Inspection on 25/08/05 for Halvergate House

This inspection was carried out on 25th August 2005.

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 23/05/07

Halvergate House 30/11/06

Halvergate House 18/05/06

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 NR28 8AU Lead Inspector Kim Patience Unannounced 25 August 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 V248033 250805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Halvergate House Address Nursing & Residential Home, 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 500100 01692 407474 407474 East Anglia Care Homes Limited Care Home 50 Category(ies) of OP Old age (50) PD Physical disability (2) registration, with number of places HALVERGATE HOUSE I55 S15642 Halvergate House V248033 250805 Stage 4.doc Version 1.40 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 category, 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 2 June 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 V248033 250805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place in the evening commencing at 5.05pm and taking approximately 5 hrs to complete. The inspection was conducted by two inspectors and took place in response to complaints that indicated staffing levels at the home were inadequate resulting in peoples needs not being met to the required standard. Generally, the complaints were upheld that staffing was not adequate and the Commission is considering enforcement action to bring about improvement as previous attemps to secure compliance have not been successful in the long term and adequate staffing has not been maintained. The Commission may also consider putting restrictions on admissions until such time as it is satisfied the staffing is adequate. During the visit, a tour of the premises was carried out, a number of resident’s rooms were entered, staff were interviewed, residents were interviewed and records were inspected. The acting manager was present at the start of the inspection and provided any assistance required during that time. Due to the nature of the inspection, only a small number of standards were assessed and some only in part. It is recommended that readers of this report do so in conjunction with the previous report written in June 2005 in order to get a more proportionate view of the service. What the service does well: What has improved since the last inspection? It was not possible to fully assess the improvements made since the last inspection due to the time and nature of the visit. However, the proprietor has appointed a new manager who will offer staff much needed stability and leadership. This is a step towards improvement. HALVERGATE HOUSE I55 S15642 Halvergate House V248033 250805 Stage 4.doc Version 1.40 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 V248033 250805 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 HALVERGATE HOUSE I55 S15642 Halvergate House V248033 250805 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) 0 N/A EVIDENCE: N/A HALVERGATE HOUSE I55 S15642 Halvergate House V248033 250805 Stage 4.doc Version 1.40 Page 9 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, 9,10 Each resident has an individual plan of care. However, due to incomplete records and poor record keeping, the home cannot demonstrate that people’s needs are met in full. Records held in respect of each individual do not demonstrate that health care needs are met appropriately. Observations of medication administration, storage and record keeping do not demonstrate that residents are protected against errors being made. Residents feel that they are treated with respect and their privacy is being upheld. EVIDENCE: The care records relating to eleven nursing needs residents were inspected. The records are kept in two parts, part one is kept in the residents room and contains the care plans and records relating to health care needs. Part two, is kept in the nurse’s office and contains the admission records. Evidence was collected from part one only, with the exception of one resident. Care plans had been completed for each aspect of care and clearly stated what the need was, how it should be met and by whom. Other documents used to HALVERGATE HOUSE I55 S15642 Halvergate House V248033 250805 Stage 4.doc Version 1.40 Page 10 demonstrate that the assessed needs were being met, such as, turn charts, dietary intake charts, bowel charts and fluid charts were seen. However, these were not present in all residents plans even-though the need for monitoring had been identified. Where charts were present, in the majority of cases they showed gaps, where either people’s needs were not met in accordance with the care plan or staff had not recorded any intervention. For example, in one case the care plan stated that the person needed to be given 1500mls of fluid in a 24 hour period and the fluid charts showed that only 250mls had been given. The turn chart for the same individual showed that one entry had been made on the 21.08.05 and no further entries were made up to the time of the inspection. Dietary intake charts for people needing assistance with their meals showed numerous gaps, again, either indicating that staff have not maintained good record keeping or people were not being provided with meals and assistance as specified in the care plans. See requirements Some risk assessments in respect of moving and handling had been completed however, these could not be found in all cases. Additionally, in at least one case, a falls risk assessment could not be found even-though there was evidence to suggest the individual was at risk of falling. See requirements. The likelihood of pressure sores was being assessed and in those cases where the likelihood was greater, appropriate equipment was supplied i.e. pressurerelieving mattress. However, as mentioned earlier, if the need for regular turning has been identified and records show that this need is not being met, in addition to poor diet and lack of fluids, then the likelihood of pressure sores is increased by inadequate care. See requirements. Evidence of nutritional screening was found and where food needed to be specially prepared to meet the individual’s needs this was indicated in the care plan. However, as already mentioned, dietary intake records did not show that people were being provided with regular meals. See requirements. The people living in the nursing unit of this home are very frail and in view of this and the time of day the inspection was conducted, it was not possible to discuss how people perceived their care needs were being met. However, members of staff were spoken with and they expressed concern about peoples needs not being met adequately and within a reasonable timescale due to the lack of staff. They also expressed concern about the lack of time to complete records in order to maintain accuracy. The medication procedures in the home were inspected in part only, MAR charts were inspected, along with the storage of medication and the nurse administering medication was observed. Medication was being stored in a locked room and administered from a lockable trolley, which is fit for purpose. HALVERGATE HOUSE I55 S15642 Halvergate House V248033 250805 Stage 4.doc Version 1.40 Page 11 On examination of the medication records pertaining to each resident, it was difficult in some cases to ascertain that medication was being administered correctly due to poorly photocopied charts. The dates were being changed at the top of the charts and did not align with the signature entered to verify that the dose had been administered at the correct time. The charts did not show an audit trail, for example, medicines were not being booked in and a carry forward figure was not indicated. It was observed that in the room where medication is stored, a box of Gabapentin was left out on the table and did not have a prescription label identifying who it had been prescribed for. Inside the box there were several strips of tablets, two of which were named as Neurontin. It was observed that on top of a medicines trolley was a tablet in a pot, this could indicate poor practice in respect of the administration of medicines as it was not possible to identify who the tablet was intended for and why it remained in the pot. In view of these observations, it is required that the management conduct a review of the medication procedures in the home. See requirements HALVERGATE HOUSE I55 S15642 Halvergate House V248033 250805 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) 0 N/A EVIDENCE: N/A HALVERGATE HOUSE I55 S15642 Halvergate House V248033 250805 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) 0 N/A EVIDENCE: N/A HALVERGATE HOUSE I55 S15642 Halvergate House V248033 250805 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) 26 The home has systems in place to ensure that it is kept clean and hygienic. EVIDENCE: The home was found to be clean and tidy at the time of the inspection with no offensive odours detected. A team of domestic staff are employed but it was not possible to assess the number of hours allocated to cleaning on this occasion. Residents spoken to reported that they were happy with the standards of cleanliness. HALVERGATE HOUSE I55 S15642 Halvergate House V248033 250805 Stage 4.doc Version 1.40 Page 15 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 staffing levels in this home have been a matter of continuing concern and remain at a level that is considered inadequate to fully meet the needs of residents. EVIDENCE: In order to assess this standard, copies of the staff rosters for a five-week period were taken, staff and service users were interviewed and records relating to residents care needs were inspected. The following information provides evidence to substantiate concerns that staffing levels are inadequate. The staff rosters show that staffing levels consistently fall below the absolute minimum stated in the notices issued by the Norfolk Health Authority in respect of nursing homes and the local authority in respect of residential care homes. Shift patterns at this home are 8-2pm, 2-8pm, 8-8am. Between the hours of 8-10pm the staff levels fall below the required minimum and are set at 1 nurse and three care assistants. Four care staff were interviewed. All expressed some concern about staffing levels at the home. One member of staff said she was the only carer on duty one Saturday with one nurse. (6.08.05 – taken from staffing rotas) At other times staffing levels have been low resulting in peoples needs not being met within a reasonable timescale. It was told that on some occasions when staffing levels had been low the last person out of bed has been at 13.30 hrs and on other occasions it has been between 11.30 and midday. Eight people HALVERGATE HOUSE I55 S15642 Halvergate House V248033 250805 Stage 4.doc Version 1.40 Page 16 need assistance with eating and some can take up to 45 minutes to finish their meal therefore placing further demand on staff time. Nurses rarely get involved with care as they have the nursing needs to attend to and are responsible for the administration of medicines for both nursing and residential. The medication round usually takes two hours to complete – this calls into question the timeliness of administration of medicines. The staffing levels in the residential unit are described by staff as adequate. There are generally two care assistants on duty and the residents are largely self-caring. However, observations during the inspection and the staffing rosters show that adequate staffing was not always maintained. Staffing levels reduce to one care assistant in the unit after 8pm and it was observed that when drinks needed to be prepared the unit was left completely unattended. Staff also said that the one care assistant allocated to residential care often had to help in the nursing wing when the need was greater, again leaving the unit unattended. Residents accommodated in the nursing unit are very frail and dependent, it was therefore difficult to communicate effectively with some of these people and very little could be gained from the conversations. In the residential unit 4 people were interviewed and were able to say that generally they considered staffing to be adequate. People were not having to wait long periods of time to be attended to and their needs were being met to a standard that they were happy with. One service user interviewed was very aware that it was difficult for staff to manage the work that they have and was aware that on occasions staffing levels had been low but felt that it did not have too much of an impact on the residential unit due to most people being largely self-caring. However, she was concerned about the lack of staff generally. The care plans relating to 11 service users were inspected. Gaps in the record keeping could be seen and may be attributed to the lack of time available to staff in order to keep records up to date or that care tasks had not been completed. For instance, one resident required a fluid intake of 1500mls in a 24-hour period, the fluid chart showed that on the 23.8.05 at 2100 hrs 100mls of fluid was given and at 2300 hrs 50mls had been given. The next entry was made at 7am on the 24.8.05 when a further 100mls of fluid had been given with the next entry at 8am 25.08.05. The dietary intake chart had frequent gaps at lunchtime and therefore did not provide evidence that meals had been given. Turn charts were incomplete and entries were found on the 21.08.05, but no further entries up to the time of inspection. Therefore there was no evidence to show that this person had been turned as required. In another case, a care plan stated that the resident needed to be turned 2-4 hourly. The turn chart on the 24.08.05 noted that the individual had been turned at 07.15, 13.00, 22.15,01.30. Following the inspection an immediate requirement was issued, and stated that the registered person must increase the staffing levels in order to meet peoples assessed needs. See requirements. HALVERGATE HOUSE I55 S15642 Halvergate House V248033 250805 Stage 4.doc Version 1.40 Page 17 The requirement to address shortfalls in staffing has been made for the second time. See standards 7-11 for further details of record keeping. HALVERGATE HOUSE I55 S15642 Halvergate House V248033 250805 Stage 4.doc Version 1.40 Page 18 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 The proprietor of this home cannot demonstrate that the home is run and managed by a person who is fit to do so, due to the lack of a registered manager. EVIDENCE: The proprietor has appointed a new manager to the home who, at the time of inspection, was completing her second week in post. The home has been without a registered manager since January 2004 and since that time has had 4 different post holders. The home needs to have a registered manager who can offer some stability and leadership in order to improve the standard of service offered to people living there. See requirements. The home is currently in breach of the conditions of its registration which require a registered manager to be in post. HALVERGATE HOUSE I55 S15642 Halvergate House V248033 250805 Stage 4.doc Version 1.40 Page 19 In respect of health and safety, there are concerns that if staffing levels are low then in the event of a fire, residents could be placed at risk due to the lack of staff to assist with evacuation procedures. Therefore, the home would not be compliant with fire safety regulations and on occasions is not meeting its own fire risk assessment. HALVERGATE HOUSE I55 S15642 Halvergate House V248033 250805 Stage 4.doc Version 1.40 Page 20 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 N/A N/A N/A N/A N/A N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 N/A 13 N/A 14 N/A 15 N/A COMPLAINTS AND PROTECTION N/A N/A N/A N/A N/A N/A N/A N/A STAFFING Standard No Score 27 1 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 N/A N/A N/A N/A N/A N/A 2 HALVERGATE HOUSE I55 S15642 Halvergate House V248033 250805 Stage 4.doc Version 1.40 Page 21 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(1a) Requirement The registered person must ensure that they maintain in respect of each service user a record which includes the information, documents and other records specified in schedule 3 relating to service users. The registered person must undertake a review of the medication arrangements in the home to improve the current situation. 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. THIS IS THE SECOND TIME THIS REQUIREMENT HAS BEEN REPEATED IN THIS INSPECTION YEAR. Timescale for action 1.10.05 2. 10 13(2) Immediate requiremen t Immediate requiremen t 3. 27 16 HALVERGATE HOUSE I55 S15642 Halvergate House V248033 250805 Stage 4.doc Version 1.40 Page 22 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. Refer to Standard Good Practice Recommendations HALVERGATE HOUSE I55 S15642 Halvergate House V248033 250805 Stage 4.doc Version 1.40 Page 23 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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