CARE HOMES FOR OLDER PEOPLE
Havelock House 57-59 Victoria Road Polegate East Sussex BN26 6BY
Lead Inspector Kathy Flynn Unannounced 19 April 2005 11.30 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 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 Older People. 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 House Version 1.10 Page 3 SERVICE INFORMATION
Name of service Havelock House Address 57 - 59 Victoria Road Polegate East Sussex BN25 6BY 01323 482291 01323 484183 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Bhardwaj Dhunnoo Vacant Care Home 27 Category(ies) of Care Home with Nursing (N) 27 registration, with number of places Havelock House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The maximum number of service users to be accommodated is twenty-seven (27). 2. The service can provide up to twenty-six (26) nursing places and one (1) social care place. 3. Service users must be aged sixty-five (65) years or over on admission. Date of last inspection 21 December 2004 Brief Description of the Service: 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 a library, GP and dentist surgeries easily accessible. The home is on two floors with a shaft lift and stair lifts giving residents access to all parts of the home. There are 21 single rooms 3 double rooms with no ensuite facilities, although there are two assisted bathrooms, an assisted shower and a number of assisted toilets. There is a large lounge, looking out to the rear garden that is accessible to wheelchairs and is used when weather permits, and a separate dining room. Havelock House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The requirements recorded in the previous inspection report were used to develop the plan for this unannounced inspection. The aims were to assess if the home had met these requirements, identify the aspects of the service that have improved and how the service could be developed for the benefit of the residents. The inspection was carried out over seven hours from 11.30am, it included a tour of the building, an examination of care plans, staff records and training, policies and procedures including the statement of purpose, medication administration charts, menus and an assessment of the provision of aids including hoists, assisted toilets and bathrooms. The inspector spoke to the seventeen residents at the home, four relatives, two visitors, the registered provider, the acting manager, three of the staff on duty and the chef during the inspection. There were no social activities at the home during the inspection but there were opportunities to sit in the lounge with staff, residents and visitors and observe the communication between them and the care provided. The home has been without a manager for two months and the deputy has been the acting manager during this time, there have been no recent admissions to the home and the staffing numbers have remained the same since the last inspection. What the service does well: What has improved since the last inspection?
A number of the requirements from the last inspection have been met and these have enabled staff to provide an improved service. Care plans are now reviewed on a regular basis, medication is now administered in line with the home’s policies and therefore ensures the safety of residents.
Havelock House Version 1.10 Page 6 Training in adult protection and abuse has provided staff with a better understanding of abuse and has enabled them to identify that making choices for residents is a form of abuse. This has encouraged staff to discuss with the residents the care and support provided and includes where they spend their time and what they would like for their meals. A more open and relaxed approach to care provision was noted during the inspection and the residents, their relatives and the staff are clearly benefiting from this. The involvement of specialist nurses has increased since the last inspection, this support has enabled staff to provide appropriate care for a resident whose behaviour has changed significantly, additional training in pressure care and the promotion of continence has enabled staff to be more informed in these particular areas of care that they provide. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Havelock House Version 1.10 Page 7 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection Havelock House Version 1.10 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 The statement of purpose and service users guide is inadequate and does not provide correct, up to date information for prospective residents and their representatives to be clear about the services provided and how the home will meet their needs. EVIDENCE: The statement of purpose and the service users guide are combined as one document in booklet form. Although a considerable amount of information is included the booklet it is not easy to read and some of the details, including the day to day management of the home and social activities, are incorrect. The residents spoken to said that they had not been provided with a statement of purpose although they also said that they felt the home provided the care and support they need. The registered provider discussed the changes that need to be made and said that he would be reviewing the information and ensuring that it is user friendly. Havelock House Version 1.10 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9. There is a clear care planning system in place that includes the involvement of GP’s and specialist nurses as required. Systems are in place to ensure that medication is administered in line with the homes policies to ensure the safety of residents. EVIDENCE: Care plans are comprehensive, they outline the assessed needs of service users, how these needs are met with risk assessments, including those for the prevention of pressure sores and the use of hoists and other aids. The involvement of specialist nurses and any subsequent changes in need are recorded in the care plan and discussed with the care staff to ensure that the residents receive appropriate care. The care plans are reviewed as residents needs change and on a monthly basis. Residents and their representatives can be involved in these reviews if they wish and there was evidence in some care plans to support this. There were some issues concerning the different opinions of members of families regarding the care provided for residents, the acting manager and the staff try to address these as they arise at the home. Havelock House Version 1.10 Page 10 Residents spoken with were aware of their care plans, they said that staff discuss the care and support provided and they felt that staff understood their choices and preferences. There were no residents at the home who are responsible for their own medicines. Medication is administered by the trained nurses, with medication administration charts completed when the medicines are given to the residents in line with the homes policies. Havelock House Version 1.10 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15. The meals in this home are good offering both choice and variety and catering for special dietary needs. EVIDENCE: An activity person offers games, discussions or individual time for a small group of residents three days a week, with a record kept of these activities. Some residents said they choose to spend their time in their rooms and do not want to join in with any activities. This was supported by the staff who explained that the residents who want to participate are encouraged to do so, with the activities provided based on what they want to do. However there is no evidence to show that residents are asked what interests they have and how the home can meet their particular social and cultural needs. At the time of the inspection there were only 17 residents in the home and the staff said they had more time to spend with them, they were sitting in the lounge talking to residents and their visitors before and after lunch. The chef demonstrated a knowledge of nutrition and a good understanding of the needs of residents, choices are offered for each meal and residents can have something different if they change their mind. The meals are pureed for residents as required with assistance at meal times provided by the care staff. Havelock House Version 1.10 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Staff have knowledge of and a good an understanding of Adult Protection issues which protects residents from abuse. EVIDENCE: Training in adult protection, abuse and whistle blowing has been provided for some staff and will be provided for all staff in the next few months. The care staff who spoke to the inspector were able to explain how this training has helped them understand what abuse is and how it can be prevented. In particular recognising that not allowing residents to make choices is a form of abuse. One example they gave was that giving a resident a perm, when she had changed her mind and only wanted her hair washed and dried, is a form of abuse. The residents who spoke to the inspector said they feel safe and secure in the home. A resident’s behaviour has changed significantly and with the involvement of the mental health care team her care needs have been reviewed. Appropriate changes have been made to the support provided to ensure that the staff and residents are protected. The staff were able to demonstrate a good understanding of her needs and how these can be met while allowing her to make choices and participate in decisions about her care. Staff who spoke to the inspector said that they had not had any training in dealing with aggression and felt that this would help them provide appropriate support and care for residents when their needs change. Havelock House Version 1.10 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22 and 26 Improvements to the appearance of the home have created a comfortable environment for residents, staff and visitors. Satisfactory systems of infection control are not in place. EVIDENCE: Rooms are redecorated when they become empty and a number have been done since the last inspection, some carpets have been replaced and there is an ongoing programme of maintenance with repairs carried out daily where necessary. Hoists, assisted baths and aids are available to ensure that appropriate care can be provided for residents. The hoists, some commodes and some bed frames were chipped and rusted, these are difficult to clean, therefore it is not possible to ensure that infection control systems are effective. Thick dust was found under some beds and the bases of some beds were dirty, cleaners are employed but a programme of deep cleaning is not in place. Havelock House Version 1.10 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30. There are sufficient staff numbers to meet the residents assessed needs. New staff members are not given appropriate training and support. EVIDENCE: Sufficient staff are on duty, day and night, to meet residents needs. The residents who spoke to the inspector said that the staff were able to provide the care and support they need. Equally the staff felt that they are able to care for residents appropriately, many have worked at the home for a number of years and have developed an understanding of residents needs and have good relationships with them. Induction training in line with TOPSS is not provided at the home, new staff are given information about the home and work with staff who have relevant experience until it is felt that they have the appropriate skills to provide care and support. This has been an outstanding requirement from previous inspections. Havelock House Version 1.10 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, 37 and 38 The appointment of a manager is required to ensure that care and support provided continues to meet the needs of residents. EVIDENCE: There is no manager in place at this home, the acting manager is currently responsible for managing the home on a daily basis with support from the registered provider. The inspector was advised that she does not wish to apply for the position of manager and the post has been advertised. The inspector was concerned that without a manager the home may not be run in the best interests of the residents, particularly as induction training and supervision are not in place. However the feedback obtained from residents, relatives and staff show that the home provides appropriate care and support for residents, that the home is comfortable and the atmosphere is relaxed and open. There are only 17 residents at the home, many have lived there for over
Havelock House Version 1.10 Page 16 a year while some have been there for considerably longer, the staff therefore have a good understanding of their needs. If the number of residents increases significantly, with current staff numbers and if a manager is not appointed, the provision of care may be affected Training in manual handling has been arranged for the week after the inspection. Staff were noted to use hoists and other aids as required to ensure the safe transfer of residents. A number of risk assessments had been completed by the manager before she left and included the use of additional radiators and restrictors on windows. The registered provider stated that he will ensure that appropriate changes are made to meet these assessments. Bed barriers are used to ensure the safety of residents, these are provided following risk assessments and the agreement of residents, their representatives or their GP. Evidence of this is included in some care plans and should be provided for all residents. Covers for these barriers are also required. Residents doors were propped open using wedges, zimmers and stools, this was discussed with the acting manager and the registered provider and in line with Fire Service advice alternative safe systems are to be introduced. Havelock House Version 1.10 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 2 x x 2 x x x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 2 2 2 x x 1 2 2 Havelock House Version 1.10 Page 18 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 OP 1 Regulation 4&5 Requirement Timescale for action 08.07.05 2. OP 12 3. 4. OP 30 OP 33 5. 6. 7. 8. OP 36 OP 37 OP 38 OP 38 That a statement of purpose and service users guide meet the regulations, Schedule 1 and the NMS is provided and made available to all residents. 16 (2)(n) That the service users social, cultural, religious, recreational interests needs are assessed and provision made to ensure these needs are met. 18(1)(a)(c Induction programme in line with ) (i) TOPPS to be developed and 19(5)(b) introduced. 24 & 26 That an effective quality assurance quality monitoring system is implemented. That the registered provider visits the home in accordance with Regulation 26 and provides a written report to the CSCI. 18 (2) That a programme of formal supervision is to be developed and introduced. 17 That policies procedures are to Schedules be reviewed and updated. 3&4 13 (4)(c) Bed barrier covers to be provided to ensure the safety or residents. 13 (4)(c) Advice is sought from the Fire Service regarding the provision
Version 1.10 07.06.05 08.07.05 08.07.05 08.07.05 08.07.05 07.06.05 07.06.05 Havelock House Page 19 9. OP 38 13 (4)(c) 10. OP 26 13 (3) of safe systems for keeping residents doors open. Action to be taken to meet the requirement of the risk assessments regarding window restrictors. Infection control policies to be followed, to include the repair of hoists, beds and commodes. A deep cleaning programme to be developed and introduced. 07.06.05 07.06.05 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 Good Practice Recommendations Havelock House Version 1.10 Page 20 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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