to do so, before this outcome area can be rated as good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the last three years there have been 9 different managers, which has meant a lack of continuity and consistent approach to the management of the care delivery. Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 27 Since the last inspection in November 2006 the home has appointed a new manager who started in March 2007. The acting manager at that time has now moved back to her role as quality assurance manager. The home has not had a registered manager since 2004. However, the proprietor has submitted an application for her registration. This took place three months after the date of the site visit and three months after the date indicated in the Improvement Plan. The new manager has approximately 17 years experience in managing a nursing home and is a registered nurse. Since her appointment she has made several positive changes and is well liked by staff. Staff spoken with, said she was very supportive and welcomed their involvement in the continuous improvement of the service. The quality assurance manager has resumed her role and has started the process of quality monitoring for the year 2007. Surveys have been sent to residents and relatives and quality audit tools are being introduced. Regulation 26 visits are being conducted in accordance with the requirements of the Care Standards Act 2000. Resident’s finances were checked and found to be in good order. A plan of staff supervision is now in place and staff confirmed that they were being offered one to one supervision, evidence of which could be found in the staff files. This is an improvement. Records relating to health and safety were checked and no issues or concerns arose. The home has systems in place to ensure fire safety and that the building is maintained to a safe standard. Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 28 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 3 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 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 X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 29 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 OP3 Regulation 14.1(a) Requirement Timescale for action 01/07/07 2. OP7 3 OP12 4 OP27 5. OP9 Every person who uses the service must have their needs thoroughly assessed prior to coming into the home so they can be assured their needs will be met 15.1 All people who use the service must have their health and care needs appropriately assessed so they can be assured their needs will be met. 15.1 All people using the service must 16.2(m) have their social care needs properly assessed so they can be assured their social needs will be met. 18.1(a) People using the service must have their needs met by staff who are deployed in sufficient numbers at all times, so they can be assured their holistic needs will be met. This requirement is made for the eighth consecutive time. 13.2, 13.4 People who use the service must have medicines given to them by staff in line with prescribed instructions at all times and this is evidenced by safe recordDS0000015642.V341413.R01.S.doc 01/07/07 01/07/07 01/07/07 01/07/07 Halvergate House Version 5.2 Page 30 keeping practice. This is to ensure people receive medicines in the way they are prescribed. This requirement is made for the fifth time since January 2006. 8. OP9 13.2, 13.4 People who use the service must have records fully and accurately completed by staff when medicines prescribed for regular administration are not given. This is to protect people’s health and welfare. This requirement is made for the seventh time since January 2006. 13.2, 13.4 People who use the service and who self-manage their medicines and keep them in their room must have their medicines secured when not in use. This is to protect other people at the home from the risk of unauthorised access. 13.4, 14 People who use the service and who self-manage their medicines must receive regular risk assessments and supervision by staff ensuring they take their medicines safely. 01/07/07 9. OP9 01/07/07 10. OP9 01/07/07 Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 31 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 OP15 Good Practice Recommendations People who use the service must have their care delivered in a way that considers their preferences and choices. People who use the service must be provided with meals that meet their needs and expectations and it is recommended that the home documents ongoing steps to resolve this particular issue. People who use the service must be assured that all areas they have access to are safe. People who use the service must be assured they have their needs met by staff who have had their criminal records checks verified. It is recommended that the home implements more frequent auditing of medication to promptly identify and resolve audit trail discrepancies arising including where residents self-manage their own medication. It is recommended that steps are taken to ensure full and accurate records are completed by staff in relation to all prescriber visits and interventions. 3 4 5 OP19 OP29 OP9 6. OP9 Halvergate House DS0000015642.V341413.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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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