Inspection on 06/08/07 for Havelock Court Nursing Home

This inspection was carried out on 6th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 16 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 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 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 & Lisa Wilde Unannounced Inspection 6 August 2007 09:00 th Havelock Court Nursing Home DS0000007024.V341696.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.V341696.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.V341696.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 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.V341696.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 22nd January 2007 4. Date of last inspection Brief Description of the Service: Havelock Court is a nursing home owned and managed by a care provider called ANS. ANS became a subsidiary of BUPA in August 2005. The home provides nursing care for 60 residents in a purpose built home in the middle of a mixed business and residential area, a few minutes walk from a major shopping centre that has full transport and community facilities. It is set in a no-through road in its own grounds, with a gate entrance and its own parking facilities. The ground floor has the reception area, offices and communal facilities and 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 residents 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 Residents Guide. Fees range from £995.00 to £1,334.00 per week and depend on the individual care needs of each resident. Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit began at 09.00 a.m. and was completed in nine hours by two inspectors. The inspection consisted of discussion with residents, staff on duty and the new home manager. There was a partial tour of the home premises and examination of records relating to care and staffing. The Commission required the manager complete a written assessment of the service provided (an Annual Quality Assurance Audit sometimes called an AQAA). Information supplied in this self-assessment is used to inform this report. The lead inspector completed a random inspection of the service in January 2007 to check on progress in meeting the requirements made in the report of the key inspection carried out on 5th September 2006. Findings from this additional visit are also included in this report. The Commission also distributed written surveys to people involved in the service. Surveys were completed by: • Two residents • One visiting health professional • The local placement and monitoring team The Commission would like to thank all those who kindly contributed their time, views and experiences to this inspection. What the service does well: The new manager is qualified and experienced and residents and staff are benefiting from his leadership and management approach. The views and opinions of people using the service underpin the new way that the organisation will review and develop the home. The home is close to transport routes and leisure facilities and regular checks are made to make sure that the building and equipment are safe. Complaints are investigated properly and people who make them are given feedback about what has been done as a result. There is good progress in ensuring that staff obtain a qualification in providing care. Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The information that prospective residents receive should be revised to include better information about the age of residents currently living in the home, who are mostly older than 65 years. Meeting the needs of such a diverse resident community continues to be a challenge for staff and residents alike. Staff must make better trained to meet the individual needs of the residents who are currently living in the home. This will help them to make better plans for peoples care. Information about staff training and experience must be added to the statement of purpose. Staff must take better care to record when they administer any medications, so that residents receive their medication properly. Although the new care planning system is easier to use, it is not accessible to people wit a learning disability or who cannot read English and the accuracy of information must be ensured. Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 7 There is insufficient evidence that residents have been involved planning their own care with key staff. Failure to review some key areas of care on a regular basis is also of concern as this may mean that care is not being delivered in accordance with current care needs. Ensuring that each person is living according to their preferred lifestyle is difficult in such a large setting, especially as the residents’ ages, needs and backgrounds are so diverse. More must be done to ensure that there are more opportunities and better ways for people to spend their time, develop and enjoy their lives. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Havelock Court Nursing Home DS0000007024.V341696.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.V341696.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The information that prospective residents receive should be revised to include better information about the residents currently living in the home, who are mostly older than 65 years. The service is recently taking better care when assessing whether it can meet the needs of prospective residents and whether they will get on with the existing residents. However, meeting the needs of such a diverse resident community continues to be a challenge for staff and residents alike. Information about staff training and experience must be added to the statement of purpose. EVIDENCE: Regulations about the resident’s guide have been amended to require greater detail to be included about the standard package of services provided in the care home, the terms and conditions which apply to key services, fee levels and payment arrangements. The guide is also required to state whether the terms and conditions (including fees) would be different in circumstances where a resident’s care is funded, in whole or in part, by someone other than the resident. (See requirement 1) Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 10 Although the service is registered as a home for adults (aged between 18 and 65) half of the residents accommodated at the time of the inspection were over the age of 65. The written guide distributed to prospective residents says “Havelock court provides nursing care for younger individuals who have chronic ill health, mental disorders or dementia.” The statement of purpose document says “Our centre has 60 registered beds for clients between the ages of 18 and 65 with physical disabilities, mental disorder of dementia. Havelock Court will no longer admit anyone over the age of 65 years”. This information could mislead prospective residents into thinking that this is a setting solely for younger people. There should be some indication that the current resident population is largely over 65 years old so that prospective residents have accurate information on which to base a decision to move to the home. (See recommendation 1) The AQAA states that of the 48 residents accommodated on 3rd July 2007 • 17 are bed fast • 17 have a physical disability • 31 need help with dressing and undressing • 45 need help with washing and bathing • 28 need help with using the toilet • 13 are singly incontinent • 18 are doubly incontinent • 8 have dementia • 21 have other mental health needs • 2 have a learning disability in addition to mental health needs • 5 are alcohol dependent • 23 are people whose first language is not English • 24 have impaired vision • 2 have specialist communication needs 13 long standing residents have neither a mental health needs or dementia, and are accommodated for nursing care needs alone. Observation of activity in a communal lounge showed that elderly frail residents are sharing living spaces with young adults who are sometimes noisy and challenging. Feedback from professionals includes an observation that there is only sometimes the right staff skills and experience mix available to support the needs of all individuals. Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 11 The fact that there is such a wide range of health and social care needs to be met, may be a factor. It is difficult for staff to be familiar with best practice in all of the areas required. Previously, the Commission has required a staff training needs analysis, based on the needs of individual residents. Although there is some progress in meeting this requirement, the new home manager must fully relate the training needs analysis to the individual needs of each resident accommodated. This will enable the development of a training plan that will better prepare staff to work with current residents. The statement of purpose does not contain sufficient information about the number of staff, and their relevant qualifications and experience. (See requirement 2) The new home manager says “The home was under much pressure in 2006 due to the wide variety and conflicting nature of challenging needs presented by a number of people using the service at that time. The home is no longer admitting anyone over the age of 65 and has therefore been undergoing a period of change. It has sought to better define what it will and will not provide in terms of care needs and ensuring that the conditions are in place to meet the needs of the individual and protect the vulnerability of the other adults already residing within the home. This is beginning to provide a more homely environment ”. This is being achieved by better pre- admission assessment and consideration of resident suitability and compatibility. The service has a number of vacancies at the time of this inspection. Recent inspection reports also raise issues relating to failure to provide the specialist care required to meet the needs of people who have learning disabilities. The Commission is currently reviewing the conditions of registration attached to this home, with the aim of simplifying them. The home is registered to accommodate adults over the age of 18 who have either a medical condition requiring nursing care, a physical disability, dementia or mental illness. There are people with ages ranging from 33 years to 82 years, currently living in the home. It must be noted that residents are not grouped or staffed into clusters. There are two units of 30 beds each and people with varying needs and of varying ages accommodated on each unit. There are two communal lounges on the ground floor, one for each of the units. Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 12 In effect this means that an elderly person with dementia is sharing a home with a young person who is physically fit but mentally unwell and a person with medical care needs but no mental ill health. This is not ideal. When asked whether the service supports people to live as they choose, a visiting health and social care professional commented “Sometimes……….. The home tends to be rather institutional. Not enough importance placed on individual activity.” The registered provider must review the aims and objectives of the home and should do so in consultation with the current residents, relatives, advocates and other stakeholders. There is a need to further define the nature of the service that Havelock Court provides and to consider how best to meet the needs of current and future residents. (See requirement 3) When a local authority refers someone to the service, the home obtains an appropriate range of nursing care and relevant specialist assessments and a member of the nursing team visits the prospective resident to complete a comprehensive needs assessment before a placement is offered. Prospective residents are encouraged to visit the home before they move in. Havelock Court Nursing Home DS0000007024.V341696.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the new care planning system is more comprehensive, accuracy of information and accessibility remain a concern. There is insufficient evidence that residents have been involved planning their own care with key staff. Failure to review key areas of care on a regular basis is also of concern as this may mean that care is not being delivered in accordance with current care needs. EVIDENCE: A new written format for writing plans detailing the care that each person needs has been introduced. This replaces the old system that was complex, repetitive and hard to use. Staff feedback about the new plans is that they are easier to use and access information from. A visiting professional also agreed that staff have better information to hand now. Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 14 The AQAA (Information supplied to the Commission before the inspection) states: ‘A full and comprehensive assessment of need is conducted upon referral and prior to admission using the BUPA Care Homes Quest assessment booklet. The design of Quest is such that the same booklet can be used to cover 3 different assessment periods – thereby demonstrating the changes and developments between assessments’. The home manager acknowledges that as Quest is relatively newly implemented in the home, the standard of use varies between individual staff. Care plans examined during this inspection as part of case tracking the care of four people indicate that: • There is an opportunity for life histories to be documented. This gives staff a better understanding of the person being cared for and is good practice. One resident, who moved into the home in June 2007, has a care plan to address issues of ‘isolation and agitation’. The plan says that staff should assist the resident to see friends and family. Elsewhere in the plan it says that the resident has no friends and family. The only other strategy in place to deal with the agitation and isolation is being prescribed a medication. Another resident, who has a learning disability, has care plans around the need for soft diet as the resident refuses to wear dentures. Another area of the care plan says there are no areas of need or risk associated with eating. This is conflicting. (See requirement 5) Nutritional risk assessments and care plans had not been reviewed as often as required by the new care planning system. There are also gaps in the review of other plans and risk assessments. There are gaps for June and July in three of the files examined. (See requirement 5) One ‘sleep’ care plan says that a resident should be checked every 15 minutes and assisted to turn in bed every three hours. Staff on duty said that this is not done as the resident moves around in bed. The care plan must be amended. (See requirement 5) Some care plans and daily notes are not written in plain English and they are not accessible to residents who cannot understand text only documents. As highlighted in previous inspection reports. DS0000007024.V341696.R01.S.doc Version 5.2 Page 15 • • • • • Havelock Court Nursing Home (See requirement 4) • There is no evidence of how residents have been involved in planning their care in some cases. There are gaps in the plans where the signatures of residents or relatives/advocates should confirm their agreement (See requirement 6) Another person, who has a permanent physical disability, has a mobility care plan that says the resident is looking forward to walking again. Whilst this is an understandable wish, the care plan does provide staff with useful and realistic information about how to deal with the psychological impact of reduced mobility. Language used in some documents is negative and sometimes overly complex. For example, phrases such as, “ This person posed no management problems today’ and, ‘the resident opined…’ should be avoided. One person has a care plan around ‘aggression’ saying that the person is vulnerable to being abused by others, or by staff, because the resident can be aggressive. This is also a poor choice of language and the feelings of residents reading the documents should be better considered. (See recommendation 2) It is also of note that some of the health care assistants, who knew residents well and who assisted with the inspection, were also able to relate practical and useful information about people’s needs and how they liked to be cared for. In some cases, this valuable information is not available in written plans. (See recommendation 3) • • • The new home manager has introduced minuted resident’s meetings. These are now happening on a regular basis and are an opportunity for residents to be consulted about the running of the home, to make suggestions and raise concerns. This addresses a requirement made for greater consultation. Each person’s personal records are now stored in an adequately secure area in the nurses stations, as required in the previous inspection report. This ensures that confidentiality is maintained. Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 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. Ensuring that each person is living according to their preferred lifestyle is difficult in such a large setting, especially as the residents’ ages, needs and backgrounds are so diverse. More must be done to ensure that there are more opportunities and better ways for people to spend their time, develop and enjoy their lives. EVIDENCE: Some of the resident are able to access the community independently. Other people need support and in some cases this is facilitated by one-to-one staffing arrangements. There are also small group outings in a hired mini-bus to places of interest like the seaside. 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, Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 17 reminiscence, in-house religious services and music, games, quizzes and dominoes, local shopping trips and recreational walks. Some residents also have additional care hours as part of their care package arrangements. In some cases these hours are used to take the resident concerned out into the community. However, records of how these hours are used are not always evident. In some cases, the results of care plans to encourage activity and engagement are not evidenced in daily logs of how the person concerned has spent their time. During this inspection it was noted that many residents were sitting in a communal lounge watching a television or playing games in small groups with staff (a second communal lounge, usually used by residents from one of the floors, was being refurbished). A member of staff was involved in teaching two residents a new card game in the activities room and other members of staff were sitting amongst the main group of residents. One resident, who does not understand English, has one DVD film to watch in her own language. There is little evidence of action taken to engage with this person or to arrange appropriate activities or community links. A relative had contributed to an activities care plan by requesting that the resident be taken to the communal lounge or garden every day. There is no recorded evidence of this happening in the brief daily logs. The resident was sitting in her bedroom on the day of the inspection. A health professional commented, “ The service tends to be rather institutionalised. Not enough importance placed on individual activity. Clients are often found to be bored in their room or doing little. Lots of clients sat in front of a TV downstairs”. (See recommendation 4) In regard to the ability of the service to respond to the different needs of individuals, a professional commented, “This has improved in regard to hair care and ethnic food, and we understand further improvements are to be made. There must be more emphasis on independent activities outside”. Given that the service is home to residents with such a wide range of age, ability, mobility, cultural background, ethnicity and spoken language, emphasis must be placed on looking at each person’s needs and lifestyle aspirations so that appropriate activities and opportunities for community involvement can be accessed. This has been the subject of previous recommendations. Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 18 In the AQAA (the self-audit supplied to the Commission before the inspection) the new home manager acknowledges that links with different ethnic/cultural groups could be better and there is a stated intention to improve links with different and ethnically diverse groups and organisations in the local area in the next 12 months. This will be of benefit to the diverse group of residents currently accommodated. A social worker commented, “ The home has a culturally diverse resident population and staff team. This has been beneficial for the person we have placed in the home who is African- Caribbean, and was one of the main reasons we considered the service for this person”. It is also noted that the new care planning system template places greater emphasis on documenting lifestyle choices and needs and wishes in regards to activities. This is an improvement. 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. Friends and family can visit residents in their bedrooms or in the communal areas. Social events for friends and families are held twice each year. Once during the Christmas period and, weather permitting, also for a summer barbecue. New decked areas in the garden are being built to increase the opportunities for relaxation and activity in the garden. Residents have access to a payphone in a quiet communal area and some residents have private telephone lines in their bedrooms. Intimate personal relationships are assessed individually with input and specialist guidance where necessary, as some residents do not have capacity to consent or are otherwise vulnerable. The daily routines and house rules promote independence, individual choice and freedom of movement, subject to restrictions agreed in individual planning and contracts. Staff were observed to knock on bedroom doors and await the residents agreement before entering. People are offered a key to their own bedroom and residents who can go out alone are advised of the keypad security code for the main entrance of the home. Areas of the home are keypad code locked to ensure that residents, who are at risk, are prevented from wandering. Cooking, cleaning and laundry are mostly done by staff, although residents, who are able to, are encouraged to take responsibility for keeping their bedrooms tidy. Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 19 Some residents are able to go out shopping for personal items, such as clothing, by themselves. If this is not possible, staff can either provide support or can arrange for items to be purchased on a resident’s behalf by staff. The records relating to these transactions show that they are safe but there is a disadvantage for residents, in that to ensure financial protection for residents, staff making purchases must always obtain printed purchase receipts. This means that purchases can only be made in stores and not in a market (where items might be cheaper and there is a wider range of culturally diverse items available). The home manager is introducing a wider range of shopping facilities, such a catalogue shopping, for residents of the home. (See recommendation 5) A range of nutritious and varied meals are provided in congenial dining rooms at set times. A record of meals served is maintained by catering staff. Residents are offered a choice of menus, including options that meet dietary needs and culturally diverse choices are prepared on some occasions each week. The AQAA states that BUPA have introduced a new menu planning system that seeks to ensure that each resident’s nutritional needs are met. There is also a ‘Night Bite’ system to ensure that food is available 24 hours a day. The catering manager has also started using different suppliers to obtain a better range of produce to make culturally appropriate meals with. Whilst this is a step in the right direction, the current outcome for some residents, who previously made private arrangements with catering staff for the purchase and cooking of produce from Brixton market, such as oxtail and goat, is less favourable. Catering staff are no longer allowed to source local produce. The home manager and catering team are in the process of identifying a suitable range of suppliers to address this. (See recommendation 6) Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 20 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents receive appropriate support with personal care, if required. Healthcare is generally good, although planning and record keeping must be improved to ensure that resident’s health care needs are always properly addressed and monitored. Steps must be taken to ensure that staff administer medication correctly at all times and to ensure that all prescribed items are available. EVIDENCE: Support plans for how people wish and need to be supported with personal care are in place, including whether someone wishes to be assisted by a man or a woman. There is also evidence that health care assistants know more about personal preferences than is written on plans. (See recommendation 3) Personal care is provided in private. Physical and emotional needs are prioritised in the new care planning system. Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 21 Comments from health professionals include ““Health care is generally good” and, “ There has been an improvement in care generally since the new manager took over. We have to monitor less about basic issues. Where they have queries we are contacted for advice”. And also, “ Healthcare needs are usually met and residents are regularly given access to the GP and the staff take seriously clients physical health problems”. The local GP was visiting the service on the day of the inspection. He commented that staff training had improved. During the case tracking of five residents care and records it was noted that: • A fluid intake chart is not being filled in properly and food is sometimes also recorded on the chart. This indicates inconsistency of recording and ineffective monitoring. A wound care plan says that dressings are to be changed twice weekly. The care plan has not been reviewed since April 2007. A recent letter from a health care specialist elsewhere in the record states that the dressings should be changed on alternate days. Staff must adhere to the specialist advice and update the homes care plan accordingly. One person is advised to have their blood sugar levels monitored ‘regularly’. The frequency that these tests must be done is not given. Two tests had been done in July. Another resident’s care plan says that blood sugars should be monitored each week. No tests were done in June and only two were done in July. This is inadequate monitoring. An elimination care plan for one resident says that the number of times that the resident is assisted to use the toilet must be documented in case laxatives are required. This is not being done. Entries in daily logs simply say ‘assisted with personal care’. One resident has a bedrail fitted to his bed to stop him from falling out. A ‘bedrail consent’ form is available in the residents file, but has not been signed by the relative. This must be done to ensure that this form of restraint has been discussed and agreed. • • • • • (See requirements 7 & 8 and recommendation 7) Arrangements and payments for chiropody services must be clarified. The home manager stated that chiropody services can and are arranged, but usually with an additional cost to the resident. The guide to the home says that Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 22 chiropody is arranged on request and does not mention an extra cost may be incurred. (See recommendation 8) Trained nurses administer prescribed medications on each of the two units. A sample check on medication administration records and stock on the second floor unit indicated that: • One resident was not given a prescribed item for four days because the item was not available as the pharmacy had been unable to supply the item in time • There is a gap in the recording for administration of pain relief for one resident. This indicates that the pain relief was either not given or given and not signed for. An off duty nurse subsequently telephoned the home to say she had given the medication but had not signed the MAR chart. (See requirements 9 & 10) Dosage instructions on a MAR chart had been altered without staff signing the alteration. This is bad practice. (See requirement 11) A stock check of three medications indicated that two out of three supplies were incorrect. The balance of tablets for two medications was wrong, when considered against amount received into the home and then administered. Justified stock checks to monitor whether medication is being administered correctly are not being done. (See requirement 9 & 10) Staff are recording when they are not administering an ‘As required’ medication when there is no need to do so (See recommendation 9) One resident, who cannot speak English, refuses all prescribed medications. There is evidence that this has been discussed with a health team involved in one specific area of health care and that the GP has been made broadly aware in medication reviews. The prescribed medications include pain relief and staff on duty confirmed that the resident is in pain at times. It is not clear what plans are in place for this issue to be discussed or addressed in either a ‘bests interests’ meeting, or some such review forum with an interpreter present. There was no indication as to whether covert administration had been considered, as in the case of another resident on the same floor, who has an agreed plan for covert administration in place. (See recommendation 10) • • • Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 23 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is evidence that complaints are investigated properly and that residents know how to make complaints if they need to. Procedures are in place to protect residents from abuse and neglect. EVIDENCE: The AQAA (Annual Quality Assurance audit) states that BUPA has a three-tier framework for dealing with complaints. This means that complaints can be resolved within the home, or at a regional and national level with input from Quality managers. Nine complaints have been received in the last twelve months, all were resolved within 28 days and two complaints were upheld. There is evidence that complainants receive appropriate feedback in all cases. Information about how to make a complaint is available in the guide and is also displayed in the home. The home manager assesses that the home has improved in its handling of complaints by being more consistent in using the procedures in the last 12 months. The home has a clear and effective complaints procedure that meets the requirements of regulation. However, the previous inspection report recommends the recording of informal complaints or comments/suggestions in order for management and staff to be aware of and effectively monitor day-today issues and concerns. This has not been implemented. Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 24 (See recommendation 11) Comments received from residents indicate that they know how to make a complaint if they wish do so. The home manager was dealing with a complaint made by a resident during the inspection. The investigation into the complaint was being conducted properly and the manager had taken appropriate action in suspending a member of staff, without prejudice, whilst the investigation was being conducted. Procedures are 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 residents can have challenging behaviour on occasion, including aggression towards others. Most staff have now been trained in ‘breakaway techniques’ and de-escalating challenging situations. Some staff said that they feel more confident and able to deal with potentially challenging situations now. The home reports incidents of concern to the Commission and local authority care managers as required. Residents whose bank accounts are managed by the home are now accruing interest on their savings. Records indicate safe handling and checking are in place. However, residents do not receive monthly statements. (See recommendation 12) Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 25 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home environment is improving with a large amount of refurbishment going on at the moment. The home is close to local shops and transport links. More must be done to ensure that the home remains free from unpleasant odours and there should be consideration as to how the service can be divided into smaller groups of residents. 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. BUPA estates management has undertaken a review of the premises and the home is currently undergoing major refurbishment work. Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 26 Communal hallways have been redecorated and the communal lounges are being done at the time of the inspection. There is a new wooden decked area leading from a lounge to the garden and plans to build another. There are also plans to refurbish the ‘smokers’ conservatory to ensure compliance with recent changes in legislation. The entrance foyer has been redecorated. During the last inspection, it was noted that there is inadequate storage space on the first and second floors 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. This has been addressed by moving equipment temporarily to an empty bedroom. This does not resolve the issue. (See requirement 12 & recommendation 13) The home is generally clean and free from offensive odours in most areas. However, one bedroom has a strong smell of urine, caused by known behaviours that are being managed as best they can be. Professionals who commented also said that the home sometimes has a bad odour of urine when they visit. (See requirement 13) All bedrooms are single occupancy, have lockable doors and meet the standards for minimum space requirements. Most bedrooms are personalised and all rooms have en-suite washing facilities. There are three communal bathing areas on the first and second floors of the home. Each floor has two shower rooms and an assisted bathroom. There is good access to local amenities, local transport and relevant support services. CCTV cameras are in use for security purposes but are restricted to the exterior of the building and entrance areas for each floor and so do not impinge on the daily life of residents. National minimum standards say that larger homes should endeavour to organise into clusters, with a maximum of 10 residents sharing a staff group, dining area and other common facilities. (See recommendation 14) The home has a purpose built and well equipped laundry. Systems are in place to maintain good hygiene and infection control. Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There is progress in developing a qualified staff team, but more must be done to ensure that staff are trained in meeting the individual needs of the people living in the home. Staff must also receive structured and timely induction training when they begin working in the home. EVIDENCE: A resident commented, “ I like the staff, they are alright”. A placing social worker commented,” I have been impressed with the staff. Communication is good and they get in contact with us when they should”. There are a total of 62 nursing and care staff and 20 ancillary staff. There is always a trained nurse on duty on each floor of the home. Nurses are either general nurses or mental health nurses, or both. Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 28 75 of care staff have attained a vocational qualification in care (NVQ) or are working towards this qualification at this time. This shows progress in developing a qualified staff team. Each • • • • • • of the six departments has a manager. The departments are: Care Housekeeping Catering Administration Maintenance Activities Training records available provide evidence that staff have received the following training during 2006/2007: • Health and Safety • HIV Awareness • Moving and handling • POVA • Dementia • Fire training • Managing violence and aggression (senior staff only) • Care planning and Supervision (senior staff only) • Clinical care • The Mental Capacity Act There • • • • • • • • • are plans for more training in 2007: Fire safety Manual handling POVA/Abuse awareness Bedrail safety training Mental Capacity Act Health and Safety C.O.S.H.H Food Hygiene HIV awareness As the home accommodates residents with a wide range of individual needs, there is a need to assess the training needs of the staff team as a whole to ensure that staff are appropriately trained to meet the needs of the individual people living in the home (For example, equalities and diversity, activities, communication, challenging behaviour, learning disability, sensory impairment, alcohol addiction, needs relating to culture and ethnicity). (See requirement 14) Full recruitment records for four recently appointed members of staff were examined and all documents required by regulation are in place. Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 29 However, one written reference is not on headed notepaper and does not have a company stamp. The administrator said that the reference was checked over the telephone to ensure authenticity, but this telephone call is not documented. This should be added to the reference along with the signature of the person undertaking the check and the date on which it was done. (See recommendation 15) 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. One of the records of staff induction training, for a member of staff who began work in the home in April 2007, does not contain sufficient evidence that the induction-training plan is being followed properly. The record indicates that ‘in-house’ induction training has not been completed within the required time period. (See requirement 15) 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. Staff confirmed that they are also able to seek advice and support from the managers as and when they need it. Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 30 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The new manager is qualified and experienced but has yet to register with the Commission. Residents are benefiting from his leadership and management approach. Steps are being taken to ensure that the views of people using the service underpin the review and development of the home. Systems are in place to promote good health and safety, although staff must adhere to advice in place, such as keeping doors closed. EVIDENCE: The new home manager joined the service in December 2006. He is a Registered Mental Nurse (RMN) and qualified manager and trainer. He has 19 years of experience in managing care services. He aims to promote an open and inclusive leadership approach to encourage involvement, participation and team working. There is positive feedback from staff, who said that they feel Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 31 able to raise issues and contribute ideas and that the manager is approachable and accessible. The convening of regular residents meetings is further evidence of an inclusive approach. The new manager is in the process of applying to register with the Commission at the time of this inspection. (See requirement 16) BUPA undertook the first audit of this service in 2006. Significant improvement in the physical environment has been a priority this year as a result. The audit included consulting with residents to find out what they think of the service. BUPA are in the process of introducing a new quality monitoring system. This will include a full annual audit of all areas of the service provided. BUPA care homes have achieved ‘Investors In People’ accreditation. The home manager and staff have regular meetings about health and safety, the minutes of which are reviewed by the regional manager. BUPA also provide regional and national advice on health and safety matters. 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. The AQAA provides information about when equipment such as gas appliances, electrical appliances, hoists, lifts, call alarm systems and fire detection equipment were last tested for safety. All were checked in 2007, apart from the call alarm system, which was last checked professionally in August 2006. A requirement made for confirmation of a satisfactory check of the homes electrical circuits is met. A written assessment of hazardous substances is in place. During a tour of the premises it was noted that a door to a kitchenette was unlocked and the door was open. The door had a sign on it that said the door should be locked at all times. (See recommendation 16) Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 32 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 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 3 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 3 3 X X 3 X Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 33 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 5 Requirement The registered person must revise the service users guide in accordance with recent changes in legislation. The registered person must supply information about relevant staff qualifications and experience in the statement of purpose. The registered person must review the statement of purpose and service users guide and should consult with all stakeholders when reviewing the stated aims of the homes. The review must consider how the home can meet the wide range of needs and ages of current and future resident populations and better define who the service is for. The registered persons must ensure that staff are trained to produce care plans, health action plans and activities plans that are accessible to service users with a learning disability and are in language and a format that service users can understand. DS0000007024.V341696.R01.S.doc Timescale for action 31/12/07 2. YA1 4 31/12/07 3. YA1 6 31/12/07 4. YA6 15(2)(a) 31/12/07 Havelock Court Nursing Home Version 5.2 Page 34 For example, person centred. The previous timescales of 31/12/06 and 31/03/07 for action to be taken to meet this requirement are not met. The registered persons must 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 previous timescales of 31/12/06 and 31/03/07 for action to be taken to meet this requirement are not met. 6. YA7 12 The registered person must ensure that evidence that residents have been involved in and agree to their written care plans must be retained where possible. Where this is not possible the plans should be agreed by a relative or advocate. The registered person must ensure that care is given in accordance with assessed health care needs and written plans. The registered person must ensure that consent is obtained from residents, relatives or other advocates when bedrails are used. The registered person must ensure that systems are in place to ensure that prescribed medications are always in stock and available. Stock checks must be justified to check whether medication is being administered correctly. The registered person must ensure that staff sign the medication administration record when they administer any DS0000007024.V341696.R01.S.doc 5. YA6 15 12 28/09/07 28/09/07 7. YA19 12 28/09/07 8. YA19 12 28/09/07 9. YA20 13(2) 28/09/07 10. YA20 17 28/09/07 Havelock Court Nursing Home Version 5.2 Page 35 11. YA20 17 12. YA24 23(2)(l) medication and that all prescribed medications are administered correctly. The registered person must ensure that staff sign any handwritten instructions on medication administration records. The registered person must ensure that bathrooms and shower rooms are not used for the storage of wheelchairs, trolleys and portable hoists. The previous timescale of 31/03/07 for action to be taken to meet this requirement is partly met. A temporary solution is in place. A permanent solution is required. The registered persons must ensure that the home is free from offensive odours. The previous timescales of 31/10/06 and 31/03/07 for action to be taken to meet this requirement are not met. 28/09/07 31/12/07 13. YA24 16(2)(k) 28/09/07 14. YA35 18 The registered person must ensure that a training needs assessment, based on the needs of the current residents, is carried out for the staff team as a whole to inform future training plans. The previous timescale of 31/03/07 for action to be taken to meet this requirement is partly met. A more detailed analysis is required. The registered person must ensure that staff receive structured induction training within six weeks and foundation DS0000007024.V341696.R01.S.doc 30/11/07 15. YA35 18 28/09/07 Havelock Court Nursing Home Version 5.2 Page 36 16. YA37 8 9 training in accordance with Skills for care guidelines within 6 months of appointment. The registered person must 28/09/07 ensure that the manager submits an application to register with the Commission. 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 The registered persons should amend the service users guide to indicate that although the service is for adults between the ages of 18 and 65 years old, the current resident population is largely over 65 years old. The registered person should train staff in writing person centred care plans and in using plain English to keep the documents accessible. The registered person should consider ways in which the valuable information that health care assistants have about individual preferences, and ways of communicating and supporting people, can be added to the care plans. The registered person should, in consultation with residents and other appropriate advisors, continue to develop the range of activities that are available to residents both in the home and in the community. Emphasis should be placed on activities that are culturally appropriate and accessible to people whose first language is not English. The registered persons should consider ways in which residents can become more involved in shopping for personal items, such as clothing. There should also be consideration of how staff can safely purchase items on a resident’s behalf from a sufficiently diverse range of places, so that personal financial circumstances and cultural and ethnic preferences can be better considered. The registered persons should consider ways in which the cultural meal preferences of all residents can be included in the homes menus. The registered person should ensure that the frequency of any regular ‘monitoring’ of specific health issues such as DS0000007024.V341696.R01.S.doc Version 5.2 Page 37 2. 3. YA6 YA6 YA18 4. YA12 5. YA16 6. 7. YA17 YA19 Havelock Court Nursing Home 8. YA19 YA1 9. 10. YA20 YA20 YA23 11. YA22 12. 13. 14. YA23 YA24 YA24 15. YA34 16. YA42 blood tests, is specified in plans. Where an area of care requires ‘monitoring’, there should be evidence of how, why and when this monitoring is happening. The registered person should clarify arrangements for accessing the services of a chiropodist and the potential financial cost of this service (if any) should be included in information given to prospective residents. The registered person should advise staff not to sign when ‘as required’ medication is not administered. The registered person should request a review for one resident, who speaks no English, needs an interpreter and who is non compliant to all medication, including pain relief. The review should consider whether this choice is fully informed and whether there are any best interests issues such as use of covert administration. 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 person should provide residents who bank via the home with monthly statements, unless risk assessment suggests otherwise. The registered persons should consider ways in which the storage areas can be increased on the first and second floors of the home. The registered person should consider ways in which the home can be organised so that no more than ten people are sharing a staff group, a dining area and other common facilities. The registered persons should ensure that there is evidence of the additional checks (for example, telephone calls) made when references for new staff are not supplied on headed notepaper and are without a company stamp. The registered person should remind staff to take note of health and safety advice posted around the building, such as keeping doors shut/or locked where necessary. Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Havelock Court Nursing Home DS0000007024.V341696.R01.S.doc Version 5.2 Page 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!