Inspection on 11/05/06 for Haven House

This inspection was carried out on 11th May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Haven House 13/04/10

Haven House 15/12/09

Haven House 02/01/09

Haven House 05/11/08

Haven House 03/07/08

Haven House 08/01/08

Haven House 30/05/07

Haven House 01/09/05

Haven House 04/05/05

Haven House 23/11/04

Haven House 29/04/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Haven House Residential Ltd Warwick Road Kineton Warwick Warwickshire CV35 0HN Lead Inspector Maggie Arnold Key Unannounced Inspection 11th May 2006 3.15pm X10015.doc Version 1.40 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 Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 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 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. Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Haven House Residential Ltd Address Warwick Road Kineton Warwick Warwickshire CV35 0HN 01926 641714 01926 641714 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) Haven House Residential Limited Robert Edward Hutchcox Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Manager must successfully complete the Registered Managers Award by April 2007. 1st September 2005 Date of last inspection Brief Description of the Service: Haven House is a conversion of three period houses in the large village of Kineton. There are twenty single bedrooms, nineteen of which have en-suite facilities. There is a shaft lift as well as two staircases, one at each end of the home. There are two sitting rooms and a dining room, and there is level access to the attractive walled garden at the rear, which gives access to the car park. Haven House is within a few minutes walk of the village centre of Kineton, which has three churches, hairdressers, a variety of shops, restaurants, pubs, banks and a post office. Two doctors surgeries, a chiropodist, an optician and a dentist are all nearby. There is a limited bus service to Stratford-Upon-Avon, Banbury, Leamington Spa and surrounding villages. Nursing care is not provided. Residents in need of attention from a nurse have access to the community nursing service, as they would in their own homes. The home’s fees range from £238.04 to £404.00 Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two consecutive days. The proprietor and manager were present on the first visit. The manager and his deputy were present throughout the second day. The majority of the residents were spoken to over the course of the inspection. The evidence for this inspection report was compiled in a number of ways. For example, by discussions with the registered persons, staff and residents, observing practice, a tour of the premises and reading of various records and documentation. The registered persons were given feedback throughout the inspection process and at the end of the inspection visit. What the service does well: What has improved since the last inspection? It is pleasing to note that, since the previous inspection, the acting care manager successfully for the vacant post of registered care manager. Work continues with improving the documentation of care plans and accompanying risk assessments. Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 6 There has been some improvement in the physical environment. For example, some carpets have been replaced and rubbish removed from the rear of the property. What they could do better: More information is required before admitting residents into the home. Prior to admission, the registered person must ensure that as much information as is possible is gathered from a prospective resident, his/her representatives (if appropriate) and relevant professionals. This will help to ensure the home can meet the residents assessed needs. It is recommended that the home refers to Care Homes Regulations 2001: Care Homes for Older People: National Minimum Standards 3.2 and 3.3 for detailed guidance regarding the type of information the home should be requesting from placing agencies or private referrals. Work must continue to ensure that all care plans and risk assessments are completed in sufficient detail to ensure staff are aware the needs of the residents. The care plans should be person centred and include all elements of the relevant national minimum standards. It is also recommended that the registered persons review the present job descriptions to ensure that the home has a person centred approach to the delivery of care and support of the residents. Greater consultation is required with residents about their day-to-day activities and social interests. The registered persons should demonstrate that they have made every effort to meet reasonable and achievable requests. Consideration should also be made to support residents to access local, social and community activities. It is also recommended that the registered person re-employ the two activities organisers who previously made regular visits to the home. It is imperative that, in the event of cause for concern, the registered person instigates the home’s Vulnerable Adults policy and procedures. The registered persons must complete the outstanding requirements relating to the general environment, including replacing the identified carpets and arranging to remove the remainder of the pile of rubbish and scrap metal in the back yard. Steps are to be taken to make good the worn and badly laid bedroom carpet which presents a potential trip hazard to the occupant of the room. Additionally the registered person must make good or replace the stained and torn coverings of the two bath seats. The registered persons must review the present infection control practice in the home. Of particular concern is the large number of partly used tablets of Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 7 soap in communal bathroom and dirty and disorganised state of the home’s laundry. As detailed in the body of this report a number of concerns have been raised regarding staffing levels. At certain times of the day the care staff are responsible for care, catering, cleaning and laundry tasks. The registered persons must make sure that there are sufficient numbers of suitably qualified and competent staff on duty at all times to meet the needs of the residents. The registered persons must ensure also ensure that staff are only allowed to work in the home when the records noted in Schedule 2 are obtained and verified. It is recommended that photocopies, taken by the home of documents such as proof of identity and birth certificates, are signed and dated by the person verifying the documents. The overall management of monies or valuables held on behalf of the residents falls well below the statutory requirements. A previous requirement to ensure that the information required in compliance with the Control of Substances Hazardous to Health (COSHH) Regulations is available for all chemicals held or used at the home has been partly met The safety and welfare of the residents, staff and visitors to the home is placed at risk as a result of bedroom doors being wedged open. Poorly placed and difficult to read fire safety instructions further compromises the safety of the persons in the care home. 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. Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 3&6 The judgement for this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents are not assured that their care needs can be met, prior to admission to the care home. EVIDENCE: Four residents files and accompanying records were selected for scrutiny. The files contained relevant professionals pre admission referral/assessments. The information in the documents varied between being detailed to very limited. One pre-admission assessment undertaken by a medical practitioner advised that the potential resident had “mild dementia” and a particular condition that was a serious factor in leading to confusion. The information on the placing Local Authority’s assessment for the same person was very limited. For example, there were no details regarding the individual’s legal status and religion was noted as “Christian”. The same referral advised that the proposed resident suffered from “Vascular Dementia”. The difficulty of finding suitable residential care for older people with an early diagnosis of dementia is acknowledged. Haven House is registered to meet the needs of older people Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 10 who are generally frail due to their age. This must be borne in mind when assessing the suitability of any proposed admissions. Another person’s pre admission referral/assessment was clear and concise in detailing the individual’s essential healthcare needs. However the document did not note whether is originated from health or social services. This could lead to future difficulties in the event of the home needing to follow up additional information. When possible, prior to admission the registered person must ensure that as much detailed information as is possible is gathered from the individual, his or her representatives (if any) and relevant professionals. Without this core information it is not possible to ascertain whether it has the potential to meet the proposed resident’s needs and wishes. Where practical the registered person must also confirm in writing to the resident, that the home can meet the resident’s health and social welfare. There was no evidence on the files to show that this had been done. It is recommended that the home refers to Care Homes Regulations 2001: Care Homes for Older People: National Minimum Standards 3.2 and 3.3 for detailed guidance regarding the type of information the home should be requesting from placing agencies or private referrals. The home does not provide an intermediate care service. Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 7,8,9 & 10 The judgement for this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The lack of documentary information on some files increases the possibility of the individual residents’ needs being overlooked. The improvement in the management of the residents’ medication helps to reduce the risk of errors and subsequent potential harm to the health of the residents. The residents are generally treated with respect and their rights to privacy and dignity are observed. EVIDENCE: As noted in the previous section the quality of information in pre admission referral/assessments varied between being detailed to very limited. Without detailed referrals it is difficult for the homes to commence a care plan. The home must ensure that care plans and accompanying risk assessments start to be developed with immediate effect for newly admitted residents. Information from the resident, family/advocates and professionals should be used to Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 12 develop the care plan and accompanying risk assessments. Over a period of weeks the care plan and risk assessments can be further developed and changed as required. Failure to start care plans with immediate effect may result in placing the resident at risk, valuable information being overlooked and new information not being recorded. For example, a referral indicated that a resident had a recurring health concern that was causing confusion. Since being in the home, the resident hadn’t suffered from the health concern. Discussions with the managers indicated that this was possibly due to the care received since being in the home. No initial risk assessment had been completed regarding the health concern and there was no documentary evidence to demonstrate how the home had met these needs. Another of the care plans that had recently been developed contained much more information and was relatively simple to cross-reference. A discussion took place regarding how the care plans and accompanying records could be further improved. It should be noted that concerns regarding inadequate individual care plans and lack of risk assessments had been raised in the previous two inspections (4th of May and 1st of September 2005) as well as an unannounced monitoring inspection which took place on 30th December 2005. The home has a monitored dosage system and accompanying daily medication record (MAR) sheets for the safe management and recording of residents’ medication. The inspector looked at three residents medication and accompanying records. No discrepancies were found and the medication trolley was clean and well ordered. A check of the management of controlled drugs and records also found no concerns. Only suitably trained staff administer medication. The medication cupboard was not inspected on this occasion. Residents were relaxed in the home and were confident when approaching the staff, managers and proprietor. Staff spoke to the residents in a informal but polite manner. Throughout the inspection there was a high level of talking and bantering between the residents and staff. All of the residents spoken to said that they liked living in the home and felt that they “ Got on well” with the staff and other residents. Refer also to the section headed Complaints and Protection. Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 12-15 The judgement for this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Some progress has been made in this area, but the outcome for the residents continues to be adequate. Residents’ social and recreational needs are limited due to the restrictions of staffing and funding levels. Residents are enabled to see their visitors when and where they choose which adds to the quality of their lives. However, unless supported by relatives, residents’ are rarely offered opportunities to access social or recreational interests outside the home. This compromises the quality of their lives. There is a lack of documentary evidence to confirm that the majority of the residents choose to take daily breakfast in bed. This raises concerns that residents’ choice may be restricted due to staffing levels. EVIDENCE: During the inspection the residents had a quiz and a bingo session that was organised and led by the care staff. The inspector was advised that other activities provided by the care staff included ball games, chair exercises and reminiscence activities/discussions. The home had recently organised a Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 14 clothes company to come into the home so residents could purchase items if they so wished. This proved to be a huge success with the residents and the manager said he planned a repeat visit later in the year. The overview from the residents was that they enjoyed the activities but continued to miss the bi- weekly visits from two external activities coordinators, which had been cancelled 12 months ago. A number of residents also said that in-house activities were sometimes cancelled or cut short due to “Staff being too busy”. One resident said “It’s upsetting when this happens because we look forward doing things”. The Commission for Social Care Inspection report dated May 2005 commented, “ Staffing shortages mean that the activities programme cannot always be carried out”. The same report recommended that the provision of two external activity organisers should be continued. Records evidenced that this provision was cancelled in June 2005. Visitors are welcomed to the home at any reasonable time. Residents can choose to see their visitors in their bedrooms, one of the two communal lounges or in the large dining room. On the day of the inspection a resident sat outside with her visitor. The inspector was advised that the majority of residents, or their family members, are responsible for the management of their own finances. During a brief tour of the bedrooms it was noted that a number of residents had brought personal possessions, including pieces of furniture, from their own homes. The home has an adequately sized dining room, which overlooks the garden. The manager, staff and residents eat together at lunchtime. There were sufficient stocks of varied foodstuffs including fresh fruit and vegetable. The inspector ate lunch with the residents, manager and staff. There was a choice of two main courses and two desserts. The meal was relaxed and unhurried with lots of general chatter around the tables. All of the residents gave positive feedback about the quality, quantity and choice of meals. Residents are able to choose whether they wish to eat in the dining room or their bedroom. A high number of residents have daily breakfast in bed. Some residents said it was their choice. Three residents said that “It’s always been like that”. Care plans must record that this is at the express wish of the individual resident and not done to accommodate the routine of the home. During a tour of the premises the inspector overheard a resident, who was taking the meal in her room, saying she didn’t like the tea time meal and wanted something else. This request was met without delay. The storage/freezer room held adequate quantities of fresh and frozen foodstuffs. Fresh provisions included bananas, oranges, carrots, leeks and two types of cabbage. Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 15 Staff meeting notes recorded that there is evidence that food supplies continue to “disappear “ from the home’s kitchen. A discussion took place regarding these concerns and the manager was advised to refer staff to the home’s Gross Professional Misconduct policies and procedures. The possibility of police involvement was also discussed. It is recommended that the registered persons consider introducing stock control systems in the home. The same staff meeting notes recorded that a discussion had taken place on the use of CCT cameras. The manager was reminded that, in general, the use of surveillance cameras in areas of the home used by residents is intrusive and unacceptable. The open ‘hatch’ between the kitchen and office compromises the privacy and confidentiality of the residents and staff. Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 16 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 the following standard(s): 16 & 18 The judgement for this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The combination of a complaints procedure and regular residents’ meetings give the residents and their relatives confident that any complaints are taken seriously. The overall outcome is based on the fact that an allegation of verbal abuse was not investigated in accordance with the home’s Vulnerable Adults policies and procedures. This places the residents at potential risk of harm. EVIDENCE: Neither the home nor the Commission for Social Care Inspection have received any complaints since the last inspection. The inspector was advised that the home has a complaints procedure. The document, which was amended in compliance with a requirement arising from the last inspection, was not inspected on this occasion. The home has regular residents meetings. One of the residents is the Chairperson for the residents’ meetings. He advised that fellow residents discussed any concerns or requests with him and he ensured these were included on the agenda. Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 17 Records seen indicated that a concern had been raised regarding an incident that might be construed as possible verbal abuse (allegation made by another staff member of a colleague shouting) of a resident. There was no evidence to demonstrate that the registered persons had undertaken an investigation. Any such incidents must be investigated without delay in accordance with the home’s Vulnerable Adults policies and procedures. Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 18 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 the following standard(s): 19 & 26 The judgement for this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. An ongoing improvement in the maintenance of the home promotes the safety and comfort of the residents. The poor standards of hygiene in the laundry area places the health and well being of the residents at risk. EVIDENCE: Although there are still outstanding requirements, there has been some improvements in the physical environment over the last twelve months. For example, a requirement to replace specified areas of carpet has been met in part. The inspector had a tour of the environment and had a brief look at the communal areas and most of the bedrooms. The home has two lounges, a dining room and adequately sized garden. All rooms seen were of a good size and some were made more homely with items of personal furniture. Some Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 19 residents said they like the size of their bedrooms and particularly appreciated the en-suite faculties. Information regarding some of the home’s policies and procedures were taped on the residents’ bedroom walls. This detracted from a homely feel. The carpet in one of the bedrooms was worn in parts and was not correctly laid resulting in a potential trip hazard. The provider said that the room would be demolished when the proposed extension work commences. In the interim period the registered provider must take steps to reduce the risk of the resident tripping on the carpet. The last three inspection reports required the registered provider to devise and implement a planned programme of maintenance, redecoration and replacement. The inspection monitoring visit report (December 2005) recorded that the Commission had received a planned programme of redecoration and refurbishment but that the plan only covered some of the works required. Nineteen of the twenty bedrooms have an en-suite facility consisting a toilet and wash hand basin. The two bath chairs in the upstairs bathrooms both fell below an acceptable standard of hygiene. The soft seating on one bath chair was torn and grubby and the second cover was grey and mouldy looking. Five bars of partly used bars of soap were found in the bathrooms suggesting the use of communal soaps. In additional to increasing the risk of cross infection, such practice is indicative of institutionalised care and compromises the dignity of the resident. With the exception of one bedroom the home smelt fresh and clean. Records evidenced that work was in progress to assist the resident with continence management. The registered persons must ensure take steps to make the room free from unpleasant odours. A requirement to remove rubble, which presents a potential hazard to residents, from the rear of the home has been met in part. The overall management of the laundry fell well below the acceptable standards of hygiene. The laundry room, which was inspected towards the end of the second day, is separate to the home in a small outbuilding. The room was in a dreadful state with dirty flooring and surfaces. Rolls of dust and fluff were clearly evident on the floor. The tumble dyer and washing machine were also grubby and dusty. There are notices on the wall identifying clean and dirty laundry areas but no designated clean/dirty/soiled laundry baskets. The laundry baskets were also dirty. For example, clean laundry had been placed in a basket, the bottom of which was soiled with dried out soap powder. The laundry sink and draining board were both dirty and dry. There was no evidence of either used or fresh supplies of disposable aprons or gloves in the laundry. Additionally the laundry room is used to store vacuum cleaners. Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 20 It should be noted that many of these concerns had been raised in the September 2005 inspection report. Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 21 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 -30 The judgement for this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There are insufficient numbers of staff to meet the personal, social and healthcare needs of the residents. EVIDENCE: The home has a small staff team most of who have worked in the home for some time. Residents spoken to said they liked the staff and “Got on well with them”. It was noted in the CSCI inspection report of May 2005 that, “Due to a small staff team there is no flexibility or sufficient numbers of staff to cover staff shortages”. The staffing rota evidenced that between 7.30 am and 8.30am there no staff are free to provide personal assistance to the residents. The cook is employed from 9.00am to 2.00pm. Three care staff commence duty at 7.30 with a fourth member of the care staff starting work at 8.30am. Two care staff prepare and serve breakfast whilst the third member of staff issues the residents’ medication. A staffing rota evidenced that there are occasions when only two care staff are on duty from 7.30am to 8.30am. Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 22 Staff must be dedicated to either catering, issuing of medication or caring duties at any one time. The three roles must not be intermingled. A high number of residents have breakfast in bed. This must be the residents’ choice and not arranged to accommodate available staffing levels. The care staff also prepare and serve the evening meals. One domestic assistant is employed on a part time basis. However the person sometimes has to cover for staff shortages. No separate laundry staff are employed in the home. The proprietor said that he would increase the morning staffing levels without delay. The CSCI report of May 2005 also noted “The rationale for lower staffing levels was based on a task focussed way of providing care and not based on the residents’ actual needs”. A job description for all carers details a proposed person centred approach to caring for the residents. For example the document directs staff to “Respect and comply with the residents’ wishes, Promote equality of the residents and contribute to meeting the residents’ social needs”. A second job description for afternoon/evening staff is task focussed. The document details various cleaning, laundry, personal care and catering tasks. The staff are advised that “If time permits sit and talk to the clients…”. One staff member was interviewed on this occasion. The experienced staff member was well informed and said she continued to enjoy her work. Scrutiny of her file evidenced that she had undertaken a variety of training. Courses covered included moving and handling, medication training, emergency 1st Aid and infection control. Other courses included Mental Illness in Older People, nutritional requirements and management of diabetes in care homes. Three staff files were selected for scrutiny. It was evident that work is in progress to improve the recruitment and supervision of staff. A new member of staff was due to commence work on the following day. A clear POVA 1st check had been received but the Criminal Records Bureau check was outstanding. A risk assessment had not been developed to establish whether/how the person could commence work prior to the CRB being received. The manager was well informed regarding the new staff member but this information was not reflected in the individual’s interview notes. Staff information included healthcare details. It is recommended that the registered persons record the management of some types of health condition, such as asthma on the individuals file. This will help to ensure that the staff member can been supported in the event of difficulties, such as an asthma attack. It was noted that a professional reference was not made on the previous employers headed notepaper. The registered persons must assure themselves of the validity of any references received. Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 23 Staff files held photocopies of documentation such as birth certificates and proof of identity. Some of the copies were a little blurred and the details difficult to decipher. It is recommended that photocopies taken by the home are signed and dated by the person verifying the documents. In the event of any later concerns this will form part of the audit trail of recruitment and interview process. The Care Homes Regulations 2001: Care Homes for Older People: National Minimum Standards 27.6 advises that staff providing personal care to residents are at least 18 years old. The registered manager has now undertaken a risk assessment regarding a younger person working in the home. A copy of the assessment has been forwarded to the Commission. Staff handovers should take place in paid time. The safety and well being of the residents would be placed at risk if the staff exercised their right to start and finish work in accordance with the staff rota. Brief records should be maintained of the information exchanged during the staff handover. This will help to ensure the continuity of care for the residents. Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 24 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 The judgement for this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The recently registered care manager has commenced work to complete the Registered Managers Award by April 2007. The lack of formalised quality assurance and quality monitoring systems increases the possibility that the home will not be run in the best interests of the residents. The failure to maintain detailed records of monies held and spent on behalf of residents places the residents at risk of financial abuse. Poor hygiene and fire safety practices places the health, safety and wellbeing of residents and staff at risk. Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 25 EVIDENCE: Since the last inspection the acting manager has, subject to one condition, been appointed as the registered manager of the home. The condition of registration is that the registered manager must successfully complete the Registered Managers Award by April 2007. The manager advised that he has already taken steps towards meeting this condition. Staffing rotas showed that, due to staff shortages the manager had , on occasions, undertaken care work. The manager was reminded that, with the exception of unexpected conditions, he must be supernummery to the staff team. The manager has a significant amount of daily administration tasks and other responsibilities to ensure the safe and smooth running of the home. For example, the conflict of roles may result in residents’ reviews and staff supervisions being delayed. The home has a residents ‘committee with a nominated resident Chairperson and residents’ representatives. The Chairperson took responsibility for collating the agenda and said he felt confident in raising any concerns with the registered provider and registered manager. There was no evidence to demonstrate that the home has an effective quality assurance and quality monitoring systems to monitor the effectiveness of the service. As noted in the previous section, the inspector was advised that the majority of residents, or their family members, manage their own finances. Scrutiny of two residents financial records raised a number of concerns. For example, the money and records were not securely stored in a locked safe or cabinet. The inspector was advised that the proprietor has now provided a small safe. Records evidenced that one resident is a subject of the Public Guardianship Office. The financial records were difficult to understand and cross-reference. Tippex had been used on the records. It was also noted that the same file contained a social services care plan dated December 2005, which was still in its unopened envelope. Information regarding a third resident’s health care details had been filed with the second resident’s financial records. This increases the risk of the healthcare needs of the third person being unmet. It also transpired that a staff member was helping a resident manage their money on an informal basis. There was no suggestion of the misappropriation of the resident’s money. Such practice places the resident at increased risk of financial abuse and the staff member of risk of allegations of financially abusing a resident. Due to time limitations Standard 38 was not fully inspected on this occasion. Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 26 The CSCI inspection report dated September 2005 raised a number of concerns regarding poor working practice in the home. A requirement to revise and implement infection control policies and procedures remains outstanding. The requirement to ensure COSHH Data sheets for all chemicals held or used in the home has been met in part. As noted in the section headed Environment, a number concerns were raised regarding the dirty laundry room, use of communal bars of soaps in shared bathrooms and grubby/worn bath seats. Concerns were also raised regarding the use of bedroom doors being wedged open. Printed fire safety procedures were posted next to fire extinguishers. However additional printed information detracted from the fire safety information. It was also noted that photocopied fire safety instructions (outside bedroom 6) were faint and barely legible. Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 27 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. 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 2 x x 2 Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14 (c-d) Requirement The registered person must ensure that, prior to admission, as much detailed information as is possible is gathered from the resident, his or her representatives (if appropriate) and relevant professionals. The registered person must confirm in writing to the resident that the home is suitable for the purpose of meeting the resident’s needs in respect of his health and welfare. 2 OP7 13 & 15 The registered provider must ensure that care plans are completed in sufficient detail to ensure staff can meet the needs of the residents. The care plans must be person centred and include all elements of the standards. Partly met since the last inspection. The registered provider must ensure that unnecessary risks to the health of residents are to be identified. The risk assessment Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 29 Timescale for action 31/07/06 30/06/06 must clearly identify the areas of concern and detail how the home plans to reduce or eliminate the risk. 3 OP13 16 (2) (m & n) The registered person must consult with residents about their social interests and make arrangements for them to engage in local, social and community activities The registered person must also consult with the residents about the programme of activities arranged by or on behalf of the home. In the event of a potential cause for concern, the registered person must instigate the home’s Vulnerable Adults policy and procedures. In order to improve the safety and comfort of the residents the registered persons must complete the remaining requirements from the previous two inspection reports. This includes replacing the identified carpets and arranging to remove the remainder of the pile of rubbish and scrap metal in the back yard and deep cleaning of bathing equipment The registered persons are also required to take steps to make good the worn and badly laid bedroom carpet which presents a potential trip hazard to the occupant of the room. 6 OP26 13 (3) The registered persons are 31/07/06 required to make good or replace the stained and torn coverings of the two bath seats. 31/08/06 4 OP18 13 (6) 15/06/06 45 OP19 13 (a), 16(c,j,k) 15/08/06 Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 30 7 OP26 13 (3) 16 (J & k) The registered persons must undertake an infection control assessment with regards to assisting residents with bathing and personal care. The registered person must ensure that the laundry room is run in a clean and orderly manner that reduces the risk of cross infection. The registered persons must ensure that all areas of the home are free from offensive odours. The registered persons must ensure that there are sufficient numbers of suitably qualified and competent staff on duty to meet the needs of the residents. The registered persons must ensure that the records noted in Schedule 2 are kept in the home. The registered persons must maintain detailed records of any monies or valuables held on behalf of the residents. The registered person is required to ensure that the information required in compliance with the Control of Substances Hazardous to Health (COSHH) Regulations is available for all chemicals held or used at the home. Unless agreed with a Fire Safety Officer, doors must not be wedged open. Fire safety instructions must be provided in a legible and easily seen format. 30/06/06 8 OP27 18 (1) (a) 30/06/06 9 10 OP29 OP34 19 (5) 17 Sch 4.3 30/06/06 31/07/06 11 OP38 13(4) 31/07/06 12 OP38 23.4 (i) 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 31 No. 1. Refer to Standard OP3 Good Practice Recommendations It is recommended that the home refers to Care Homes Regulations 2001: Care Homes for Older People: National Minimum Standards 3.2 and 3.3 for detailed guidance regarding the type of information the home should be requesting from placing agencies or private referrals. It is recommended that the registered person introduce a stock control system in the home for the management of food supplies. It is recommended that the policies and procedures be removed from the residents’ bedroom walls and maintained in folders in each of the bedrooms. In addition to improving the homely look of the bedrooms, the documents will be more easily accessible to the residents. It is recommended that photocopies, taken by the home of documents such as proof of identity and birth certificates, are signed and dated by the person verifying the documents. It is recommended that the registered persons review the present job descriptions to ensure that the home has a person centred approach to the delivery of care and support of the residents. 2 3 OP15 OP19 4 OP29 5 OP30 Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Haven House Residential Ltd DS0000004321.V293797.R01.S.doc Version 5.1 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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