Inspection on 18/12/08 for Havelock House

This inspection was carried out on 18th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Havelock House 01/09/09

Havelock House 17/01/08

Havelock House 26/04/07

Havelock House 03/05/06

Havelock House 04/10/05

Havelock House 19/04/05

Havelock House 21/12/04

Havelock House 06/07/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Havelock House 57 - 59 Victoria Road Polegate East Sussex BN26 6BY     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Deborah Calveley     Date: 1 8 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Havelock House 57 - 59 Victoria Road Polegate East Sussex BN26 6BY 01323-482291 01323482622 jules48k@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Bhardwaj Dhunnoo,Mrs Tarramattee Dhunnnoo Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 27 Number of places (if applicable): Under 65 Over 65 27 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 27 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Havelock House is registered to provide nursing care for up to 26 older people and personal support for one. Situated in a residential area of Polegate, it is within walking distance of the high street and the railway station, with the library, GP and dental surgeries being easily accessible. The home is on two floors with a shaft lift and stair lift giving residents access to all parts of the home. There are 21 single rooms and 3 double rooms with no en-suite facilities, although there are two assisted bathrooms, an Care Homes for Older People Page 4 of 35 Brief description of the care home assisted shower and a number of assisted toilets. There is a separate dining room and a large lounge, looking out to the rear garden that is accessible to wheelchair users and is used by all service users when weather permits. Potential new service users can obtain information relating to the home via CSCI Inspection Reports, Care Managers, Placing Authorities, the internet, by word of mouth and by contacting the home direct. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Havelock House will be referred to as residents. This unannounced inspection was carried out over 6 hours on the 18 December 2008. There were 24 service users living in the home on the day of which three were case tracked and spoken with and another 4 care plans were selected for review of specific areas. During the tour of the premises four other residents both male and female were also spoken with. Care Homes for Older People Page 6 of 35 The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Two members of care staff, cleaner and cook were spoken with in addition to discussion with the appointed manager. Telephone contact was made with visiting professionals following the visit and their views and comments are incorporated into the report along with the information received verbally during the site visit. What the care home does well: What has improved since the last inspection? What they could do better: The Statement of purpose needs to be available within the home and for visiting relatives, prospective residents and health professionals. The home needs to confirm in writing to the prospective resident or their representative that with regard to the needs assessment completed the home can meet the needs of the prospective resident. This ensures that decisions around admission to the home are informed. All residents admitted to home need to have a base care plan in place to ensure their needs are met on admission and to inform the staff and the residents safety. Health assessments need to be improved to ensure residents receive appropriate and person centred care that meets their assessed needs and to minimise any risks. Urgent action is taken to address the poor practice observed made in dispencing/administrating medications to residents.This will reduce the potential risks of harm to residents. An appropriate programme of activities needs to be created that is realistic and based on the residents preferences to ensure that their social and leisure needs are met on an individual basis. Residents comments included: Not much happens, They do their Care Homes for Older People Page 8 of 35 best. There is a need to ensure that that there is a robust refurbishment and maintenance programme to ensure that the home meets the residents needs and expectations. there are a number of chairs in the communal areas that place residents at risk from choking on exposed foam and cross infection from unsealed chairs. Quality monitoring and quality assurance systems need to be in place, in order that all residents, staff and other interested parties can give and receive feedback about the service that they experience. At present there is still no registered manager, the appointed manager has been in post for at two years or more and this position needs to be formalised to ensure there are clear lines of accountability and leadership. The provider needs to make available the regulation 26 documentation that follows the monthly unannounced visit to the home. The use of wheelchairs in the home needs to be reviewed and the use of appropriate foot plates be introduced to reduce the potential risk of injury to the residents. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission, although people are not assured in writing that their needs will be met. Intermediate or rehabilitative care is not provided at Havelock House. Evidence: The appointed manager confirmed that there is a Statement of Purpose and Service Users Guide in place, which contains information about the home and the services it provides along with the qualifications of the staff. The Statement of Purpose was not readily available and therefore not seen and it was agreed that a copy would be sent to the CSCI. At the time of writing the report this had not been received. The service users guide was seen in some residents bedrooms and was in need of updating. Care Homes for Older People Page 11 of 35 Evidence: It was confirmed whilst talking to residents that the contract arrangements were clear and understood. There is a copy of the terms and conditions of residency included in the homes information documents. The homes certificate of registration is not correct and this needs to be referred to the registration team with the correct information. A review of the care documentation confirmed that pre-admission assessments are completed by the appointed manager. The last three admissions to the home were identified and the records relating to the admission procedures followed were reviewed. This confirmed that pre admission assessments are completed and provide a clear assessment of prospective residents care needs. These are completed by the manager prior to admission to the home. Prospective residents are seen either in their home or hospital before admission and the input from relatives and other professionals is used whenever possible. This approach should be more clearly recorded on the assessment documentation to demonstrate the procedure followed. It was however noted that the home does not confirm having regard to the assessment that the home can meet the assessed needs of the prospective resident. This was discussed with the manager who was advised that this should be completed in writing in accordance with the required documentation. The manager was able to verbally demonstrate her knowledge and awareness of the different specialities required in the home and ensures that the registered general nurses (RGN) and carers employed have attended relevant courses to deal with the needs of the elderly and also specialised courses for certain diseases. Trial visits to the home can be arranged and the appointed manager confirmed that residents are invited to a trial period to ensure suitability of the home. This is clearly stated in the statement of terms and conditions. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although care documentation provides a good framework for the delivery of care it needs to be developed to provide clear guidance to care staff on all the care needs of the residents, along with robust systems for risk assessment to ensure individual person centred care is delivered. Residents are not protected by the homes ordering and administration medication practices at this time thus placing residents potentially at risk. Evidence: The care documentation pertaining to three residents were reviewed in depth as part of the inspection process and a further four were identified for review of specific areas. The format of the care plans used in the home are comprehensive and detailed and two residents confirmed that they had been involved in planning their care. The residents were found in the main to have care plans specific to their needs, however not all viewed evidenced regular review. Some had not been reviewed since July 2008. It was a concern that a new admission to the home did not have a care plan in place for any of her needs thus not providing the staff with guidance in meeting her needs in Care Homes for Older People Page 13 of 35 Evidence: the early stages of her admission to the home. This is vital as the staff have no knowledge of her capabilities for example mobility and nutrition. This places residents at risk from uninformed staff. The care plans all contain tools for assessing and monitoring the health needs of their residents and these include nutritional, moving and handling and tissue viability tools. The wound care records for one resident were confusing and the main care plan for skin integrity and relating assessment tool did not correspond with the short term care plan also in place. The staff need to cross reference information carefully to ensure the resident receives the appropriate care. The nutritional assessments are completed, but not all followed through as directed by the guidance. From discussion with the appointed manager it is understood that shortfalls had been identified within the care plans, however these had not yet been undertaken by the staff recently employed. The home needs to ensure that the shortfalls are addressed to protect the residents and promote their health and well being. Risk assessments for personal safety in respect of bedrails are included in the care plans as required, however there is no risk assessment in place for use of call bells or for the people who can not use this facility. This needs to be followed through with an appropriate plan of action such as regular monitoring, when identified as required. Staff spoken with confirmed that they received a full report on each resident daily, but agency staff spoken with stated that they did not always get chance to read the care documentation that is kept in the main nurses station. The agency carer that arrived during the inspection visit did not receive a handover before commencing work. There are daily notes written at the end of each shift and these contained a good level of information. The health needs of residents are adequately met with evidence of good multi disciplinary working taking place on a required basis. Residents are registered with one GP from one of the two local surgeries. Residents are encouraged to attend the GP surgery where able and home visits are conducted as and when necessary. Referrals to the Occupational Therapist, Physiotherapist, Dietician and Audiologist are made via the GP or the hospital. Direct access to a domiciliary dentist is available. A visiting Chiropodist attends residents six weekly with additional appointments being arranged if necessary. A domiciliary optician attends the home annually. Staff initials were noted on each entry and there were no printed names or job designation recorded as recommended at the last key inspection. In line with the Nursing and Midwifery Councils (NMC) guidance on Report Writing and Record Keeping, staff must date time Care Homes for Older People Page 14 of 35 Evidence: and sign each entry and include their printed name and designation. This remains a recommendation of good practice. The clinical room is compact in size kept clean and tidy and there are suitable storage facilities for medication stocks and dressings. A medicine trolley is stored in the room and the staff keep it clean and organised. From direct observation the morning medications were administered safely from the trolley but not signed for at the point of administration. This was an immediate requirement at the last key inspection and will now be a statutory requirement notice at this inspection. This was brought to the managers attention. There is a small fridge and temperatures of the room and fridge are recorded daily. There are policies and procedures in place for staff to refer to regarding the safe administration, storage, disposal and recording of medication including insulin administration. There are systems for recording and checking controlled drugs. The Medication Administration Charts (MAR) were viewed, gaps were identified and these need to be followed up by the senior staff. The MAR sheets include the codes use by staff for the non administration of prescribed medicines and it was identified for one resident that medication was out of stock for 5 days. Handwritten entries need to be signed and dated and include who prescribed the changes. As discussed during the inspection, this needs to be introduced to provide vital information for the GP and for audit purposes. The comparison signatures of staff able to administer medication were available and current. Risk assessments for those residents that wish to self administer their medication are in place if required. The home need to ensure that the British National Formulary (BNF) or MiMMs are current for use by staff. During the tour of the premises it was noted that there were topical creams and drink thickeners that were left without their lid on, thus allowing the items to be contaminated. Feedback from a health professional was positive regarding the home and confirmed that advice was sought as and when required. Staff were seen to be respectful and considerate to all residents whilst attending to their needs. There was a concern raised regarding a resident being inappropriately dressed whilst sitting out in his chair with his door open, this does impact on the residents dignity. Each of the residents were addressed by their preferred term and dressed appropriately in well-laundered clothing. Care Homes for Older People Page 15 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents would benefit from a robust and stimulating activity programme. The lifestyle experienced by residents does not always match their expectations choice or preferences Evidence: There was little reference in the care notes in individual files of the residents mental health needs or how to engage positively with the residents. There is no activity programme in place and the activity co-ordinator post is vacant at this time. The appointed manager confirmed that the post has recently been filled. Records found in care files viewed had recorded when relatives and friends visit, but did not detail specific activities attended or trips out. This is an area that needs to be developed to ensure that residents social and mental health needs are met. Special activities are arranged for birthdays and festive occasions such as Christmas, Easter and other seasonal holidays. It was confirmed by the staff that the residents are supported and enabled to join local events that are held in the the village and attend the Church Services at the nearby church if they should wish to. Residents are facilitated to maintain their independence Care Homes for Older People Page 16 of 35 Evidence: for as long as they are able. There are no restrictions on visiting times as long as consideration is shown to all the residents. Residents individual wishes regarding religion are respected and arrangements are in place for residents to receive Holy Communion if they wish. The home would welcome any potential new resident who has special cultural religious or spiritual beliefs and would make the necessary actions to accommodate their needs. The residents spoken with said they are treated with respect and that every one is very kind they look after us very well. Communication between the staff and residents was seen to be fairly positive, but due to the staff shortages little interaction was seen during the morning. The homes menus are devised on a four week rolling programme. The mid day meal was observed and was seen to be organised and well managed. It was confirmed that residents had a choice at lunchtime which included a vegetarian choice. Those residents saying they did not like the main choice were seen to have alternatives provided that they did want. This was confirmed by the residents spoken with. Menus are used and circulated the day prior to the meals being provided, there are no records kept on what food is eaten by each resident unless there is a problem and it was discussed that records are beneficial in identifying appetite traits early. All feedback about the food was complimentary and comments included Nice food No complaints. The dining areas is pleasant and well furnished with natural light. The tables are attractively set with napkins and tablecloths. The meals provided looked appetising and were served in a manner that ensured it looked attractive. A negative comment from residents was that there is no fresh fruit assessable to them. The cook on duty confirmed that she will meet with residents to discuss their dietary requirements when required. The safer food better business book is completed everyday, the last Environmental Health Organisation inspection report could not be found, but it was said that it was fairly recent. The appointed manager said that the recommendations had been actioned. Care Homes for Older People Page 17 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place to record and investigate complaints. Training in adult protection is provided for staff to protect residents from abuse. Evidence: The home has a written complaints procedure and this is displayed in the home and provided within the Service Users Guide. The appointed manager reported that no complaints had been received in the previous twelve months. However from information received there has been a complaint made. The appointed manager stated that it was not made as a formal complaint. Residents spoken with stated that they would talk to the manager if they had a problem, it was also said that despite bringing their concern to staff, changes took a long while to happen. Criminal Record Bureau checks (CRB) and Protection of Vulnerable Adult checks (POVA)are carried out on all new staff. These need to be followed through and appropriate action taken as necessary on information documented on CRBs. There have been two safeguarding alert level 1 investigations in the past year which have been resolved satisfactory. Staff have attended training in the Protection of Vulnerable adults, this was evident from the staff files that were viewed. Care Homes for Older People Page 18 of 35 Care Homes for Older People Page 19 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Havelock House has the potential to provide residents with a homely and comfortable environment with communal rooms and a shaft lift that enables them to have access to all parts of the home, however the residents are put at risk by the poor maintenance of the home and poor quality furnishings. Lack of robust infection control measures within the home also place residents health at risk. Evidence: Havelock House is situated in a residential area of Polegate, it is within walking distance of the high street and the railway station with the library, GP and dental surgeries being easily accessible. The location and layout of the home are suitable for its stated purpose. It was confirmed that there is an ongoing maintenance and refurbishment programme in place, but it is a slow process and there is still much to do to bring the home in line with current standards expected by residents. The lounge furniture needs to be audited and replaced as some are not fit to be in use, at least five had ripped covering and the foam was exposed which is a choking risk as Care Homes for Older People Page 20 of 35 Evidence: well as a source of cross infection. Two chairs were identified as smelling offensive as they are not appropriately covered. These were identified to the appointed manager. There are adequate communal bathrooms and shower rooms in the home with specialist equipment to ensure all residents can have a bath or shower. However one was found below the expected standard and therefore needs prompt action to ensure it is cleaned thoroughly, especially the bath seat and bath and that the radiator cover and the toilet are repaired. The home has specialised equipment available throughout the home to promote independence. During the inspection it was noted that staff were using lifting and supporting equipment in the main appropriately, however care needs to be taken when using the equipment to ensure the residents feet are considered. The home has a range of special mattresses and seat cushions, which are used on an assessed needs basis to prevent tissue damage. The staff were able to discuss how they procure special equipment if they should need it. The staff need to ensure that the settings are checked daily and that the equipment is functioning properly. One mattress was seen to be malfunctioning, this was reported to the appointed manager. The use of using divan beds for residents that have high nursing needs needs to be reviewed and appropriate high/low beds be provided. this will ensure the sagfety of the resident and staff. Call bells are provided in all areas, however not all residents in the communal area had access to this facility and were unsupervised at times during the inspection. This impacts on the residents safety and well being. The lighting in the home is of domestic quality and there are above bed lights as well as the main ceiling lights. Water temperatures are controlled and monitored monthly and a record kept. Random temperatures were taken and were of the recommended level. The maintenance person confirmed that there are systems in place for monitoring, safety issues such as fire checks, fire drills, PAT testing, electrical tests and gas and boiler checks and all the rooms are routinely checked for safety and maintenance issues. The records in the home confirmed they were up to date from the prospective of the maintenance person, but from the tour of the building the staff are not reporting many of the problems identified. Maintenance shortfalls identified included broken cabinets, broken beds and broken bathing equipment, these were identified to the manager. It was confirmed that there are polices and procedures for infection control in place, they were not available for review and are currently being updated. It was discussed that the staff need to be able to access policies and procedures at all times. The home Care Homes for Older People Page 21 of 35 Evidence: is kept clean by two cleaning personnel and the home was in the main adequately clean, however there were offensive odours noted in one area on the ground floor and some carpets are in need of deep cleaning. There were gloves and aprons freely available in the home and staff were seen to be using them appropriately. Sluice facilities are provided, the ground floor sluice was untidy and the sluice covered with boxes and therefore could not be used. Bins were in use for clinical waste without a lid, again causing offensive odours and a potential source of infection. The laundry was in need of cleaning and the floor needs to be repaired to ensure it is impermeable. Whilst soiled linen was appropriately put in red bags, they were then left opened on the floor, causing odours and again a potential source of cross infection. These shortfalls were discussed during the inspection. Care Homes for Older People Page 22 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A review of staffing levels based on residents dependency levels is needed to ensure there are sufficient staff to meet the residents needs. There is now evidence that staff receiving the necessary training to perform their job competently. Evidence: The staffing rota was viewed and identified that for the twenty four residents living in the home, there is normally four carers and one registered nurse on duty during the day and two carers and one registered nurse on at night. The staff rota in place details staff designations and hours of working and includes the appointed managers hours. Separate staff are employed for cooking, kitchen, cleaning, laundry, maintenance and gardening. On the day of the inspection however, the staffing levels were down by two carers which did impact on the positive impacts for the residents at that time. An agency carer arrived during the morning shift. The Appointed Manager reported that there had been a high turnover of staff over the past few months. A selection of staff recruitment files were viewed and demonstrate that a robust recruitment process has been maintained to protect residents and contained all the Care Homes for Older People Page 23 of 35 Evidence: relevant information required. There was evidence of health questionnaires, Criminal Record Bureau checks, two references, a resume of previous employment and work permits where necessary. All the paperwork is kept within a locked room. Some areas of the recruitment process were discussed and need to be reviewed to ensure transparency and openness. There is an induction programme in place and has been introduced for all staff. Files seen confirmed this. New staff are required to complete an initial induction programme and undertake mandatory training including fire and health and safety. This leads into foundation training, in preparation of NVQ training. At present 65 per cent of staff have an NVQ qualification with further staff enrolled on a course. The induction and foundation training is in line with the Skills for Care guidance. The provider facilitates regular training sessions and recent ones have included safe cleaning, food hygiene, nutrition, infection control, moving and handling and fire safety. There is a rolling programme of training, which will ensure that staff receive the training necessary to meet the residents needs. A sample of individual staff training files were viewed and it was evident that staff had received training in Moving and Handling, Fire Safety, Food Hygiene, pressure area breakdown prevention and infection control. RNs also receive training in wound care and continence promotion.There is a record of staff training in place, but it does not identify the frequency and refresher dates and the appointed manager stated that a training matrix is available and would be forwarded to the CSCI, this had not arrived by the time of writing this report. Staff training certificates are not reflective of the training attended by staff. Staff spoken with confirmed that they received the training necessary to perform their job. Care Homes for Older People Page 24 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and staff would benefit from a managerial approach that provides leadership and promotes the health and safety of the residents. Quality Assurance systems are not in place and therefore the home can not effectively measure whether it is meeting it aims and objectives. Evidence: The appointed manager is a qualified RN and has worked in the elder care home environment for the past eleven years. She has worked at Havelock House for over two years and has to still apply for registration as manager with the CSCI. The appointed manager stated she conducts audits on care plans and had identified shortfalls, but these shortfalls have not been acted on as yet. At the last key inspection, 17 January 2008, it was reported that the Registered Provider has purchased a new software package that will enable an effective Quality Assurance system to be introduced. This software package requires another computer Care Homes for Older People Page 25 of 35 Evidence: to be linked so that all staff may have access to records that require auditing and or monitoring for Quality Assurance purposes. This has still not happened. There have been no questionnaires sent out to residents or stake holders since the last key inspection. Results of questionnaires are not published. Staff meetings are held three monthly and minutes are taken. Residents meetings are held periodically throughout the year and at times agreed by residents. Regulation 26 visits are undertaken by the registered provider but no records of these were available for viewing, these need to be available at all times. The home does not take any responsibility for any of the residents finances and most residents have family friends or representatives who protect their financial affairs. Staff receive individual formal supervision and records are appropriately maintained. All staff receive notice of their planned supervision dates throughout the year. Staff spoken with confirmed that they received regular supervision and yearly appraisals. Havelock House was not seen to be maintained to an acceptable standard and systems need to be developed to report any problems to the maintenance person that needs attention. A refurbishment and decorating programme needs to be in place to meet the homes statement of purpose and to ensure that residents are protected. Certificates relating to Health and Safety in the home were reviewed and found on the whole to be full. Full records of hot water checking are kept there are measures in place to prevent Legionnaires disease but poor maintenance in bathrooms contravenes the policies. The health and safety policy is up to date. It was however noted that environmental risk assessments are not fully recorded this was discussed in full on the inspection visit. To protect and promote the residents safety, the call bells need to be assessible to the residents at all times and the appropriate use of leg plates on wheelchairs. The staff room continues to be the designated smoking area. This room is clearly signed in accordance with the new fire regulations regarding smoking on premises. Residents who wish to smoke are escorted by a staff member to this room. The homes policies and procedures were not available and are currently being reviewed. The accident book was seen and was seen to be completed competently. First aid boxes need to be in available in the home and checked regularly. Care Homes for Older People Page 26 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 That the registered person produces and makes available to all service users an upto date statement of purpose setting out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the home. The Statement of purpose was not available on request and therefore does not allow prospective service users to make an informed choice about the service. 07/03/2009 2 3 14 That the registered person 07/03/2009 confirms in writing that having regard to the assessment made on any prospective service user that the home can meet those needs. That service users and their families are assured in writing that the home can Care Homes for Older People Page 28 of 35 meet the assessed needs of prospective service users. 3 7 15 That the registered person ensures that all care plans are reviewed regularly and reflect the changing needs of the service users. That all new service users have an initial care plan in place to guide staff in meeting their needs. To ensure that all residents recieve consistent care to meet their assessed needs. 4 8 14 That the registered person 07/03/2009 ensures that that suitable risk assessments are completed in all areas of risk and cover the use of specialist equipment such as matresses risk of choking and risk of falls to promote resident safety To ensure the residents safety and well being. 5 9 13 That the registered person ensures that medications are signed as soon as dispensed. That all topical and oral medications have their appropriate lids on. Handwritten entries need to be signed and dated and include who prescribed the changes. That service users are given 07/03/2009 07/03/2009 Care Homes for Older People Page 29 of 35 their prescribed medication in a timely manner. To ensure the residents health needs are met. 6 10 12 That the registered person ensures that the dignity of the service users is maintained at all times. that the service users are treated with res[pect at all times. 7 12 16 That the registered person 07/03/2009 ensures that all service users have a social care plan that is designed to meet their interests and preferences. That service users isolated in their bedrooms have a plan of care to ensure that they receive interaction and stimulation. That a programme of activities is developed based on service users preferences and interests. To ensure that service users social and mental health needs are met. 8 16 22 That the registered person ensures that the service users are reassured that all complaints are taken seriously and acted on within the set timescales. 07/03/2009 07/03/2009 Care Homes for Older People Page 30 of 35 To ensure that service users are confident that complaints are taken seriously and acted on. 9 19 23 That the registered person ensures that the home is maintained to a good standard, both internally and externally. That a plan of maintenance and refurbishment is in place and adhered to. that the home environment meets its stated purpose. 10 22 16 That the registered person 07/03/2009 ensures that there is specialist equipment to meet the service users needs. That appropriate high/low beds are provided for those in receipt of nursing care. That all pressure relieving equipment is in good working order and that staff check it regularly. That all service users have access to a call bell or that an alternative system/monitoring schedule is devised. To ensure the service users are safe at all times. 11 26 13 That the registered person ensures that the home is kept clean, hygenic and free from offensive odours. 07/03/2009 07/03/2009 Care Homes for Older People Page 31 of 35 That the sluices are fit and ready for use. That all bins have appropriate lids. That the guidelines are followed in respect of soiled linen. That the chairs identified are repaired or replaced. That the floor in the laundry is impermeable. That all staff follow the homes policies and procedures in the standard of cleanliness and infection control measures To ensure the health and well being of the service users. 12 27 18 That the Registered Provider 07/03/2009 ensures that there are sufficient staff on duty to meet the needs of the service users at all times. to ensure the safety of all service users. 13 31 9 That the registered person ensures that the home is managed effectively. That the managers role is formalised and registered with the CSCI. 07/03/2009 Care Homes for Older People Page 32 of 35 That the home is run in the best interests of the service users. 14 33 24 That the registered person ensures that an effective quality assurance and monitoring system to be implemented. 07/03/2009 To ensure that the home is run in the best interests of the service users. 15 33 26 That the registered person 07/03/2009 performs an un announced visit to the home and a written report be available in the home. To ensure that the home is run in the best interests of the service users. 16 37 17 That the registered person ensures that the homes policies and procedures are in place and available for staff to refer to. To ensure the safety of service users. 17 38 12 That the registered person ensures that service users have access to a call bell at all times or have an approprite risk assessment and system of monitoring in place. That service users are transported in wheelchairs with foot rests. 07/03/2009 07/03/2009 Care Homes for Older People Page 33 of 35 To promote thesafety of the service users. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 34 of 35 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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