Inspection on 20/07/09 for Havelock Court Nursing Home

This inspection was carried out on 20th July 2009.

CQC 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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Havelock Court Nursing Home 01/08/08

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 16/02/2010.

Key inspection report 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 20th July 2009 09:30 Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Havelock Court Nursing Home DS0000007024.V374894.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.V374894.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 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. There is an activities room, 2 lounges, each with a decked area and a conservatory, 2 dining rooms and a back garden with an area for people who wish to smoke. 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 folder of useful written information about the home is available at the home and on request. Fees start from £950.00 per week and depend on the individual care needs of each resident. Havelock Court Nursing Home DS0000007024.V374894.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 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection was carried out over three days. The first day there were two inspectors and a specialist pharmacist inspector. On the third day there were two inspectors and a Local Area Manager for the Commission. The methods used to assess the quality of service being provided include: • • • • • • • • • • • • • • • Talking with the home manager Looking at the Annual Quality Assurance Audit document completed by the manager (this document is sometimes called an AQAA and it provides the Commission with information about the service) Talking with staff on duty during the inspection Talking with some of the current residents Talking with a visiting GP Talking with other visiting health professionals Talking with a relative Having lunch and observing mealtime arrangements with the residents at the home A tour of the premises Looking at records about the care provided to some 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 Getting feedback from the Local Authorities, who place residents in the home Sending surveys. Surveys were completed and returned by 8 residents, 1 relative, 4 staff and 2 health professionals The Commission would like to thank all who gave their time, views and experiences to this inspection process. What the service does well: The home is purpose built and suitable for its stated purpose. All residents have single bedrooms with en-suite bathrooms. The aspirations and care needs of prospective residents are assessed before they are admitted to the home. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 6 The assessed and changing needs of each resident are reflected in a written plan for how they are to be cared for and supported, and residents are able to take risks as part of maintaining as much independence as possible. Risks relating to healthcare needs are well documented and reviewed regularly. Residents are able to develop and maintain their friendships and relationships whilst living in the home. There are a range of in-house activities for people to take part in and a small, but dedicated, team of trained staff to assist in planning and organising activities and outings. The home is generally clean and tidy and warm enough. Meals are prepared hygienically and they are generally enjoyed by the residents. The healthcare needs of prospective residents are carefully assessed before they are admitted to the home, and a local GP visits the home each week to conduct a surgery. The GP is satisfied that the healthcare needs of the residents are being addressed and met. Healthcare needs are well met and the service works well with external health professionals. Staff are following the homes procedures by ensuring medicines are given safely. A health professional commented, The home copes well with a wide mix of residents with regard to race, nationality, ethnicity, age, physical and mental disability, especially as some of the residents exhibit challenging behaviour regularly. Carers and nurses seem to manage well. Staff are well trained and supervised regularly A relative commented, The home is good at providing information and also keeping our family updated when my aunt is admitted to hospital. What has improved since the last inspection? A relative commented In general the staff are very helpful and caring. The general upkeep and cleanliness have improved greatly. There is now a colourful newsletter about the home that residents are invited to contribute to. One resident contributed a cake recipe and a group of residents were assisted to prepare the cakes. Since the last inspection the new home manager has worked with the current resident population and staff to re-configure the service. This was because of a wide range of age and need. As a result of this review, residents have been divided into two groups. People living on the first floor are now generally younger and physically able and people accommodated on the second floor Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 7 may be older and/or have physical disabilities. Two of the residents did not wish to move bedrooms and their decisions were accepted. There are better records about what action the home takes when someone makes a complaint. The home environment continues to improve with the ongoing refurbishment programme underway. Attractive outdoor space is being enjoyed. Quality assurance systems, based on seeking the views of residents and other stakeholders are being increasingly introduced. What they could do better: Prospective residents and their families have adequate information about the home and the services it provides. Although some additional information is required in the Service Users Guide A member of staff commented There could be better communication between management and staff. A resident commented They should get more staff and change the menu. More must be done to ensure that residents who need help are given appropriate assistance with eating and drinking. There should be more opportunities for people to prepare some meals or snacks for themselves and there must be better records of all the meals served, as meals prepared to meet peoples cultural needs are not well recorded. A relative commented I very rarely get any updates from the care home regarding my aunts medical status. How she is progressing with her medication or how she is coping - unless I ask. I would love to know more about my aunts progress. A health professional commented There has been a large turnover of home managers and acting managers in the past 12 -24 months who often seem to change direction/policy, there needs to be consistency. There doesnt appear to be sufficient staff to follow through with residents on exercises given by the Occupational Therapist or Physiotherapist. Visits to religious services seem sporadic due to lack of care staff and there appears to be few male staff, which may be an issue for some male residents. And, There doesnt appear to be sufficient staff to follow through with residents on exercises given by therapists. There are some gaps in the monitoring of peoples health issues, such as diabetes, which must be improved. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 8 Some residents are currently confined to their bedrooms because they do not have the mobility aids required for them to move around the home, this impinges on the quality of their day to day lives. Residents can be part of their local community although staff support is limited and community access is not provided on a regular basis in some cases. Residents, who receive one to one care and support as part of their package of care, may benefit from staff being better advised on how this time should be used. There is adequate support with personal care and grooming. Some people may need a more help than they are currently getting. More must be done to ensure that people have the aids and adaptations that they need and that personal care takes places in private and in a dignified manner. More should be done to make sure that each resident knows what to do if they wish to make a complaint, as four out of nine people surveyed said that they did not know how to make a complaint. There is policy and procedure in place in regards to keeping people safe from abuse and whistle blowing; staff are also trained in these areas. However, there is concern that the provider is not working effectively with the local authority in regards to a recent complaint and ensuing safeguarding investigation. Effective joint working is essential in protecting people. More must be done to ensure environmental safety and there are ongoing problems with repairs in some of the bathing areas. Odour control is an issue in some areas of the home. Recent recruitment records do not meet required standards in some cases and must be improved. Professional references for staff need to reflect their previous employment record and should be from previous employers Care must be taken to ensure that the home maintains the correct skills mix of staff at all times. Cuts made for economic reasons must not affect the safety of the residents. Any staffing changes must be made after individual nursing and care needs are properly assessed. The residents and staff will benefit from a period of management stability, as there have been numerous changes in recent years. Systems are place to promote health and safety, but there must be better monitoring of the state of repair of fire doors and window locks. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 9 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 10 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.V374894.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 2. Standard 6 is not applicable. People using the service experience Good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their families have adequate information about the home and the services it provides, although some additional information is required in the Service Users Guide. The aspirations and care needs of prospective residents are assessed before they are admitted to the home. EVIDENCE: There is a BUPA folder called Useful Information that provides current and prospective residents with information about the home and the services provided. The statement of purpose is one of the documents included in the folder and it provides information about the home, the staff, and key policies and procedures. The statement of purpose has been revised to include information about the new manager and staff and identifies that the home will increasingly focus on its services for people with a mental disorder and those with physical disabilities, between the ages of 18 and 65. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 12 Since the last inspection the new home manager has worked with the current resident population and staff to re-configure the service. This was because of a wide range of age and need. As a result of this review, residents have been divided into two groups. People living on the first floor are now generally younger and physically able and people accommodated on the second floor may be older and/or have physical disabilities. Two of the residents did not wish to move bedrooms and their decisions were accepted. As required in the previous inspection report, some additional information is still needed in the information pack (Service Users Guide) in accordance with minimum standards and changes in the Care Homes Regulations in regard to information about fees. The guide does not state the cost of the basic package of care at the home and it does not state whether the placement fees are the same for both private and local authority funded places. A copy of the most recent Commission inspection report should also be added to the guide. This should be done to ensure that prospective residents and their families and friends have an independent view to consider when choosing a care home. There should also be contact information for the local social services and healthcare authorities. This information may be of use to residents and their families and friends. At the time of this inspection there are 45 people living in the home and 15 vacancies. Residents are admitted on the basis of an assessment of their needs. Full needs assessments are obtained from referring local social services and health authorities. This allows the home manager to make an initial assessment of the homes ability to meet the persons needs. The manager, or other senior nursing staff, then visit the prospective resident to conduct the homes own assessment of need. Residents and their relatives are invited to visit the home where possible, although people are often admitted directly from hospital and this is not always possible. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessed and changing needs of each resident are reflected in a written plan for how they are to be cared for and supported, and they are able to take risks as part of maintaining as much independence as possible. EVIDENCE: We looked at care plans for eight residents during this inspection. All are up to date and contain useful information about the changing care needs of the residents. The nurses act as key workers and develop specific care plans for all areas of need identified in regular assessment, for example one resident is noted to eat quickly so there is a related care plan to ensure that his food is cut into small pieces. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 14 Each plan contains a brief life history where possible (if the information is available) and information about social care and health needs. Residents and their relatives are encouraged to take part in developing these plans and there is a space for them to sign their agreement to the planned care and support. There are plans for each area of health and social care required and regular assessment of risks relating to nutrition, risk of falls and tissue viability. Social care needs are also planned for and there are specific sections that have information about what people like to do and their hobbies. Care plans and needs assessments are checked regularly by the managers and quality assurance teams. Nurses are given written feedback about the quality of the plans checked and any additional information that is to be added. Night care assessments include looking at whether bed rails are needed to prevent people from falling out of bed. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 15 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): This is what people staying in this care home experience: 12, 13, 14, 15, 16 & 17. People using the service experience Adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to maintain their friendships and relationships whilst living in the home. If they are able to go out by themselves they can have a lifestyle of their own choosing. Emphasis must be placed on improving the lifestyles of those who needs more assistance or who lack the mobility aids needed to enjoy a fulfilling life. Meals are prepared hygienically and they are enjoyed by the residents. More must be done to ensure that residents who need help are given appropriate assistance with eating and drinking. There should be more opportunities for people to prepare some meals or snacks for themselves and there must be better records of all the meals served. EVIDENCE: Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 16 Some of the residents are able to access the community independently. Most people need support and, in some cases, this is facilitated by one-to-one staffing arrangements. Staff also support small groups of residents to local shops and cafes and there are daytrips to places of interest, for example a rip to the seaside was arranged this summer. 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. 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 out into the community. Activities staff maintain a record of individual participation levels and produce activity reports for care reviews. We noted that staff who provide one to one support for some of the residents, do not always have a plan for how the time and extra support should be utilised. Staff delivering one to one care and support would benefit from advice and input from the activities co-ordinator as to how this time could be utilised. 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, some residents are now involved in maintaining and planning the newly refurbished garden area. There is a monthly plan for activities and examples of activities include: • Aromatherapy • Arts and crafts • Movie matinees • Quizzes, Bingo and games • Manicures and beauty makeovers • Food tastings • Garden picnics • Topical discussions and reminiscence • Musical events, such as Nat King Cole and Frank Sinatra days • Karaoke • Birthday celebrations and parties • In house religious services and singing The activities team fund raise by having table sales of small items, such as plants and arts and crafts, to staff and visitors. The activities co-ordinator is enthusiastic and strives to arrange culturally appropriate activities for the diverse resident population, for example, one resident is Rastafarian and the activities co-ordinator is developing links to a local support group of friends. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 17 All cultures are celebrated on important and relevant days of the calendar and staff are finding a multi-cultural calendar that provides information and advice useful in planning and preparing for events. There is now a colourful newsletter about the home that residents are invited to contribute to. One resident contributed a cake recipe that a group of residents were assisted to prepare the cakes. It is harder for some residents with physical disabilities to engage in activities or to socialise and go out as they do not have wheelchairs at this time. Friends and relatives are welcome to visit and are able to spend time in bedrooms or communal areas of the home. Residents can have their visitors join them for a meal in the home, for which a small charge is made. Meals are served in two dining areas on the ground floor but residents can eat their meals in their bedrooms or in the lounges if they prefer. On the first day of the inspection we had lunch with the residents. The food was enjoyable and well presented. Staff are on hand to assist residents to eat, but at times the staff need to be more observant. One resident was struggling for some time to cut up their chicken. This was not noticed by carers. When this was pointed out to staff they went immediately to help but by this time the resident had lost interest in the food, although they did eat a pudding. Residents eating and sitting positions need to be reviewed generally. We noticed several residents were not in a good position to eat their food. Some were not pushed up to the table and some were not sitting in a good upright position to eat their meal comfortably. On the third day of the inspection we again observed mealtime arrangements. Table layout was poor in one dining room, making it difficult for residents, some of whom use wheelchairs, and assisting carers to move around the room. The manager contacted us after the inspection to tell us that the layout of the dining room tables had been reviewed and changed to make access easier. We noted that there were no drinks on the dining tables. One resident requested a drink. He waited at least 10 minutes before it arrived and then it was a small glass which he downed quickly and wasn’t offered a refill. There were two different types of fruit squash available but he was not offered a choice. There is no provision for residents to help themselves to drinks. The resident was given a large piece of chicken which he was unable to cut up and he gave up when it proved too difficult. He requested ice cream for desert but again he was unable to cut the ice cream up into smaller pieces and he nearly dropped the whole of it onto the floor whilst trying to eat it in one piece from his spoon. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 18 There was little verbal information given to residents about what menu choices were available or what they had been given. The standard of cooking is good and meals are served hot. There is a large catering style kitchen that is well equipped and has a four star hygiene rating. The chef meets all new residents to discuss their meals preferences. Cultural needs are considered and the chef said that a range of cultural alternatives are prepared but not always documented in records and menus. By the third day of the inspection that chef had re-drafted the menus to highlight the cultural options that are available. Snacks are available, on request, throughout the night, for example, sandwiches. Residents do not have access to a kitchen to prepare their own meals or snacks, but the activities co-ordinator is encouraging people to take part in snack preparation and cake mixing. Residents would benefit from an opportunity to cook for themselves as part of their rehabilitation. Meal times are fixed with snacks available in between or at night if requested. There are small serving kitchens on the first and second floors. These kitchens are used to serve breakfasts sent up from the main kitchen. There are no facilities for residents to make their own meals, snacks or hot and cold drinks. Residents can choose when to get up and when to go to bed, and they have access to all communal areas of the home. The main entrance and passenger lift have a keypad code system as some residents would be at risk if they went out alone. Other residents, assessed as being able to go out alone, know the security code to get in and out of the building and the passenger lift between floors. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is adequate support with personal care and grooming. Some people may need a little bit more help than they are currently getting. More must be done to ensure that people have the aids and adaptations that they need and that personal care takes places in private and in a dignified manner. Healthcare needs are generally well met and the service works well with external health professionals. There are some gaps in the monitoring of peoples health issues, such as diabetes, which must be improved. Staff are following the homes procedures by ensuring medicines are given safely. Recommendations are made for improved storage temperature checks, record keeping and actions to be taken when a prescribed medicine is unavailable fro the pharmacy. EVIDENCE: The home provides residents with a good degree of flexibility, for example people get up and go to bed at times that suit them. People are supported with their personal grooming where necessary, and the nature of the support Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 20 required is detailed in a specific care plan. A hairdresser visits the service once a week and staff were observed to assist people with hair plaiting and personal grooming. Consideration is given to the gender of staff supporting personal care. The bathroom and shower room facilities are in need of review as there is no shelving or hooks to store clothing and toiletries. We observed one female resident being supported out of a shower room and along a communal hallway with only a towel wrapped around her. This is not respectful of her dignity. We discussed this with the home manager during the inspection and she contacted a member of maintenance staff to put some shelves and hooks up in the bathrooms and shower rooms. We received comments from a health professional that some residents do not have the aids that they need, specifically wheelchairs. During the inspection we found that two residents were unable to leave their bedrooms because they did not have personal wheelchairs and there are no general use transfer chairs available in the home. These residents are having their meals and personal care in their bedrooms. This is unacceptable. The home must seek specialist advice about the type of aids needed and these items must be provided. The community wheelchair assessors visited the home on the third day of the inspection and explained that residents do not automatically qualify for free wheelchairs unless certain criteria are met. Many Havelock residents would not meet the current eligibility criteria. There is expectation that a nursing home should have a range of such mobility equipment available to enable the residents to move around the building, use the communal facilities and socialise. A member of staff explained that some of the residents are too tall to sit comfortably in the shower chair available and that there should be a variety of chairs available to suit peoples individual size, need and preference. There is no hoist or bath chair for the bath, so the bath can only be used by the able bodied. Residents with physical mobility needs can only be provided with a shower (if they are able to get to the shower room) or wash in their bedrooms. Feedback from a local authority contracts monitoring team indicates that more could be done for people who have some ability to self-care as they had found that staff are not monitoring or prompting the replacement of items such as toothbrushes and toiletries. Given that some of the residents also have a cognitive impairment this type of monitoring and assistance should be considered and provided, where necessary. Records relating to healthcare needs are generally in good order and there is evidence that nurses contact external health services as required. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 21 A GP from a local practice was conducting a weekly surgery on the first day of the inspection. He gave positive feedback about the abilities of the nursing team and their effective management of the residents healthcare. He said that the staff are good at keeping him informed about healthcare concerns and any falls, even if the resident had apparently sustained no injury. The Primary Care Trust have arranged for the GP services to be provided by another local group practise and residents will be signed up with the new practice shortly. A specialist community nursing team also visited some of the residents during the inspection and they also gave positive feedback about the healthcare of the people they were visiting. They said that in spite of frequent management changes, the care team were dedicated and the head of nursing had done a fantastic job in training and developing the team to meet the healthcare needs of the residents they visit. Records are held of consultations with health professionals. Health related issues are recorded and included in risk management. We saw evidence that residents are given access to an appropriate range of healthcare services, for example, chiropody, physiotherapy, dental care and podiatry. Another healthcare professional commented, in regards to the services ability to respect peoples privacy and dignity, that staff ,Sometimes need to be more aware of using curtains in bathrooms, even if doors are closed, and knocking and waiting before entering residents rooms (especially non-care staff). There is also concern that the home Seems to have difficulty in accessing external help from the NHS and Social services and in accessing equipment such as wheelchairs, walking sticks, hospital beds and the services of an Occupational Therapist. And also, There doesnt appear to be sufficient staff to follow through with residents on exercises given by therapists. The occurrence of pressure sores is well documented and photographs are taken as wounds are noted and treated. People often return from hospital with pressure sores and these wounds are recorded and photographed immediately. We looked at how blood sugars were being monitored for one resident who is diabetic. The blood sugar levels are meant to be checked daily. We noted that there were no records of checks for three days in the two months preceding the inspection. There is no record of why these checks were not done. Blood sugar levels must be monitored as required. We inspected medication records, medication storage areas, training for staff, and observed staff giving medicines to residents. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 22 At this inspection, evidence from medication records and storage areas showed that the home is meeting the medication standard. We observed staff giving medication and completing medication records accurately, providing evidence that staff are following the homes procedures, ensuring medicines are given safely. Records are kept of the receipt, administration and disposal of medicines, and inspection of these together with stock checks showed that the home can account for all medicines held on behalf of residents. Staff have recently had refresher medicines training provided by the supplying pharmacy which they said was useful. One resident is being supported to store and take her own medicines. A risk assessment is in place to make sure this is safe and this is being reviewed regularly. One resident is having medicines added to food as they are refusing necessary medicines. The GP, pharmacist and next of kin have agreed this, and there is a written record of this. The resident has recently had some instances of challenging behaviour which is out of character, and there was evidence that a referral to the mental health team has been made. Medication records together with stock checks showed that residents are receiving their medicines on time and as prescribed except in 4 instances. Four prescribed medicines had not been available at the home in July for between one dose and 7 days. The Manager has started a log book where staff note when prescriptions are not received from the GP or medicines are not received from the pharmacy. There was evidence that staff had been in regular contact with the pharmacy to try to obtain these medicines. The pharmacist confirmed that these had been out of stock at the wholesaler. As the outcome for residents is still that medicines have been missed, the home must speak to the prescriber to get an alternative medicine prescribed if there are long term supply issues. Controlled drugs are being stored and recorded accurately. Stock checks showed that these are being used as prescribed. Quantities are checked at each handover to ensure no misuse. There are some minor improvements needed to the register: -the name of the resident and the controlled drug must be added to the top of every page used -the number of the pages used must be added to the index at the front of the register. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 23 The temperature of the clinical rooms and fridges are being monitored to ensure medicines are kept at the right temperatures and remain fit for use. The clinical room temperatures are all within range. Two of the clinical fridge thermometers are not reading accurately. The maximum temperature over 24 hours read 22C and 26C on the day of the inspection instead of between 2C and 8C. This should be investigated. For one medicine, warfarin, the anticoagulant clinic had changed the dose in April 2009, however the medication chart had not been changed to reflect this. Staff were giving the correct amended dose. If the GP or clinic makes any changes, and the medication charts are received with the old information, staff must make these amendments by hand, and sign and date with a reference to who made the change and when. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints procedure, although some residents said that they did not know what to do to make a complaint. More should be done to make sure they understand what to do. There is policy and procedure in place in regards to keeping people safe from abuse and whistle blowing; staff are also trained in these areas. However, there is concern that the provider is not working effectively with the local authority in regards to a recent complaint and following safeguarding investigation. Effective joint working is essential in protecting vulnerable people. EVIDENCE: There is a written complaints policy and procedure that meets the minimum standards and regulatory requirements. The complaints procedure is posted in the reception area of the home and it is in the written guide to the home. Records of formal complaints are maintained in the managers office. There are also hard backed books on each floor of the home for staff, residents and visitors to record any concerns and/or compliments. The home manager checks and signs these books regularly and follows up on any concerns raised. Complaints will also now be looked at as part of the homes monthly quality assurance monitoring. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 25 The Annual Quality Assurance Audit (the document, sometimes called an AQAA, that the provider completes to provide the Commission with information about the service) states that the manager has an open door policy. Her office is located in the reception area of the home so that she is more accessible and visible to residents, staff and visitors. Concerns are also discussed in review meetings with individual residents and their families and in group meetings for relatives and residents. Of nine people who commented in surveys, four said that they did not know how to make a complaint and five said that they did. Given the variety of language, sensory and cognitive differences within the current resident population, more could, and should, be done to ensure that each resident not only has access to appropriately written information, but also that they understand the information and know what to do if they want to make a complaint. As recommended in the previous inspection report, there are better records of the complaints that have been made and how they have been dealt with and the home is working with the local authority to identify any deprivation of liberty issues. A booklet outlining the local authority procedure for safeguarding vulnerable adults is available on each floor of the home for staff reference. Staff receive training in abuse awareness and safeguarding procedures. There is a policy for Whistle-blowing in place. Recruitment checks include verification that applicants are not on the register of people who are, because of previous concern, prohibited from working with vulnerable adults and there is also an enhanced check for any criminal record. There are policies in place to protect residents from financial abuse. Some residents manage their own finances. BUPA have gradually changed the way that residents money is managed on their behalf. The homes administrator is no longer the financial appointee for any of the residents and local authorities are required to undertake this role if a next of kin or other appointee is not available. The administrator is responsible for contacting the appointees to request cash top ups and statements. Money held in safekeeping is deposited in a Clients Deposit Account. Individual balance sheets are drawn up each week. This means that residents may not be able to make larger cash withdrawals without giving the home administrator some notice. We looked at records relating to a sample of recent cash withdrawals and transactions. Each is signed by the resident and two members of staff. The safekeeping of valuables documents is also recorded. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 26 There are records of four completed safeguarding investigations undertaken by the local authority since the last inspection. One investigation, in regards to resident on resident aggression, was substantiated and resulted in a resident being asked to leave the home. Three other investigations in regards to abuse were inconclusive. In June 2009 a resident made a complaint about a member of staff. This resulted in the local authority undertaking a safeguarding investigation. The local authority notified us that they have placed an embargo on the home. This means that they are not currently referring anyone new to the home for placement and they are advising other local authorities of the embargo also. They advised that they have taken this action as they are not satisfied with the actions taken by the provider during, and in regards to, the ongoing safeguarding investigation. We are writing to the home about this. As required in the previous inspection report, the staff have got better at ensuring that the Commission is notified of significant events that have happened in the home. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29 & 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home environment continues to improve with the ongoing refurbishment programme underway. Attractive outdoor space is being enjoyed. However, more must be done to ensure safety and there are problems with some of the bathing areas. Odour control is an issue in some areas of the home. EVIDENCE: As part of the inspection we had a tour of the premises. 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 to people who use wheelchairs. The home is close to high street shopping, leisure facilities, public transport and relevant health services. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 28 The home was noted to be generally clean and tidy. There is a reception area and receptionist. There is a new board with staff names and their photographs. BUPA estates management undertook a review of the premises when they took over and the home has been undergoing a major refurbishment programme as a result. Communal areas of the home are redecorated and are brighter. There are two large decked areas with patio furniture leading from the communal lounges on the ground floor. Two vacant bedrooms have been turned into small communal television lounges. This means that residents have a wider choice of communal area to spend time in, and one that is smaller and closer to their bedroom. The garden areas are improving and provide a small but pleasant outside space, which residents are encouraged to take part in planning and maintaining. There is still inadequate storage space for equipment on the first and second floors. Two vacant bedrooms are being used as storerooms as a temporary measure. This does not resolve the problem. 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 toilet facilities. The home is in a densely populated residential area and is overlooked in parts. The bedroom windows have curtains but no nets or blinds. Privacy and dignity may be compromised. There are three communal bathing areas on the first and second floors of the home. Each floor has two shower rooms and a bathroom. Shower rooms on the first floor are in need of repair. One has a drainage problem and is not in use. This bathroom was not in use because of drainage problems during the previous inspection also. A second shower room has cupboards with missing doors, poor lighting and poor ventilation. Bathrooms must be maintained in a good state of repair and the decor and fittings should be reviewed as they are not attractive or comfortable. CCTV cameras are in use both inside and outside of the home. CCTV, if required at all, should be restricted to entrance areas for security purposes. The need for, and the positioning of, the CCTV cameras should be reviewed to ensure that they do not impinge on the privacy and daily lives of the residents. There is a strong smell of urine outside one of the bedrooms and along the corridor. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 29 Some of the bedrooms were noted to be in need of redecoration, with scuffed walls, stained carpet and missing nameplates. We noted that some of the fire doors were not closing properly. The home manager contacted estates and this was rectified by the end of the inspection. However, there must be regular checks that the door closing mechanisms are safely operating and in a good state of repair. We noted that there are gaps around the frames of some of the doors on the ground floor in the communal lounges. These must be checked and if they are designated fire doors they must be repaired, as the large gaps will allow smoke to travel through the building. Bathroom extractor fans have not been cleaned and many taps could not be turned off properly and are constantly dripping. A window restrictor in a small communal lounge on the first floor was badly damaged and essentially ineffective as a barrier to opening the window. This was pointed out to the home manager who arranged for the repair to be done immediately. The repair had not been reported prior to the inspection. This highlights the need for all window restrictors to be checked regularly for effective operation. There are bed bugs in the building. Some of the bedrooms were being treated at the time of this inspection. Individual bedrooms are being treated several times although the problem re-occurs. Wider treatment may prove more effective. There are adequate hand washing facilities and there are clinical waste procedures and a disposal contract in place. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 30 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The organization has clear recruitment procedures to protect and keep the residents safe. Recent recruitment records do not meet required standards in some cases and must be improved. Staff are trained and competent to do their jobs. They are better supervised and there are more team meetings. Care must be taken to ensure that the home maintains the correct skills mix of staff at all times. Cuts made for economic reasons must not affect the safety of the residents. Any staffing changes must be made after individual nursing and care needs are properly assessed. 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. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 31 There is a culturally diverse staff team that reflects the resident group and the local population. We found the residents benefit from having a consistent and reliable staff team. Most staff had been with the organization for a number of years. We checked ten staff files and found four new staff had been recruited but only three had started since the previous inspection in August 2008. Two were care assistants and one was an administrator. The personnel files for these staff were examined. The recruitment procedures follow BUPA recruitment policy and procedure, which are generally good and confirm that staff are vetted, but there is evidence that they need to be more robust. Most of the ten checked have the appropriate documentation which is held along with completed application forms. We note that all had two references but four do not have a photograph. Some employment history’s are brief and do not go back far enough. References do not always match with the work prospective staff said they have previously done. References should match previous employment histories. Application forms should be checked and prospective staff should be asked to supply a complete chronology of their work with any missing information about what they were doing during periods of time they were not working, before being offered a job. Because of recent events involving the Border Agency the home has put in place an immigration documentation check list for all staff being recruited to ensure they do not employ staff who are not able to work in this country. The administrator said they had training in what to look for and were able to contact the Border Agency about any concerns they may have relating to prospective member of staff. We were told they would not employ anyone until they had all the records in place. At the start of employment all staff receive mandatory training and complete the induction programme. There is a basic induction program and additional induction is provided according to the role of the staff member, should it be nurse, carer, administrator or catering staff. Staff are given a training work booklet that they complete in the first two months to verify competencies and topics covered. We saw a copy of this and saw this is signed by the member of staff and their line manager. The training needs of staff are recognized and provided for. The qualified nurses have been issued with a Qualified Nurse Learning Portfolio that is given to all BUPA trained staff. This incorporates BUPA induction, ongoing training records and supervision records. The home offers a wide range of training to keep staff up to date with current thinking as well as the mandatory training they are required to provide each year. This is displayed on the office notice board. We were given copies of the training program and a copy of the training Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 32 matrix confirming which training staff had under gone. We saw copies of certificates on staff files we checked. 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. We saw staff had training in POVA (Protection of Vulnerable Adults), DOLS (Deprivation of Liberty Safeguards) and medication training. Nursing staff have also participated in training and development provided by the Care Home Support team. BUPA Care Homes has achieved Investors in People accreditation and is due to be reviewed end 2009. We were told staff receive regular one to one supervision where they would discuss any issues that had arisen within their work practices and any other training needs would be identified. Each head of department is responsible for making sure their staff are supervised. We were given a copy of the supervision matrix and saw this is now happening regularly, as recommended in the previous inspection report. We spoke to staff who confirmed this. The manager said they were having regular team meetings. There are regular team meetings for heads of departments as well as full team meetings as well as a registered nurses meeting. Copies of the team meeting minutes were on file. Increased frequency for team meeting was also recommended in the previous inspection report. From our observations during the inspection, staff seemed to be caring and respectful of residents and had the skills to care for the residents (noted shortfalls in mealtime support aside). External professionals and staff have concerns about staffing levels and staffing levels being cut. This needs to be looked at in relation to the needs of the residents. We saw copies of the rota. These confirmed the number of staff on duty. We were told by the manager they were adjusting the number of staff on duty in relation to the numbers of residents on each unit. For example if a unit had a number of empty beds, staffing levels would be cut. It appeared it was the trained nurses that were being cut. This was being done without assessing the needs of the residents or the unit as a whole. This is not good practice. We identified that recent changes to the number of nurses available on each floor, from two to one, was causing an inadequate skills mix when the nurse went to the ground floor to administer lunchtime medications to residents. This meant that there was no nurse on the units upstairs for up to an hour. This is unacceptable in a nursing home. A qualified nurse must be on duty and available at all times on each of the units. At the time of writing this report the home manager has confirmed that she and the deputy manager, who are both Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 33 qualified nurses, are covering the floors whilst the nurse attends to the medications downstairs. There are also two nurses on duty on two days each week, when the GP rounds occur. This allows nurses the extra time needed to discuss care and update records. Nurses we spoke with during this inspection are concerned that recent improvements in communication and care planning will be adversely affected by these staffing cuts and we found care and nursing staff morale to be low. The Commission received an anonymous complaint from a member of staff in February 2009. The person who contacted us was concerned that staffing levels were too low and that the residents were being put at risk as a result. We asked BUPA to investigate the complaint was upheld in part. Staffing levels were reviewed and changed as a result. A health professional commented, There doesnt appear to be sufficient staff to follow through with residents on exercises given by the Occupational Therapist or Physiotherapist. Visits to religious services seem sporadic due to lack of care staff and there appears to be few male staff, which may be an issue for some male residents. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 34 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents and staff will benefit from a period of management stability, as there have been numerous changes in recent years. Quality assurance systems, based on seeking the views of residents and other stakeholders are being increasingly introduced. Systems are place to promote health and safety, but there must be better monitoring of the state of repair of fire doors and window locks. Management must better consider the implications for the service before they make adjustments to staff skills mix and staffing levels. EVIDENCE: The home manager was appointed after the last inspection and she is not yet registered with the Commission. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 35 The home manager is responsible for health and safety and there are associated in house policies and procedures and a range of mandatory staff training. There are numerous in house checks and external examination of equipment in use at the home. Environmental and fire risk assessments and evacuation procedures are in place. However, as there are many safety areas highlighted in this report. The home sends notifications of any incidents talking place. A representative of the provider visits the home each month to do a mini-inspection. The reports on the outcomes of these visits are available to the manager and are stored in the home. BUPA has introduced a new quality assurance system and a member of the quality team visits the home regularly. We met with the quality manager during this inspection and reviewed an audit that is written in accordance with current national minimum standards. There is a customer satisfaction survey and regular unannounced audits of all key areas of the running of the home. The home manager comments in the AQAA (Annual Quality Assurance Audit) that information sharing could be improved. A health professional commented There has been a large turnover of home managers and acting managers in the past 12 -24 months who often seem to change direction/policy, there needs to be consistency. A member of staff commented There could be better communication between management and staff. Overall we found staff morale to be low. Staff are concerned that managers have made changes to staffing levels without discussion with staff and without considering peoples nursing care needs properly. Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 36 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 X 4 X 5 N/A INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 2 28 3 29 2 30 2 STAFFING Standard No Score 31 3 32 3 33 2 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 2 X X 2 X Version 5.2 Page 37 Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc 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 YA17 17 There must be a record of the food provided for service users. The record must be sufficiently detailed to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for individual service users. The registered provider must ensure that residents have the technical aids and equipment they need to maximise independence, determined by professional assessment, reviewed and changed or DS0000007024.V374894.R01.S.doc Timescale for action 31/01/10 31/10/09 3 YA18 23(2) 31/12/09 Havelock Court Nursing Home Version 5.2 Page 38 replaced promptly as the residents needs change, and regularly serviced. 4 YA19 12 The blood glucose levels of people with diabetes must be monitored at the required intervals. Residents must receive medications that are prescribed. Action must be taken when prescribed medications are not available, for whatever reason, to seek alternatives from the prescriber. Fire doors must be maintained in good working order at all times. Window restrictors must be maintained in good working order at all times. 31/10/09 5 YA20 13(2) 31/10/09 6 7 YA24 YA24 23 23 31/10/09 31/10/09 8 YA24 12(4)(a) 30/11/09 Close Circuit Television cameras (CCTV) if required at all, must be restricted to entrance and exterior areas and be positioned for security purposes only. The need for, and the positioning of, the CCTV cameras currently in use must be reviewed to ensure that they do not impinge on the privacy and daily lives of the residents. The home must be free from offensive odours. Bathrooms and shower rooms must be maintained in good working order. The registered person shall ensure at all times suitably qualified, competent and experienced persons are in such numbers as appropriate for the DS0000007024.V374894.R01.S.doc 9 10 YA30 16 23 30/11/09 30/11/09 YA27 11 YA33 18 31/10/09 Havelock Court Nursing Home Version 5.2 Page 39 health and welfare of the residents. 12 YA34 19 The registered person must not employ a person unless they have obtained all the information specified in Schedule 2 of the Care Homes Regulations. 31/10/09 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 YA1 Good Practice Recommendations A copy of the most recent Commission inspection report should also be added to the Service Users Guide. This should be done to ensure that prospective residents and their families and friends have an independent view to consider when choosing a care home. The Service Users Guide should contain contact information for the local social services and healthcare authorities. This information may be of use to residents and their families and friends. The activities co-ordinator should be involved in planning one to one time with specific residents. Some residents would benefit from being able to prepare some of their own meals as part of their rehabilitation. A specific rehabilitation kitchen would be a welcome addition. Staff should ensure that residents are positioned correctly to eat properly during mealtimes. Staff should ensure that residents are offered sufficient drinks with their meals. Staff should ensure that meals are served in a way that enables the residents to eat them properly, for example, cutting up food items into smaller pieces. DS0000007024.V374894.R01.S.doc Version 5.2 Page 40 2 YA1 3 4 YA14 YA17 5 6 7 YA17 YA17 YA17 Havelock Court Nursing Home 8 YA18 Staff should better consider the degree of support required for people to maintain their own personal care, for example, whether a person may need prompting and assistance to monitor and replace items such as toothbrushes and toiletries. Bathroom facilities should allow for the storage of clothes and toiletries needed during and after bathing so that residents do not have to go back to their bedrooms wrapped only in a towel. Given that the home is registered to accommodate people with a physical disability there should be an Occupational Therapists assessment of the environment with a view to make it accessible to people with a physical disability. The following details should be added to the Controlled Drugs register: -the name of the resident and the controlled drug must be added to the top of every page used -the number of the pages used must be added to the index at the front of the register. Two of the clinical fridge thermometers are not reading accurately. The maximum temperature over 24 hours read 22C and 26C on the day of the inspection instead of between 2 and 8C. This should be investigated. If the GP or clinic makes any changes to the dosage of a prescribed medication, and if medication charts are received with the old information, staff must make these amendments by hand, and sign and date with a reference to who made the change and when. More should be done to ensure that each resident not only has access to written information about making a complaint, but also that they understand what to do. Residents should be consulted about the need to provide additional window coverings, such as blinds or net curtains, if bedrooms are overlooked by other buildings. This should be done in the interests of privacy and dignity. Bathroom and shower room decor and fittings should be reviewed. Professional references for staff need to reflect their DS0000007024.V374894.R01.S.doc Version 5.2 Page 41 9 YA18 10 YA18 11 YA20 12 YA20 13 YA20 14 YA22 15 YA26 16 17 YA27 YA34 Havelock Court Nursing Home previous employment record and should be from previous employers and preferably be written on headed note paper or be stamped with the organizations company stamp. 18 YA35 Residents would benefit from staff having eating and swallowing training from the speech and language therapist and / or the care home support team. The registered persons should consider ways in which the storage areas can be increased on the first and second floors of the home. 19 YA24 Havelock Court Nursing Home DS0000007024.V374894.R01.S.doc Version 5.2 Page 42 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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