Inspection on 18/08/08 for Haughgate House Nursing Home

This inspection was carried out on 18th August 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Haughgate House Nursing Home 14/08/06

Haughgate House Nursing Home 16/11/05

Haughgate House Nursing Home 15/08/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Haughgate House Nursing Home Haugh Lane Woodbridge Suffolk IP12 1JG Lead Inspector Kevin Dally Unannounced Inspection 18th August 2008 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Haughgate House Nursing Home DS0000063952.V370207.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. Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Haughgate House Nursing Home Address Haugh Lane Woodbridge Suffolk IP12 1JG 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) 01394 386249 F/P 01394 386249 Haughcare Limited Miss Joanne Sandra Emms Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th August 2006 Brief Description of the Service: Haughgate house is located on the outskirts of Woodbridge, close to the A12. All local services can be located in the centre of Woodbridge, which is approximately 2.5 miles away. The home provides 31 places in total for people with medical nursing needs, and the accommodation is provided within 29 single and 1 shared room. All rooms have hand washbasins, and the 14 bedrooms in the new extension are provided with ensuite toilet facilities. There are two large lounges, a large dining room, a sluice room, bath and shower facilities. All bedrooms and communal areas for the residents are on the ground floor with level wheelchair access to all areas. The first floor accommodation has been converted into office space and for use as a staff training room. The homes weekly fee range is from £500 to £725 per week. Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This key unannounced inspection focused on the main standards relating to older people. The report has been written using all the information gathered before and during the inspection. Miss Joanne Emms the manager, and Mr Mark Carter one of the owners, was available at the inspection and provided us with relevant information about the home. We were shown around the premises and were able to spend time with some of the residents (4) and staff (2), and talk with some of the relatives (3) visiting the home. This gave us information about what people thought about the home and the quality of the care provided. Some residents care plans; residents’ and staff records, maintenance records and training records were also checked. The Commission for Social Care Inspection (CSCI), also sent surveys to the home to distribute, prior to the inspection. Comments were received from 8 residents, 8 relatives, and 7 staff members who provided us with feedback on how they thought the home was run. A selection of their views and opinions about the home are included within this report. Prior to the inspection, the management also completed the CSCI annual quality assurance assessment form (AQAA). This enables the home to inform us on how well they are meeting the national minimum standards, and allows them to say what they do well, what they could do better and any plans to improve the service. Some of the information from these documents has been used in this report. A tour of the building was completed which included checking the communal rooms including the dining room, and a sample of several residents bedrooms, with the residents’ permission. What the service does well: People who use the service are provided with nursing care and support that meets their care requirements. People told us, ‘this is an extremely well run home, staff seem well trained and friendly’, or ‘they enable residents and family to feel at home’, or ‘the home is brilliant in meeting my medical support needs’. Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 6 The home provides a modern purpose built, homely environment, with appropriate nursing facilities. Staff members are ‘friendly and kind’ to the residents and their families. The home’s gardens and courtyards are very accessible and maintained to good standards. The home offers good catering services, meals of which are served to the resident in their own room, or in the dining room, as they choose. The home provides opportunities for more mobile residents to access activities within the home or wider community. One person told us, ‘There is plenty to do including visits to the beach, flower arranging, or going to the local pub’. The home’s quality assurance processes ensure that residents and relatives views are sought around the quality of the care, which the home then use to make improvements in the service. Care plans would record the care and support agreed. Staff members would be appropriately recruited, trained and supervised to ensure that they could meet the nursing care needs of the residents at the home. Residents would be treated with equality and respect, by staff who are committed to improving their quality of life. What has improved since the last inspection? What they could do better: This unannounced inspection found the home continued to positively improve its service with most standards assessed as met. Some issues around the record keeping and accounting for some medicines should be improved and addressed, to ensure that the residents are kept safe. Some nutritional information had not been updated and could be improved to ensure the home is more aware of the changing nutritional status of any vulnerable residents. Recommendations have been made. Please contact the provider for advice of actions taken in response to this Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 7 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. Haughgate House Nursing Home DS0000063952.V370207.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 Haughgate House Nursing Home DS0000063952.V370207.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): 1, 2, 3, 4, 5. The home does not offer intermediate care therefore standard 6 was not assessed. Quality in this outcome area is good. People will receive key information about the service, and their care needs will be assessed prior to them entering the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The information provided by the home (AQAA) said that ‘we provide up to date documentation including advice on financial contributions and assessments’. Previous inspections have shown that the home provides a good range of information for prospective residents, including a service user guide, which tries to answer some of the questions people may have about moving into a care home. The guide provided key information including the aims of the service, the services and facilities, the management structure of the home, and how to make a complaint. Surveys (CSCI) received from residents and Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 10 relatives told us that they had received enough information about the care home to help them make decisions. Residents’ records checked showed that the home had completed detailed assessments for each person in order to ensure that they could meet these peoples’ care needs. The information included an assessment of their current situation, background information, medical problems, dietary requirements medication needs, and some risk assessment information. The manager told me that she would complete a home or hospital visit to undertake a care assessment, and that prospective residents or their families could also visit the home to see if this was suitable for them. Residents are usually offered a months trial before longer-term agreements are put into place. The home had a standard contract of the terms and conditions of the service, including the fee structure and payment methods. As the majority of residents were private clients, most had received a personal contract. The residents’ records checked confirmed that contracts had been provided. The home was able to show us that they provided a well-trained work force that could meet the care and nursing needs of the people who lived at the home. For example, staff training included safeguarding training, fire, moving and handling training, food hygiene and infection control training. Some of the specialised training noted included nutritional care, diabetes training, risk assessment training and oxygen therapy training for nurses. Feedback received from staff informed us that they had received training which was ‘relevant to their role’ and which ‘helped them understand and meet the individual needs of the residents’. The home recorded that around 50 of their care staff (13 of 26) had achieved a national vocational care qualification (NVQ) level 2 or above, with a further 4 currently working towards this award. This informed us that around half of the staff group had achieved a formal care qualification, and of the home’s ongoing commitment in ensuring a competent and qualified workforce. Surveys (CSCI) received from relatives (8) said that the care home ‘always or usually’ meets the needs of the residents, that staff have the right skills and experience to look after people properly, and that they give their relative the support and care that they expected. One resident said, ‘I think they do most things well’. The following is a selection of feedback received from residents and relatives about the care provided by the home. ‘The friendly atmosphere includes good personal relationships between most of the carers and patients. I think the nurse manager is excellent’. ‘Coming here 7 years ago has been one of the best things that has happened to me’ Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 11 ‘I think this is an extremely well run home. The staff team seem well trained and very friendly’. ‘I visit regularly but anything untoward is communicated to me immediately’. The following is a selection of feedback received from the staff group who made the following points. ‘I think we could possibly spend more time with individual residents who would like a chat, but there is not always time’. ‘There is a good level of care and the home and grounds are kept nice. A nonformal approach is kept and the ethic of the home is ‘a home away from home’. ‘I think that if the attitude among the staff was ‘teamwork’, then it would lead to a better level of care’. Haughgate house provides a comfortable, friendly and safe home for the residents. The home is always clean and tidy and they receive a good standard of care’. Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 12 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, 10. The quality in this outcome area is good. People can expect nursing support that would meet their healthcare needs, and their care plans will explain their needs and reflect their choices of care. The home recognises the need to improve some minor shortfalls in medicine practices to assure people they will not be placed at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The information provided by the home (AQAA) said, ‘New care planning is currently being developed and will be introduced through a trained nurse meeting, and then implemented’. Two care plans checked showed that the new care plans were now in place and these fully described the nursing care needs for those residents. The care plans use the ‘activities of daily living’ approach, which identifies various areas of healthcare needs. For example, one care plan had identified and provided detailed guidance around communication difficulties, continence care needs, personal care etc. The plans also provided very specific nursing care Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 13 information and included assessments around each resident’s weight, nutritional issues, pressure area care risks, falls assessments, and moving and handling risk assessments. An example of good practice was seen where one resident’s weight had been carefully monitored each month, for the past 12 months, so provided good evidence of weight gains or losses. Reviews in the care plan notes showed that nursing staff continued to closely monitor any changes. There was also an additional chart that measured their body to mass index (BMI) but this chart was not fully complete. The care plan also included a ‘personal history’ page, which was a very personal look at that person’s family, previous work and social background. A second resident who was blind was visited to see if the care identified in their care plan, matched with the care they received. The care plan recorded they were ‘visually impaired’ and provided detailed guidance around how to fully support this person. Examples of good practice and inclusion included guidance like, ‘ensure the room layout is not changed’ or ‘encourage social participation’ or ‘explain the food being served’. In discussion with the resident they told me, ‘I keep the room the same so I know where things are’, or ‘The food is OK. Staff help me with my food choices and preferences’, and ‘ I am visited by the activities person, and staff take me for a walk in the garden’. Records checked showed us that nursing staff liaise with other healthcare professionals, for example, the chiropodist, the doctor or dentist. Accident records checked for the previous 6 months showed that there had been 72 accidents during this period, of which 42 related to one resident. The home had well documented strategies in place that included risk assessments and monthly monitoring, a pressure mat, hip protectors, frequent visits by staff, reviews by their doctor, and the involvement of their family with the matter. Other accident records checked showed only one off incidents. Residents and relatives spoken with during the inspection said they were usually happy with the quality of the nursing care and support given. During the inspection we observed that all residents looked well care for, were well groomed, and constantly attended to by staff. Staff worked hard throughout the morning, assisting and supporting the residents with their care needs. Eight residents completing the survey said that they ‘always or usually’ received the care and support they needed, and that staff were ‘always or usually’ available when they needed them. Further, six residents said that they ‘always or usually’ received the medical support they needed, 2 did not say. Eight relatives who returned surveys said staff ‘always or usually’ met the needs of their relatives, and that they provided the support and care that they expected or had agreed. A selection of comments from residents or relatives about the care provided included the following views. Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 14 ‘I think the home is a very, very well run home, and the staff are excellent. They go out of their way to make family and friends feel welcome’. ‘Sometimes there can be fairly long delays waiting for the bell to be answered, but I have never been without help or advice eventually’. ‘I have a personal bell to press if I need to, and this is always responded to’. Staff members made the following points about the care provision. ‘I think the home offers a high standard of care, the staff are friendly and there is a homely atmosphere’. ‘Haughgate house provides a comfortable, friendly and safe home for its residents’. The nurse in charge of the shift was accompanied on the medicine round during the lunchtime period. Medicines are administered from the portable lockable trolley, and medicines were noted as properly labelled, and stored. The nurse was seen to follow safe practice in the checking of residents’ medication administration records (MAR) charts, and locking the medication trolley, if they had to leave it for a short period. Three residents’ medicines were audited (8 in total) to check that the records balanced with the medicines left in the containers. Seven of the 8 medicines checked balanced with the records, but 1 did not balance instead showing a surplus of 14 tablets. On checking the home’s stock records with the manager, this showed us that an additional box of tablets had been issued for the resident, before the old stock had been completed. This new stock had not been recorded on the MARS chart, so explaining the extra tablets. The records showed us that the resident had continued to receive their prescribed medicines as directed by their doctor. The manager told us that she would investigate how this had occurred. One of 3 residents’ MAR charts checked showed that their medicines had not been signed for on 1 occasion. Some of the new medicine MAR charts stock start dates had not been underscored on the MARS records, as required by the home’s medicines policy. The medicines policy checked provided good guidance and best practice for staff to follow, when administering medicines. Care plans checked included an assessment of each new resident’s medications, and current medicines were appropriately recorded on their MAR sheet. Staff were observed to be polite and caring towards the residents, and showed respect and maintained their dignity during care sessions. One resident told me, ‘My privacy and dignity is kept. The staff are very good, kind and helpful’. Staff were seen to knock on doors, and to ask residents what they wanted. One resident told me, ‘staff ask me which clothes I would like to wear’. One relative said, ‘Our relative is looked after and is very happy here’. Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 15 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 good. Residents can expect the home to address their social and recreational needs and be supported to maintain contact with family and friends. They are offered a choice of nutritious well-presented meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Time was spent during the morning speaking with residents and checking the daily routines and activities provided for them. One resident told me they mainly preferred their own company, but had plenty to do during the day. This included reading, but due to failing eyesight, a visitor came each week to read to them personally. Further, they had access to audio books, which they could access whenever they wished. The home’s activities person also visited and assisted them with any personal tasks they needed. The resident said that they enjoyed good contact with their family and friends, who could visit the home at any time without restrictions. They also told us that they had a telephone in their room, which the family used to keep in contact with them, during the week. Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 16 Two relatives we met told us their relative had recently moved into the home, and they visited quite frequently. They said the home was ‘excellent’ and they ‘could not speak a word against it’. They found staff were ‘friendly and kind’ and their relative was ‘happy here’. The information provided by the home (AQAA) told us that a variety of activities are provided for the residents’ enjoyment. They said, ‘We involve the residents in the life of the home with a varied programme of activities’. Examples they told us about included opportunities for the residents’ friends and families to join in with some of the home’s activities including meals and special events such as the summer fete, and Christmas activities. Further the home celebrates special occasions such as birthdays, mothers’ and fathers’ day, harvest festivals, Halloween, and Burn’s night. The home state they now have a full time activities co-ordinator who provides small and large group activities, and also one to one activities. They are also responsible to ensure that a record is kept of the activities undertaken by each resident, and these were found in the care plans checked. The home told us that they had planned pub lunches, a seaside trip, and a garden centre trip. Six of seven residents’ surveys told us that there are ‘always or usually’ satisfied with the activities arranged by the home. One said ‘sometimes’. One resident said, ‘My blindness and deafness make it difficult to join in activities, but I don’t mind this. I enjoy listening to my radio, being taken for walks, or sitting in the garden and being read to. I have also joined in outings’. The home provided us with a 3-week menu plan, and this showed that there was a selection of varied hot menu choices for the residents. Examples of some of the main hot menu options included roast lamb, shepherds pie or chicken curry and rice, quiche salad, roast chicken, sausage pie or liver, fish in breadcrumbs, baked gammon or pasta bake, beef stew or toad in the hole. The meal on the day of the inspection was a choice of cod and cheese sauce or sausage, egg and chips, mashed potato, peas and turnips. Dessert was a departure from the listed menu choice of treacle sponge and custard, and had been replaced by a choice of chocolate or strawberry gateau. There was a diabetic alternative of banana custard. At lunchtime staff were seen supporting some of the residents with their meals. Some of the residents we spoke with told us that they were satisfied with the meals provided. One person told us they enjoyed the meals ‘too much’, and another resident confirmed that staff ‘always assisted them’ with their meals. Drinks were seen as available throughout the day and were provided at lunchtime with the meal. Feedback received from 7 residents told us that 6 of 7 residents ‘always or usually’ like the meals at the home. One said ‘sometimes’. Some of the comments received about the meals included the following views. Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 17 ‘The cooks and kitchen staff do a wonderful job coping with my food requirements, and are getting to grips with some suggestions made by the dietician. The food is well presented and tasty for which I am grateful for’. ‘The meals are good but too sweet’, or ‘I think the meals can be boring’. Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 18 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. People can expect the service will listen to their concerns, and take appropriate action to safeguard residents’ welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaint procedure was provided within the Haughgate House statement, should a resident or relative wish to raise any concerns with the management. The home had received 1 complaint and a number of compliments about the service, within the last year. The complaint received was around problems with the laundry and the home had responded and resolved this issue. Feedback from 7 of 8 residents confirmed they new how to make a complaint to the home. One did not say. One resident said, ‘I have rarely been worried or annoyed or upset, and the home is willing to listen and talk to me’. A selection of the compliments received by the home included the following views. ‘Thank you for looking after our relative so well, and making their birthday special’. ‘Thank you for all the wonderful care you gave our relative over the last few months. They were treated with unfailing kindness and patience’. Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 19 ‘Please accept our families thanks and appreciation for the tea provided and the use of the home’s lounge’. There was company policy for the safeguarding and protection of vulnerable adults (POVA), with information and instructions on what to do. The home was aware of their responsibilities in reporting any allegations of abuse to the Social Services team for further investigation. One safeguarding alert had been made by the home to Social Services within the last year, around the actions of a member of staff. Staff records checked included criminal record bureau (CRB) and protection of vulnerable adult (POVA 1st) checks, reference checking and identity checks, which would ensure that staff were suitably checked and cleared to work with vulnerable adults. Discussion with the management and staff records checked confirmed that adult safeguarding training was provided for staff. This was to ensure they knew what to do in the event of any allegations of abuse by a resident. One staff member said, ‘We receive mandatory training such as safeguarding training, moving and handling, infection control, fire and food hygiene training annually. Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 20 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, 20,21,22, 24, and 26. Quality in this outcome area is good. Residents will benefit from a comfortable, adequately maintained environment that will meet their accommodation needs. The home recognises the need to improve some minor shortfalls in the cleaning practices to assure people of a clean environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Haughgate house is located on the outskirts of Woodbridge, close to the A12. All local services can be located in the centre of Woodbridge, which is approximately 2.5 miles away. The home provides 31 places in total for people with medical nursing needs, and the accommodation is provided within 29 single and 1 shared room. All rooms have hand washbasins, and the 14 bedrooms in the new extension are provided with ensuite toilet facilities. Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 21 There are two large light and airy lounges, a large dining room, a sluice room, bath and shower facilities. All bedrooms and communal areas for the residents are on the ground floor with level wheelchair access to all areas. The first floor accommodation has been converted into office space and for use as a staff training room. There is easy access to well-maintained grounds and gardens, located by a stand of large trees. The home is usually well maintained to ensure the decoration of the building is kept to a good standard, and the fixtures, fittings and furnishings are all decorated to good standards. Bedrooms checked were furnished with specialist equipment, call bells, and good quality furnishings. Residents were allowed to bring their own personal belongings and the rooms checked showed they were organised to personal taste. One resident with poor eye sight told me that the arrangement of furniture in their room always remained the same, as they then remembered the layout, and could move freely around. During a tour of the home, the carpet in the central hallway area of the new extension was noted as being partially stained. The management told us the home had held a fete on the previous weekend and that visitors had tracked in silt from the garden. Staff we spoke with said that some markings had been there for longer, and that cleaning staff had tried to address these concerns. However, the management informed us after the inspection that this had been addressed by shampooing, and that it had improved the condition of the carpet. They also advised us that a twice yearly steam clean had now also been arranged, with the first clean now completed. One room checked was noted to have an unpleasant odour, which the home was aware of. The management advised us that since the inspection, this odour had now been eradicated, and that the carpet would now be frequently shampooed. In all other areas checked the home was found to be clean, bright, and odour free. Showers and bathrooms checked were found well maintained, clean and hygienic, with suitable bath hoist equipment. Feedback from seven residents said that the home was ‘always or usually’ fresh and clean’. One did not say. One resident told us, ‘I am not able to see properly, but I understand from my visitors that the home is very fresh and clean’. Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. Residents would have their healthcare needs met by adequate numbers of staff who are sufficiently trained to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides places for up to 31 residents, and is divided into 3 sections. The manager told us that the care staffing levels for the morning period (7-2 or 8-2am) was intended as 1 registered nurse (RN) and 6 carers, 2 carers for each section. The rota checked for a 2-week period between the 10th - 23rd August 2008 showed that these levels had been maintained during this period, including during the weekends. Staff levels in the afternoon (2-8pm) were 1 registered nurse (RN) and 4 carers, and at night 1 registered nurse (RN) and 2 carers. These levels were confirmed by feedback received from the staff group. The rotas checked showed that the home did use occasionally use agency staff but more frequently during some of the busy holiday periods when home staff go on annual leave. Positively the home tries to use the same agency staff, so they become familiar with the residents and the layout of the home. There were no concerns about the number of hours or days worked during the week, and the rota showed us that staff received appropriate periods away from work. The home does not actively use long days to cover the day shifts. Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 23 Feedback received from 8 of 8 residents said that staff were ‘always or usually’ available when they needed them, and 7 of 7 staff told us that there were ‘usually or always’ enough staff to meet the needs of the people who use the service. Feedback from 7 of 7 staff members said their recruitment had included employer checks, for example criminal records bureau (CRB) and reference checks, prior to them commencing employment. Staff records checked showed that the home had undertaken criminal bureau records (CRB) and protection of vulnerable adult (POVA) checks, reference and identity checks, to ensure that staff were suitably checked and cleared to work with vulnerable adults. Recruitment records also contained completed application forms; health questionnaires, and employment histories to show they were suitable for the position. One nurse’s records checked showed that the home had checked their professional identification number (PIN) number to evidence that they were currently registered with the nursing and midwifery council (NMC), UK, which evidenced their professional right to practice as a nurse. The home has its own in house training, and so provides induction and foundation training for new care staff members in line with the common induction standards based on the skills for care standards. This provides a programme of assisted and self-directed learning for staff around 6 key core care subjects that are completed within the first 12 weeks of employment. The induction records we checked for one new employee showed that they had received core training that included moving and handling, first aid, fire training, health and safety and infection control, safeguarding adults, and communication training. Information provided by the home and one nurses’ records checked showed us that nursing staff received specialist training which included information on diabetes, risk assessment, oxygen therapy, safety in the home, basic life support and dementia care training. The home recorded that 13 of 26 care staff (50 ) had achieved a national vocational care qualification (NVQ) level 2 or above, with a further 4 currently undertaking this course. This showed us that around half of the staff group had achieved a formal care qualification, and of the home’s ongoing commitment to ensuring a competent and qualified workforce. Feedback received from one care worker said, ‘After completion of the induction, I was encouraged to do the nation vocational qualification (NVQ) training, which comprehensively covered all sections of my role as a healthcare assistant’. Feedback from 7 staff members said that they were given training ‘relevant to their role’, and 6 of 7 staff members said this ‘helped them understand and meet individual needs’ Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 24 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, and 38. Quality in this outcome area is good. Residents will benefit from a well run home that seeks their views about the service provided. This judgement has been made using all the available evidence including a visit to this service. EVIDENCE: Miss Joanne Emms, the manager, is a trained nurse and registered with the nursing and midwifery council (NMC). Miss Emms commenced working in care in 1990 and qualified in 1993. She has held various posts in the public and private sector including experience in trauma and orthopaedics, the deputy and manager’s posts in a nursing home, a junior nurse in a large nursing home, and a school nurse. She was offered the post as the deputy manager of Haughgate House in May 2006 before gaining the managers position. In Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 25 addition to her nursing qualifications, she has completed the ENB adult nursing course, and completed an NVQ Level 4, registered managers award (RMA). Feedback received from relatives about the running of the home included the following views. ‘This is a very well run nursing home, and the staff are excellent’. ‘I have nothing but praise for Haughgate, there are always plenty of staff on duty who are always busy’. The home uses a variety of quality assurance measures to assess if it is meeting peoples’ expectations of the service, and to consider how it can improve the service provision. The home provided us with the results of a quality care survey completed in August 2008. This provided direct feedback to management around how well staff meet the residents’ needs, the meal provision, home activities, the environment, and visitors’ views on the service. Feedback to the home asked what residents most liked about the service and this included some of the following comments. ‘The home is friendly and has helpful staff’, or ‘There is a happy friendly atmosphere’, or ‘The medical care given is very good’. Improvements suggested were ‘sky television’, ‘television noise to be reduced’, or ‘a resident and families forum’. The feedback showed that residents and relatives are included in the quality assurance process, and that the home were aware of what improvements were needed. The information provided by the service (AQAA) confirmed that the home has a range of policies and procedures for staff, which includes health and safety, and financial procedures, which are regularly reviewed. Staff records show that they have received health and safety training including moving and handling, fire procedures, infection control and food hygiene training. This was confirmed by feedback received from staff. The tour of the premises showed that the building was usually well maintained. The home maintained fire check records and undertook weekly hot water temperature checks to ensure that these remained safe for the residents. These were not checked on this occasion. Staff records checked showed the home continued to provide staff supervisions with their line manager. Feedback from the staff group stated that they ‘regularly’ meet their line manager for support and to discuss how they are working. Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 26 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 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x 3 x 3 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations The home should ensure that charts recording specialised nutritional needs, for example body to mass index (BMI) information, are updated to ensure they are aware of a residents changing nutritional status. The home should ensure that new stock medicines issued for a resident, their totals are recorded on their MARS chart. This is to avoid errors and ensure that medicines can be properly audited. The home should ensure that staff sign all resident’s MAR charts after administration of medications, to avoid errors and keep people safe. The home should ensure, as per the home’s medicine policy, that nursing staff underscore the start dates of new stock medicines on the residents’ MAR charts. This is to ensure that staff can audit the residents’ medicines and keep people safe. 2. OP9 3. 4. OP9 OP9 Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Haughgate House Nursing Home DS0000063952.V370207.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!