Inspection on 05/09/06 for Havelock Court Nursing Home

This inspection was carried out on 5th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 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 01/08/08

Havelock Court Nursing Home 06/08/07

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 09/07/2008.

CARE HOME ADULTS 18-65 Havelock Court Nursing Home Havelock Court 6-10 Wynne Road Stockwell London SW9 0BB Lead Inspector Sonia McKay Unannounced Inspection 5 & 6th September 2006 09:45 th Havelock Court Nursing Home DS0000007024.V310425.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.V310425.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.V310425.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 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) ANS Homes Limited John Cunningham 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.V310425.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 March 2006 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 the first and second floors have the service user bedrooms. 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 lift to all floors, and a keypad system for all communal doors to ensure the safety of service users with dementia who wander. Prospective service users are given a copy of the Service Users Guide that gives information about the home and the services provided. A copy of the most recent CSCI inspection report is available in reception and is also contained within the documents that make up the Service Users Guide. Fees range from £1100.00 to £5500.00 per week and depend on the individual care needs of each service user. Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted in thirteen hours over two days and involved examination of records relating to care, staffing and the premises. There was a tour of the premises and discussion with four service users, the registered home manager, acting deputy manager, nursing, care and ancillary staff. The CSCI pharmacist examined medication handling and administration on the second day of the inspection and a report of this inspection is sent separately. The registered home manager completed a pre-inspection questionnaire to provide the CSCI with current information about the service and comment cards were received from: • 28 Service users • 9 Relatives/visitors • 1 Local authority monitoring officer • 2 Health and social care professionals • 2 General Practitioners A local authority monitoring officer and therapist also provided comments about the service by telephone. What the service does well: What has improved since the last inspection? Confidential records and written information is stored securely in redesigned nursing stations on the first and second floors. New carpets have been purchased for ten bedrooms and the reception area. Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 6 Detailed quality assurance systems involving audits of all areas of the home and service provided have been conducted. Staff have been trained or attended refresher courses in safe moving and handling, health and safety, fire safety and the protection of vulnerable adults. Senior staff have been trained in managing challenging situations and supervising staff. There are plans in place for ensuring that service users are cared for in smaller groups so that they get more individual attention. What they could do better: Written plans for individual care must be more person centred and service users must be involved in developing these plans where possible. The plans must also reflect any changes in the care that a service user needs or receives and must clearly identify action to be taken to address any need identified. Service users must be more involved in the running of the home and in decision making. As the home accommodates service users with a wide range of abilities and health and social care needs there is a need to undertake a staff training needs assessment and to develop a training plan that ensures that staff are adequately trained to meet the specific needs of individual service users. The physical environment must be refurbished and persistent problems such as inadequate storage space must be addressed. All areas of the home should be free from offensive odours. The safety and maintenance of wheelchairs must be improved, and action must be taken to ensure the safety of electrical equipment and mains circuitry. Staff must ensure that service users do not have access to dangerous areas of the home (sluice rooms). Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Havelock Court Nursing Home DS0000007024.V310425.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.V310425.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need to make an informed choice about where to live and their individual needs are assessed. EVIDENCE: There is an informative Statement of Purpose and Service Users Guide. These documents were reviewed in August 2006. The acting deputy manager described the process for assessing the needs of individuals referred to the service and pre-admission assessments for two service users were examined. An appropriate range of nursing care and relevant specialist assessments are obtained and a member of the nursing team visits the prospective service user to complete a comprehensive needs assessment before a placement is offered. Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Current and changing care needs are not adequately addressed in individual care plans in some cases and the plans are task orientated rather than goal orientated and person centred. Service users are not involved in developing written care plans and there is only limited consultation and participation in making decisions about the running of the home. Service users are supported to take risks as part of maintaining an independent lifestyle where possible and confidential written information is no longer stored in a highly visible area. EVIDENCE: The written plans for the care of four service users were examined. The plans are developed using an extensive standardised format and include a full assessment of the service user’s needs, including the use of recognised nursing assessment tools and risk assessments. Each element of the care plan is regularly reviewed, dated and signed by a member of the nursing team. Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 11 The written plans identify each problem area in a separate care plan and some service users have over fifteen individual care plans, making it difficult to ascertain the relevance and priority of each individual plan. (See recommendation 1) There is regular re-evaluation of each element of the care plan although the written evaluation often just reiterates the problem rather than identifying clear actions to meet a specific need. Nursing care needs are generally addressed appropriately but social care needs are often identified but not addressed. For example, one service user does not speak English and staff that speak his language are not available, making communication, social interaction and involvement in activities difficult, but there is no plan of how this can be addressed. (See requirement 2) Another service user, who also has a significant learning disability, is assessed as having unmet needs in the area of sexuality but there are no plans in place to obtain specialist advice on how these needs can be addressed and met. (See requirement 2 & recommendation 2) The assessed needs of one service user include long-term alcohol addiction. The associated care plan records that he should be discouraged from drinking alcohol, however staff identified that this plan has been unsuccessful and alternative alcohol management practice is in place. This practice, which involves staff intervention, monitoring and guidance around alcohol consumption, is not documented in the care plans. (See requirement 2) A local authority placement officer has concerns that staff do not demonstrate a clear understanding of another service users needs and that the care plan in place is not always followed. Although one member of staff has attended a short training course relating to supporting a service user who has a learning disability, the wider staff group who are working with this individual has not undertaken the appropriate training and the care and health-planning system in place is still not accessible to the service user. (See previous requirement 1) Service users are not usually involved in developing or reviewing the care plans and do not sign any of the written documentation. There are plans to introduce a new care planning system in January 2007. Ways in which service users can be involved in care planning should be considered. (See recommendation 3) A key working system is in place. The system relates to daily task distribution and a key nurse and carer are assigned a group of seven service users to work Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 12 with on a daily basis. Some service users commented that they were not sure who there key workers are and that they do not meet with any of the staff on a regular basis to discuss future plans or current issues. (See recommendation 4) There is evidence that the home manager takes appropriate action to ensure that the rights of service users to make major decisions about their lives where possible, liaising with legal professionals and placing authorities as necessary. Service user consultation meetings do not take place although the activities coordinator does facilitate a degree of group discussion. Service users would benefit from a more co-ordinated approach to consultation and participation in all aspects of the running of the home. A service user said In my last placement I was a service user representative but they dont have anything like that here, another said Nobody asks what I think about things anymore. Of the comment cards received from service users: • 12 service users said that they would like to more involved in decision making within the home • 5 service users said that they would sometimes like to more involved (See requirement 3) Standardised risk assessments within individual care files are reviewed regularly and cover topics such as nutrition, fire safety, falls, moving and handling and tissue viability. Risks relating to unsupervised community access and challenging behaviour are also well documented. Although confidential information is not locked in a cabinet, there have been improvements in storage arrangements with newly refurbished nursing stations on the first and second floors and confidential records are no longer openly displayed. Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A range of group activities is available but this should be developed to ensure that all service users have an opportunity for meaningful and enjoyable activity. Most service users enjoy the meals served in the home, but there is a need to provide more variety and to consider how cultural preferences can be provided more often. EVIDENCE: Some of the service users are able to access the community independently. Other service users need support to access the community and in some cases this is facilitated by one-to-one staffing arrangements. One service user regularly attends activities such as bowling with a local voluntary organisation with the support of a member of the home staff team. A range of in-house activities is co-ordinated by a dedicated activities organiser. Examples of activities available include group discussion, life history Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 14 work, reminiscence, in-house religious services and music, games, quizzes and dominoes, local shopping trips and recreational walks. On the day of the inspection staff were supporting individual service users with flower arranging and in the afternoon there was a religious session that involved group singing. One service user commented, “ I enjoy going to church and the religious services that are held at Havelock Court”. Some service users are not keen to join in the group activities. One service user said, “They are not my sort of thing”. Although some service users are supported on a ‘one to one’ basis at times allowing for supported community access and ‘one to one’ activity in the home, others are not and for these individuals there should be consideration of how they can be better engaged and stimulated. (See recommendation 5) The care plan for another service user says that he has no interest in any forms of activity due to a language barrier, although his mental health plan says that he should be encouraged to engage in organised activities. There are no translations or commonly used phrases available and it is not clear what action staff are to take to address this unmet need. (See requirement 2 & recommendation 5) Staff assist the service users with benefits/finance problems if they require. ANS is currently the state benefit appointee for 17 service users. There are no restrictions on visiting times, although the main reception is only staffed between the hours of 8.30a.m and 8.00p.m, after which the nursing staff can admit visitors via the gated entry system from each floor of the home. However, one visitor commented that they are asked to leave at 9.00p.m. (See recommendation 6) Friends and family can visit service users in their bedrooms or in the communal areas. Friends and family social events are held twice each year. Once during the Christmas period and, weather permitting, also for a summer barbecue. Service users have access to a payphone in a quiet communal area and some service users have private telephone lines in their bedrooms. Intimate personal relationships are assessed individually with input and specialist guidance where necessary, as some service users do not have capacity to consent or are otherwise vulnerable. Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 15 The daily routines and house rules promote independence, individual choice and freedom of movement, subject to restrictions agreed in individual planning and contracts. Staff enter service users bedrooms and bathrooms with the individuals permission and normally in their presence. Staff were observed to knock on bedroom doors and await agreement before entering. Service users are offered a key to their own bedroom and service users who access the community independently are given the keypad security code for the main entrance of the home. Areas of the home are keypad code locked to ensure that service users who are at risk are prevented from wandering. Staff were observed to talk to interact with service users and to respect the wishes of service users who chose to be alone. Cooking, cleaning and laundry staff undertake these specific areas, but some service users who are able, take responsibility for keeping their bedrooms tidy. A range of nutritious, varied, balanced and attractively presented meals are provided in congenial dining rooms at reasonably flexible times. Service users are offered a choice of menus, including options that meet dietary needs and culturally diverse choices are prepared on some occasions each week. However, two service users with specific cultural preferences buy their own ingredients and request kitchen staff to prepare separate dishes at each main meal. Of the comment cards received from service users: • 23 service users said that they liked the food served • 3 service users said they liked the food served sometimes One service user commented, “I would like more choice of food for breakfast and supper”. Another service user with specific cultural preferences does not eat the hot suppers available and instead has a sandwich that he says, “Gets a bit boring”. (See recommendation 7) Service users nutritional needs are assessed and regularly reviewed including risk factors associated with low weight, obesity and special dietary requirements such as diabetes. Service users who need help to eat or are fed artificially are assisted appropriately. There is regular input from the H.E.N team for service users who are on P.E.G feeds. Overall the comments received from service users are positive, the majority saying that they enjoy living at Havelock Court and feel that they are treated well by staff and that they feel well cared for. Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & 19. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users receive personal support in the way that they prefer and require and their physical healthcare needs are met. EVIDENCE: Personal support is provided in private and intimate care is provided by a person of the same gender where possible and if the service user wishes. Service users choose their own clothes, hairstyle and makeup and their appearance reflects their personality. Particular attention has been paid to ensuring that one elderly service user maintains an immaculate manicure. Times for getting up/going to bed, baths, meals and other activities are reasonably flexible (including evenings and weekends) subject to any restrictions agreed in the individual plan. Service users receive additional specialist support and advice when needed from physiotherapists and occupational therapists. Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 17 General and psychiatric nursing care is provided or supervised by registered nurses and is monitored, recorded and regularly reviewed. There is consistency and continuity of support for service users through a designated key worker system and individual working records setting out the preferred routines and likes and dislikes of service users who cannot easily communicate their needs and preferences. Some service users also have a small team of designated one-to-one staff. Records of healthcare examined suggest that service users are receiving an appropriate range of health care input including routine screenings, and healthcare advice is obtained as and when necessary. The outcomes of each health consultation are recorded individually. Comments received from two general practitioners involved in the healthcare of service users living in the home indicate that home staff communicate clearly and work in partnership with the group practice and that the doctors are satisfied with the overall care provided to service users. One visiting health professional comments “ Staff at the home are very helpful and friendly”. Two service users have pressure sores at the time of this inspection. The progress records for one service user provide evidence of continued healing and care. Healthcare needs such as epilepsy and diabetes are well documented, monitored and controlled. Although there is good reactive physical healthcare and treatment of known healthcare issues, there is a need to plan healthcare in a more pro-active way with some service users. For example, one service user has not had an eye test for two years but there are no plans in place to schedule a test. (See requirements 1 & 4) The CSCI pharmacist examined the handling of medication in the home. The report of this inspection is sent to the home separately. Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. 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. Although there is a satisfactory complaints procedure in place there is a need to ensure that staff are better able to address concerns and assist service users to raise issues and complaints. There is progress in developing procedures to protect service users from abuse, neglect and self harm although further training is needed to ensure that staff are familiar with reporting procedures and how to handle challenging situations. EVIDENCE: The home has a clear and effective complaints procedure that meets the requirements of regulation. However, the previous inspection report recommended the recording of informal complaints or comments/suggestions in order for management and staff to be aware of and effectively monitor dayto-day issues. This has not been implemented. (See recommendation 8) Comments received from service users indicate that the majority know who to talk to if they are unhappy about their care. However, one service user said that a member of staff had been reluctant to assist him to write a formal complaint on one occasion. (See recommendation 9) There have been four complaints recorded since the last inspection in March 2006. All were responded to within 28 days. Three were found to be unsubstantiated and one, in regard to the safe moving and handling of a Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 19 service user, was partly substantiated. Appropriate action was taken in response to the complaint to prevent reoccurrence. There have been two adult protection investigations in the last 12 months. One investigation was in response to a service user with unexplained bruising and the other was in regard to the appropriateness of a relationship between two service users, one of whom is vulnerable. The home has taken appropriate action in response to recommendations made as a result of these multidisciplinary strategy meetings. An immediate requirement was issued on the 31st July 2006, after an adult protection strategy meeting, in regard to failure to notify the CSCI about the bruising and other significant events that had taken place in the home. The local authority had not been notified of increasing levels of challenging behaviour, a possible cause for the unexplained bruising. The immediate requirement was addressed immediately and the CSCI is now being notified of significant events in the home. Procedures are now in place for responding to suspicion or evidence of abuse or neglect and the local authority adult protection co-ordinator will be providing additional staff training. 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. Some service users exhibit intensely challenging behaviour on occasion, including aggression towards others. A number of senior staff have been trained in ‘breakaway techniques’ and de-escalation of challenging situations since the last inspection visit. It is proposed that this training will now be cascaded to all staff, as recommended in the previous inspection report. Progress with this internal training will be examined during the next inspection visit. (See recommendation 10) Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is suitable for purpose but is in need of extensive refurbishment and redecoration. There is inadequate storage space for equipment and supplies and some areas of the home have an unpleasant odour. 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 now in need of major refurbishment. There is inadequate storage space on the first and second floors of the home and bathrooms and shower rooms are used to store wheelchairs, trolleys, hoists and large quantities of continence aids. This is unsafe as it restricts the floor space available when assisting service users to bathe. (See requirement 5 & recommendation 11) Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 21 BUPA estates management has undertaken a review of the premises and is developing an extensive maintenance and renewal programme. All bedrooms are single occupancy, have lockable doors and meet the standards for minimum space requirements. The carpets in ten bedrooms have been replaced since the last inspection visit and there is a programme of redecoration in place. Most bedrooms are personalised and all rooms have ensuite washing facilities. Some bedrooms have an unpleasant odour of urine and many rooms are being used to store large quantities of continence aids and food supplements. (See requirement 6 & recommendation 11) Waste bins in the bathrooms and shower rooms are without lids. This is unhygienic. (See recommendation 13) Carpets have been replaced in the ground floor reception and are on order for the ground floor corridor. Carpets on the staircase between the ground floor and first floor are badly stained. 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, although one of the bathrooms on the first floor is currently out of order as it is leaking water down to the ground floor. All bathrooms and shower rooms are in need of refurbishment. 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 of the home and do not impinge on the daily life of service users. National minimum standard 24.3 stipulates that larger homes be organised into clusters of up to 10 service users sharing a staff group, dining area and other common facilities by first of April 2007. There are plans in place to achieve this in the communal areas of the home on the ground floor. There are narrow exterior gardens and a seating area. The gardens are poorly maintained and are overgrown in some areas. (See recommendation 12) Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are an adequate number of qualified staff available, but there is a need to ensure that staff are better trained to meet the specific needs of individual service users. Recruitment policies and practices provide service users with adequate protection and staff are well supervised. EVIDENCE: A care staff induction programme in accordance with Skills for Care is in place. Statutory training includes fire safety, manual handling and moving, COSHH, food hygiene and health and safety. Nursing staff, support staff and ancillary staff received induction as appropriate to their individual roles. Each are: • • • • • • of the six departments has a department manager. The departments Care Housekeeping Catering Administration Maintenance Activities DS0000007024.V310425.R01.S.doc Version 5.2 Page 23 Havelock Court Nursing Home There are 13 registered nurses, 44 care staff, and 20 ancillary staff. 55 of the care staff have an N.V.Q (National Vocational Qualification) at level 2 or above. Some of the service users have a learning disability. Specialist professionals in involved in the care of one service user have identified that key staff will benefit from training in person centred planning, health action planning and producing an accessible activities schedule. One member of staff, who regularly provides the service user with ‘one to one’ support has attended a days training in meeting the needs of this service user. However, the training does not cover all of the areas identified in this previous requirement and other key staff that work with the service user have not been trained and were observed to find communication and interaction difficult. (See requirement 1) Training records available provide evidence that staff have received the following training during 2006: • Health and Safety • HIV Awareness • Manual handling • POVA • Dementia • Fire training • Managing violence and aggression (senior staff only) • Care planning and Supervision (senior staff only) • Clinical care BUPA are in the process of introducing an extensive staff training and professional development plan. As the home accommodates service users with a wide range of individual needs there is a need to assess the training needs of the staff team as a whole. (See requirement 7) Full recruitment records for four recently appointed members of staff were examined and all documents required by regulation are in place. The home manager has also obtained updated enhanced CRB (Criminal Records Bureau) checks for members of staff previously employed with only a Scottish CRB, as required in the previous inspection report. 14 of these CRB checks were examined and found to be satisfactory. Staff have regular, recorded supervision meetings at least six times a year with their senior/manager in addition to regular contact on day-to-day practice. Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. 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 large home is managed well by the registered manager and management team. Service users are involved in the quality monitoring of the home and their views underpin the quality assurance system. Although there are systems in place to monitor environmental safety in the majority of areas, the home has failed to ensure the safety of wheelchairs and electrical equipment. EVIDENCE: The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. He has extensive management/supervisory experience and has nursing and management qualifications. He is currently working an extended notice period before leaving employment in the home. Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 25 ANS homes were taken over by BUPA in August 2005. There is a significant amount of organisational change going on at this time, including the introduction of BUPA policies and procedures, new care planning systems and staff training. BUPA undertook a service user satisfaction survey in the autumn of 2005. The findings of this survey were published in February 2006. 30 of the Havelock Court service users received questionnaires and 97 responded. 76 rated the quality of service as excellent/very good, 21 rated the service as excellent, 55 rated the service as very good, 21 rated the service as quite good and 3 rated the service as neither good nor poor. Service users were asked to comment on staff in the home, the building and the surroundings, bedrooms and communal rooms, food and activities. They were also asked to make suggestions for improving the home. Service users will receive feedback about this involvement in the revised Service Users Guide to the home, which is currently being developed. 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. Each department is audited individually and the process began in August 2006. The overall findings will be available by December 2006. Health and safety responsibilities are shared between the home manager and the maintenance manager. 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. Environmental certification examined during this inspection provide evidence that: • The annual gas appliance safety certificate was issued in September 2006. • The annual small electrical appliances tests were conducted in March 2005. The tests are now overdue. (See requirement 8) • Electrical circuitry was safety tested in February 2006. The outcome of the test was unsatisfactory. (See requirement 9) • A pest control contract is in place and checks are conducted on a quarterly basis. • The L.F.E.P.A (fire authorities) inspected the premises in 2005. • Fire safety equipment is tested regularly and fire evacuation drills are conducted with the required frequency • Environmental risk assessments are in place and are reviewed regularly Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 26 The maintenance manager carries out checks on wheelchairs in use in the home. During the inspection it was noted that a wheelchair belonging to one service user only had only one footplate. Staff commented that this had been the case for over a year. This places the service user at risk of serious injury. (See requirement 10) Sluice rooms on the first and second floors were left unlocked when not in use on the second day of the inspection. This is dangerous. (See requirement 11) Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 27 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 3 2 3 3 X 4 X 5 X 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 3 27 2 28 2 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 X X 3 X 3 X X 2 X Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 28 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 YA6 YA32 YA19 Regulation 15(2)(a) Requirement Timescale for action 31/12/06 2. YA6 15 12 3. YA8 12(5) 4. YA19 14 15 The registered persons must ensure that staff are trained to produce care plans that are in language and a format that service users can understand. For example, person centred plans, health action plans and activities plans that are accessible to a service user with a learning disability. The timescale of 31/10/05 for this previous requirement is not fully met. The registered persons must 31/12/06 ensure that care plans and risk assessments are reviewed to reflect current and changing needs and that there are specific plans in place to meet each identified need. The registered persons must 31/12/06 increase the opportunities for service users to be consulted on and participate in all aspects of the running of the home. The registered person must 31/12/06 ensure that the healthcare needs of service users are assessed and recognised and DS0000007024.V310425.R01.S.doc Version 5.2 Havelock Court Nursing Home Page 29 5. YA24 23(2)(l) 6. 7. YA24 YA30 YA35 16(2)(k) 18 8. YA42 23(2) 9. YA42 23(2) 10. YA42 13(4)(c) 12(1) 12(1) 11. YA42 that procedures are in place to address them. The registered person must ensure that bathrooms and shower rooms are not used for the storage of wheelchairs, trolleys and portable hoists. The registered persons must ensure that the home is free from offensive odours. The registered person must ensure that a training needs assessment is carried out for the staff team as a whole to inform future training plans. The registered persons must ensure that all small electrical appliances are safety tested annually. The registered persons must take action to rectify the faults identified in the testing of the mains electrical circuitry carried out on 06/02/06. The registered person must ensure that wheelchairs in use at the home are safe at all times. The registered persons must ensure that sluice rooms are locked when not in use. 31/12/06 31/10/06 31/12/06 31/12/06 31/12/06 31/10/06 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA6 Good Practice Recommendations The registered person should prioritise written care plans and ensure that staff are not completing and reviewing unnecessary documents routinely. The registered persons should seek specialist advice on meeting the identified sexuality needs of a service user with a significant learning disability. DS0000007024.V310425.R01.S.doc Version 5.2 Page 30 Havelock Court Nursing Home 3. 4. YA6 YA7 YA6 YA7 5. YA12 YA14 6. YA16 7. YA17 8. YA22 9. 10. 11. 12. 13. YA22 YA23 YA24 YA28 YA30 The registered persons should, where possible, involve service users in developing their written plans for care. The registered persons should review the system for key working to ensure effective care planning and review, regular and effective communication with service users and an element of service user choice. The registered persons should consider ways in which service users, who do not wish to or are unable to join in the current group activities, can be engaged in alternative activities. The registered persons should ensure that service users are able to entertain visitors in accordance with the ‘open’ policy in place unless there are specific reasons why visitors should not be allowed to stay in the home after a specific time in the service users ‘best interests’. The registered persons should consider ways in which the cultural meal preferences of all service users can be met when planning menus and for increasing the menu choices available at breakfast and supper. The registered persons should ensure that a comments/suggestions book is kept on each floor for service users and staff to access to record and monitor day-to-day issues. The registered persons should take steps to ensure that all staff are aware of how to assist or support a service user to make a complaint or raise a concern. The registered persons should ensure that staff are trained in safe breakaway techniques to better equip them to deal with challenging behaviour and physical aggression. The registered persons should consider ways in which the storage areas can be increased on the first and second floors of the home. The registered person should ensure that the communal gardens are adequately maintained and safe for service users to access. The registered person should ensure that waste bins in bathrooms and shower rooms all have lids. Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Havelock Court Nursing Home DS0000007024.V310425.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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