Inspection on 01/08/08 for Havelock Court Nursing Home

This inspection was carried out on 1st August 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Havelock Court Nursing Home 20/07/09

Havelock Court Nursing Home 06/08/07

Havelock Court Nursing Home 05/09/06

Havelock Court Nursing Home 06/03/06

Havelock Court Nursing Home 18/08/05

Havelock Court Nursing Home 24/03/05

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

CARE HOME ADULTS 18-65 Havelock Court Nursing Home Havelock Court 6-10 Wynne Road Stockwell London SW9 0BB Lead Inspector Sonia McKay Key Unannounced Inspection 1st August 2008 10:15 Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 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 Havelock Court Nursing Home DS0000007024.V368527.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 Adults 18-65. 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. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Havelock Court Nursing Home Address Havelock Court 6-10 Wynne Road Stockwell London SW9 0BB 020 7924 9236 020 7738 6914 enquiries@havelock.ansple.co.uk www.bupa.co.uk BUPA Care Homes (ANS) Ltd 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) Manager post vacant Care Home 60 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Mental disorder, excluding learning of places disability or dementia (0), Mental Disorder, excluding learning disability or dementia - over 65 years of age (0), Physical disability (0), Physical disability over 65 years of age (0) Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. MD(E) up to 5 services in this category PD(E) and DE(E) when the current service users in this category vacate there are to no further admissions into these categories service users who are liable to be detained under the Mental Health Act l983, including Sections 2 and 3, must not be admitted until the relevant Sections are discharged if the number of service users in the category of MD rise above 30, staffing ratios for each shift should be maintained in accordance with the Staffing Notice dated 15 March 2002 for the top floor of the home 6th August 2007 4. Date of last inspection Brief Description of the Service: Havelock Court is a nursing home owned and managed by a care provider called ANS. ANS became a subsidiary of BUPA in August 2005. The home provides nursing care for 60 residents in a purpose built home in the middle of a mixed business and residential area, a few minutes walk from a major shopping centre that has full transport and community facilities. It is set in a no-through road in its own grounds, with a gate entrance and its own parking facilities. The ground floor has the reception area, offices and communal facilities and bedrooms are located on the first and second floors. The ground floor has an activities room, 2 separate lounges, 2 conservatories, one of which is for smoking, 2 dining rooms, and a back garden. There is a passenger lift to all floors, and a keypad system for all communal doors to ensure the safety of residents who may wander. A copy of the most recent Commission inspection report is available in reception. A residents guide to the home is being reviewed and can be requested from the home. Fees range from £995.00 to £1,334.00 per week and depend on the individual care needs of each resident. Havelock Court Nursing Home DS0000007024.V368527.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 1star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection was carried out over three days. Two inspectors visited the service on the first day and one inspector attended on the second and third day. The methods used to assess the quality of service being provided include: • • • • • • • • • • • • • • Talking with the deputy home manager, who is currently acting as the manager of the service Looking at the Annual Quality Assurance Audit document completed by the deputy manager (this document is sometimes called an AQAA and it provides the Commission with information about the service) Talking to staff on duty during the inspection Talking to eight of the current residents Joining residents for lunch on two days A tour of the premises Looking at records about the care provided to five of the residents Looking at records relating to recent staff recruitment and training Looking at the way medicines are handled by staff in the home Looking at issues that the Commission has been notified about since the last inspection and how they were handled Sending surveys to residents, relatives, staff and visiting professionals before the inspection Eleven staff completed and returned surveys Fifteen Residents completed, or were assisted to complete and return surveys A complementary therapist and a relative also completed surveys The Commission would like to thank all who kindly contributed their time, views and experiences to this inspection process. What the service does well: There is a consistent staff team. This means that residents have a chance to get to know them well. There is also a culturally diverse staff team that is reflective of the resident group and the local population. Qualified nursing staff assess the needs of people referred for placement in the home to ensure that the home can meet the persons needs. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 6 Health and nursing care needs are managed well and systems are in place to ensure that residents get the right medication at the right time. Comments from current residents and visitors include: “ It is a loving home”. “ The home does well at managing and providing support and care for residents, many of whom appeared to have challenging behaviours or high degree of care needs regarding physical ability. Most do this with an exceptional degree of patience and often with a smile!” Any complaints about the service are investigated properly and systems are in place to monitor the quality and safety of the service being provided and the home environment. What has improved since the last inspection? What they could do better: Information about the home and the services it provides have been drafted but not yet finalised and distributed to prospective residents. This must be done to ensure that they have adequate information on which to base their decision to use the services of the home. Some residents said that they would like to have known more about the home before they moved in. Senior staff must have a better understanding of how to report safeguarding concerns so that residents are consistently protected by the home and local authority procedures for protecting vulnerable adults. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 7 The home has not had a registered manager for over twelve months. Interim management arrangements are in place. The senior staff have worked well to maintain the service but would benefit from clear and effective leadership. External grounds could be improved so that residents have a pleasant garden area. BUPA are currently working with residents, who vary in age and need considerably, in how to best to arrange the home environment. 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. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. More must be done to ensure that prospective residents have adequate information about the home before they decide to move in. Observations made during the inspection indicate that service is improving. More consideration is now given to using the facilities effectively, with groups of residents that have more in common coming together in communal areas, also sharing similar experiences. Trained nurses assess the needs of prospective residents before placement is offered in the home. This ensures that the home is able to meet a persons needs. EVIDENCE: Senior managers are currently working with managers in the service to revise the statement of purpose and the associated guide for residents. Regulations about the resident’s guide are amended to require greater detail to be included about the standard package of services provided in the care home, the terms and conditions which apply to key services, fee levels and payment arrangements. The guide is also required to state whether the terms and conditions (including fees) would be different in circumstances where a Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 10 resident’s care is funded, in whole or in part, by someone other than the resident. At the time of writing this report there is some progress in producing revised information in a written guide to the service. The required revisions are taking place but the documents are yet to be finalized, published and distributed. They are not currently available in the home. A resident who moved to the home recently said that he did not receive a copy of the guide to the home when he moved in. Another commented, “ I would have loved if I had been given much more information about this home before moving in”. Many residents who completed surveys did not receive and a written guide to the home and thought there should have been better information about the home available to them before they moved in. Copies of the final documents (revised Statement of Purpose and revised Service Users Guide must be supplied to the Commission and all residents on completion. (See requirement 1) It must be noted that residents are not grouped or staffed into clusters. There are two units of 30 beds each and people with varying needs and of varying ages accommodated on each unit. There are two communal lounges on the ground floor, one for each of the units. There are fewer residents over the age of 65 than last year and there is discussion about how the needs of residents with such a wide range in age and need can be better met in this service. One suggestion put forward by the service is to accommodate older residents on one floor and younger residents on the other. This is currently being discussed with residents and staff. Discussion during the inspection indicates that the home will remain as a service for younger adults with nursing care needs. The home is demonstrating progress in meeting individual needs. Staff feel more competent at supporting the resident group, especially people with learning disabilities, and those with sometimes challenging behavioural support needs. Staff spoken with said that specialist training, geared to training staff in understanding the needs of people with a learning disability, had been useful. Staff said they feel more confident in their communication skills as a result. When a local authority refers someone to the service, the home obtains an appropriate range of nursing care and relevant specialist assessments and a member of the qualified nursing team visits the prospective resident to complete a comprehensive needs assessment before a placement is offered. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 11 Prospective residents are encouraged to visit the home before they move in, but this is not always possible as many are discharged directly from hospital into the service. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The residents assessed and changing needs are reflected in the written plans for how they are to be cared for and supported. People are able to take risks as part of maintaining independence and risks associated with health needs and mobility are assessed and recorded regularly to ensure ongoing safety. EVIDENCE: Tracking the cases of five people currently using the service including residents who have lived at the home for some time as well as some more recently admitted. We found that a resident that has lived at the home for some has an up to date care plan in place, appropriate risk assessments are present too. The care plans are developed from the individual needs assessments based on individual goals, aspirations and need. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 13 Case tracking is used to evaluate the quality of the service delivered. The home has made good progress in collating and recording all the information gained from working with individuals and professionals. They use this information effectively and record it in the BUPA documentation (Quest) introduced in 2007. Written plans are comprehensive and reflect the services and support that the home provides to meet the health and personal and social care needs of residents. Plans are kept up to date; also risk assessments are regularly reviewed and amended to reflect changing needs. As well as individual assessment information there are records of the next of kin, social worker, GP and other relevant professionals. There is evidence of involvement of relatives in care planning; also evident is the fact that relatives are kept fully informed on resident’s welfare. Daily records are maintained that confirm the care and support delivered both day and night time in accordance with planned care. The progress of each resident is also discussed at handover. Residents are supported to lead meaningful lives that involve taking risks. Risks are assessed and recorded; records contain information on the appropriate action to take to reduce identified risks. These are held with care plans. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is improving the range of activities available for residents and closer attention is being paid to developing an activities program that better considers cultural needs. Feedback from staff and residents is that they are generally satisfied with the quality and range of meals. Meals sampled during the inspection were good. EVIDENCE: Some of the residents are able to access the community independently. Other people need support and in some cases this is facilitated by one-to-one staffing arrangements. There are also small group outings in a hired mini-bus to places of interest, like the seaside. Some residents also attend external day services and groups either alone or with staff support. There is a small activities room on the communal ground floor. A range of structured ‘in-house’ activities is arranged by an activities co-ordinator. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 15 Examples of activities available include group discussion, life history work, reminiscence, in-house religious services and music, games, quizzes and dominoes, local shopping trips and recreational walks. Some residents also have additional care hours as part of their care package arrangements. In some cases these hours are used to take the resident concerned out into the community. Activities staff maintain a record of individual participation levels. The ground floor communal areas were lively during the inspection. Residents were observed to benefit from the number of activities available. On day one some residents participated in hobbies with the activities coordinator. As part of the care planning, lifestyles are taken into account. The home is striving to have a full and varied activities programme that considers the need of all residents. So far the progress is good. Residents were observed to be enjoying board games, watching television, talking or playing chess with a member of staff. Feedback from residents who commented during the inspection is varied, some were bored and said that staff were too busy doing things for people to spend time just chatting with them as much as they would like. Others were engaged with staff or family and friends and some were sitting alone for long periods with little engagement or interaction. Another resident said that there are always enough activities arranged and he also attends a mens club every week. A member of staff commented that the service could do better by providing more outdoor and in-house activities for the residents. A visiting therapist commented: “ From my limited observation staff appear to take time to find out what residents want and make every effort to do this. However, sometimes Ive noticed that what the residents want to do isn’t always in their own interests safety wise and not possible for staff to provide unless the resident has one-toone attention”. All cultures are celebrated on important and relevant days of the calendar and staff are finding a multi-cultural calendar giving information and advice useful in planning and preparing for events. This is an improvement. Some residents do not speak English and this makes it difficult for staff to interact and find out what they want to do. There are close links with family members in these cases and relatives assist with translation and planning with staff. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 16 There have been a series of daytrips, with residents enjoying trips to the seaside and local attractions. There are regular shopping trips and visits to parks and cafes. On the third day of the inspection the home was celebrating Jamaican Independence Day. A number of residents and staff in the home are of Caribbean background; they spoke of the importance of celebration in people’s lives. The atmosphere was lively as music played. Residents joined in the theme and enjoyed having a good time. Caribbean dishes were also available on the menu. Friends and relatives are welcome to visit and are able to spend time in bedrooms or communal areas of the home. There are also smaller communal sitting rooms that are more private. There are no double bedrooms available. Residents enjoy the meals at the home; residents spoken with find that the food is to their liking. Meals served during the inspection were attractively served and nutritious. Meals are served in two dining areas on the ground floor but residents can eat their meals in their rooms or in the lounge if they prefer. Residents needing assistance with eating a meal were assisted by staff that demonstrated appropriate patience and attentiveness. A selection of the dishes available for the three main meals each day is displayed on menus; these consider the cultural preferences of the resident group. There are also snacks available at night on request. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents receive personal support as they wish, but more should be done to ensure that residents do not stay in stained clothing after meals. Physical and emotional healthcare needs are recognised, recorded and addressed and residents are protected by the homes policy and procedure in regard to safe administration of medications. EVIDENCE: The home provides a good degree of flexibility, for example people get up and go to bed at times that suit them. Individuals are supported with grooming. They choose their clothing and dress in clothes that they feel comfortable in. Smoking areas are available for residents that smoke. Residents receive the support to promote self-esteem but care is needed to attend to issues that could hinder this. An observation was made that a resident had a soiled her top during lunch, the top was not changed during the afternoon. A Recommendation is made for care to be taken by staff to ensure Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 18 that residents are supported to maintain their appearance and to change soiled clothes as necessary. (See recommendation 1) Care plans include guidance on personal care and support that is individualised and that is important in getting the cooperation of the resident. Consideration is given to preference for carers of the same gender. Records are held of consultations with health professionals. Health related issues are recorded and included in risk management. For example a resident at risk of fractures due to medical condition has this information recorded in the care plan and risk assessment. Clear guidance is also recorded on the methods of transfer including the equipment that is used. Also provided is pressure-relieving equipment for those at risk of developing pressure sores. This is identified in pre admission assessments; indicators are that this is continually monitored as part of the care delivery. Three members of staff on the first floor were spoken to about the management of areas of risk to health, and how this achieved It is evident that staff are familiar with the healthcare conditions of residents, are experienced and competent in appropriately managing these conditions. The home has an effective system in place that promotes the health of residents. Records present demonstrate that individuals’ health conditions are continually monitored; also that professional advice is sought promptly and recommendations followed if there are any concerns observed. A GP has a weekly surgery at the home; records show that frequent consultations take place for residents with the doctor. Records were present of a CPA held recently for a resident; this was held alongside the care plan. A small number of residents experience pressure sores. Records are maintained of the care given and progress. As part of the quality control measures in place the home has a robust system in place for monitoring the management of pressure sores and identifying the response to treatment. Records are maintained of daily care of all wounds. Monthly audits are completed to analyse and inform on wound care. These reports are then submitted to head office detailing how and when the pressure sores were acquired, the equipment in use and the response to treatment. For those with diabetes and requiring close monitoring, blood sugar readings are held to confirm that these are monitored in accordance with recommendations. Daily records are consistent; the information is relevant to the individual and reports on the progress of the individual and the support given by staff. . Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 19 We looked at fluid balance charts for two residents. The daily records included details of all liquids consumed. The output section was not always completed satisfactorily, however the daily records did confirm this, and it was not cross referenced to the balance chart. Residents spend much of the time in the lounge downstairs during the day, but the fluid charts are held in the office upstairs. It is recommended that staff use the fluid charts effectively for residents and cross-reference them with other daily records. (See recommendation 2) Medication profiles are in place for residents. The trained qualified nurses administer all prescribed medication. The medication procedures were examined. The home no longer experiences problems with receiving medication stocks. Medication trolleys were observed to be attended to at all times when in use. Records show that anti viral medication and controlled drugs are regularly audited. Medication received into the home is checked and recorded. We looked at the medication records and the medicine supply for three residents. There were no gaps in the medication administration sheets. All were signed and dated to indicate that correct dosage was given. On checking the medication stock present for three residents there was a discrepancy with the stock of paracetamol for one resident. This was accounted for on the rear of the MAR sheet, tablets were destroyed on two occasions but recorded as refused on the front sheet, and this caused the discrepancy when totalled. A recommendation is made. Staff should make sure that correct codes are used at all times on medication administration records. The home has now introduced a system to regularly audit and spot check on all medication stock. On day three of the inspection this was checked again and found to be an effective tool in monitoring that medication is being administered correctly. Comment is received from a visit in therapist include: “ Whenever I have expressed concerns about physical or emotional/mental well-being of residents I see, they have always been acted on”. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The views of the residents are listened to and acted upon and there are opportunities for residents to raise concerns informally as well as to make formal complaints, although there could be better record of the feedback given to a person making a complaint so that this can be monitored. Systems are in place to protect residents from abuse, neglect and self harm although occasional failure to consistently follow reporting procedures could lead to failure in providing swift and adequate protection to vulnerable residents. EVIDENCE: The AQAA (Annual Quality Assurance audit) states that BUPA has a three-tier framework for dealing with complaints. This means that complaints can be resolved within the home, or at a regional and national level with input from Quality managers. The home has a clear and effective complaints procedure that meets the requirements of regulation. There is also a record of complements and concerns. Information about how to make a complaint is available is displayed in the home. Comments received from residents indicate that they know how to make a complaint if they wish do so. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 21 The record of complaints and how they were investigated was examined and showed that a record is kept and monitored by senior managers. Records show that complaints are investigated properly and appropriate action taken to address any issues identified. There could be better recording of the method of feedback to the complainant, as this has not been recorded in all cases. (See recommendation 3) There are policies and procedures in place for responding to allegations of abuse or neglect. Any issues or complaints that have safeguarding implications are recorded in a separate folder. A copy of the local authority safeguarding adult’s procedures are available for staff reference. Procedures are in place for responding to suspicion or evidence of abuse or neglect. The home manager is aware of the need to refer staff that may be unsuitable to work with vulnerable adults under P.O.V.A protocols. There are currently two safeguarding investigations underway. One investigation is in regard to an allegation made by a resident and another in regard to an allegation of suspected abuse. In the first instance the local authority made the home manager aware of an allegation against a member of staff and an investigation is underway. The local authority safeguarding adults team were notified but the Commission was not notified until the second allegation was being discussed some weeks later. (See requirement 2) In the second instance an allegation that was previously investigated and unsubstantiated was repeated. The acting home manager had contacted the local authority mental health team but not the safeguarding team. The home manager sought advice from the Commission about what should be done, as she was not comfortable in assuming the allegation was unsubstantiated. The Commission advised that safeguarding procedures should be followed. The safeguarding team has now been advised and an investigation is underway. This is evidence of lack of clarity in reporting safeguarding issues which may result in delay or failure to report, delay in investigation or inappropriate investigation by the home. This could lead to poor outcomes for vulnerable adults. (See requirement 2 & recommendation 4) Some residents can have challenging behaviour on occasion, including aggression towards others. Most staff have been trained in ‘breakaway techniques’ and de-escalating challenging situations. Some staff said that they feel more confident and able to deal with potentially challenging situations now. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 22 The home reports incidents and injuries to the Commission in a timely manner and local authority care managers are also kept up to date. Residents whose bank accounts are managed by the home accrue interest on their savings. Records indicate safe handling and checking are in place. However, residents do not receive monthly statements. (See recommendation 5) Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home environment is improving. It is situated close to local shops and transport links. EVIDENCE: The ground floor provides communal areas, staff offices and the kitchens and laundry room. The first and second floors provide bedrooms and bathing facilities. The purpose built home is suitable for its stated purpose and is accessible but is in need of refurbishment in some areas. The home was noted to be clean and tidy and there were no unpleasant odours. The home is accessible to people who use wheelchairs, although there are no areas of the home for residents. BUPA estates management has undertaken a review of the premises and the home is currently undergoing major refurbishment work. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 24 Communal areas of the home are redecorated and are much brighter. There are now two large decked areas leading from the communal lounges and patio furniture is being delivered soon. A passenger lift broke down on one occasion since the previous inspection. The home manager said that the replacement motor had proved reliable since. The reception area has been redecorated after a water leak caused damage to the décor. The garden areas are untidy at present but there are plans to improve them once the refurbishment of the building is completed. There is a conservatory with an extractor fan for people who wish to smoke. During a previous inspection, it was noted that there is inadequate storage space on the first and second floors and bathrooms and shower rooms were being used to store wheelchairs, trolleys, hoists and large quantities of continence aids. A requirement was made about this and two vacant bedrooms are being used as storerooms as a temporary measure. This does not resolve the problem. (See recommendation 6) During the previous inspection it was noted that one bedroom had a bad odour of urine. The home manager has taken steps to reduce the impact of some challenging behaviours by liaising with local authorities to find better floor coverings. This has improved the freshness of the bedroom and communal corridor nearby. A requirement made in this regard is therefore met. All bedrooms are single occupancy, have lockable doors and meet the standards for minimum space requirements. Most bedrooms are personalised and all rooms have en-suite washing facilities. There are three communal bathing areas on the first and second floors of the home. Each floor has two shower rooms and an assisted bathroom. There is good access to local amenities, local transport and relevant support services. CCTV cameras are in use for security purposes but are restricted to the exterior of the building and entrance areas for each floor and so do not impinge on the daily life of residents. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a consistent staff team and an improving training programme. Senior staff would benefit from more frequent supervision. Recruitment procedures provide residents with protection. EVIDENCE: There are team of qualified nurses and trained carers. There are also administrators, laundry operatives and kitchen staff. There is a receptionist and a repair and maintenance person. Each department has a head that reports to the home manager and deputy home manager. The residents benefit from having a consistent and reliable staff team. Six new staff members were recruited in the past twelve months. These included nurses, bank care staff and ancillary staff. The personnel files for all of these staff were examined. Recruitment procedures are good and confirm that staff are vetted thoroughly. Appropriate documentation is held along with completed application forms. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 26 There are occasions when staff have little work experience and participate in training with local small training providers. For one new staff member, no longer in employment, a reference was sought from one such training agency. It is recommended that references from high street private training centres are also supported by additional professional references where possible. (See recommendation 7) The home provides a wide range of training. At the start of employment all staff complete the induction programme, induction provided is developed according to the role of the staff member, should it be nurse or carer. Staff receive mandatory training as part of the induction programme. A workbook is completed in the first two months to verify competencies and topics covered. The training needs of staff are recognised and provided for. Available and displayed on the office notice board is a record of mandatory training completed by each member of staff, mandatory training is up to date. This covers 2007-08 periods. In addition staff receive training in response to the needs of the user group. Staff undertook training in communication skills, understanding how to support people with learning disabilities and also covered are management of challenging behaviour. BUPA can support carers to undertake a vocational qualification in providing care (NVQ). Fifteen of the twenty-seven carers have already achieved the award and a further four carers are completing the course. Others have expressed interest in beginning the course. Nursing staff have also participated in training and development provided by the Care Home Support team. There is also a culturally diverse staff team that is reflective of the resident group and the local population. The majority of staff receive regular one to one supervision. Team meetings are less frequent. Minutes of the last two team meetings were seen. (It is recommended that team meetings be held more frequently and senior staff members should receive regular supervision. (See recommendations 8 & 9) A visiting therapist commented: “ The home does well at managing and providing support and care for residents, many of whom appeared to have challenging behaviours or high degree of care needs regarding physical ability. Most do this with an exceptional degree of patience and often with a smile!” Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 27 “ From my observations the majority of staff to their best to maintain individuals privacy and dignity”. Comments from staff include: “ Clients change, ethnicities change and needs change so we do training from time to time” “Staffing levels and sick payments could be better!” “They should employ more staff to provide a better service for clients”. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The service will benefit from a period of management stability but is generally well run. Systems are in place to ascertain the views of residents and others and there are plans to use this feedback to inform changes in service. There are also systems to ensure environmental health and safety. EVIDENCE: The most recently appointed home manager joined the service in December 2006 but took up an alternative position with BUPA earlier this year. He is a Registered Mental Nurse (RMN) and qualified manager and trainer. He is currently supporting the deputy home manager to act up as manager by visiting the home each week. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 29 The registered managers post is currently vacant. A new manager was being interviewed and appointed at the time of this inspection. The area manager has also recently changed. Feedback from staff during this inspection indicates that some have found the frequent changes in management difficult at times. BUPA undertook the first audit of this service in 2006. Significant improvement in the physical environment has been a priority as a result. The audit included consulting with residents to find out what they think of the service. BUPA are in the process of introducing a new quality monitoring system. This will include a full annual audit of all areas of the service provided. BUPA care homes have achieved ‘Investors In People’ accreditation. The home manager has overall responsibility for ensuring staff receive appropriate health and safety training applicable to the area of the home they are working in. The maintenance manager monitors environmental health and safety. A written assessment of hazardous substances is in place. Safety instructions are posted on doors if necessary. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 X X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 2 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 2 X 3 X X 3 X Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 31 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 YA1 Regulation 4&5 Requirement The Statement of Purpose and Service Users Guide to the home must be revised to include all information required by current Regulation. Copies of the revised Statement of Purpose and Service Users Guide must be supplied to the Commission by 2. YA23 37 The registered person must notify the Commission, without delay, of any allegation of misconduct by the registered person or any person who works at the home. 30/09/08 Timescale for action 19/12/08 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 YA19 Good Practice Recommendations Staff should ensure that residents are assisted to change their clothing if they become stained or soiled during DS0000007024.V368527.R01.S.doc Version 5.2 Page 32 Havelock Court Nursing Home 2. 3. 4. 5. 6. 7. 8. 9. YA19 YA22 YA23 YA23 YA24 YA34 YA36 YA36 daytime activities or mealtimes. Staff should use the fluid charts effectively for residents and cross-reference them with other daily records. Managers should retain records of feedback given to complainants about the outcome of any investigation. Senior staff should familiarise themselves with notifications and adult safeguarding procedures to ensure that procedures are implemented consistently. The registered person should provide residents who bank via the home with monthly statements, unless risk assessment suggests otherwise. The registered persons should consider ways in which the storage areas can be increased on the first and second floors of the home. It is recommended that references from high street private training centres are also supported by additional professional references where possible. Team meetings should be held more often. Senior staff should be supervised more often. Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Havelock Court Nursing Home DS0000007024.V368527.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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