Inspection on 13/04/10 for Haven House

This inspection was carried out on 13th April 2010.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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 11/05/06

Haven House 01/09/05

Haven House 04/05/05

Haven House 23/11/04

Haven House 29/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 29/06/2010.

Random inspection report Care homes for older people Name: Address: Haven House Warwick Road Kineton Warwick Warwickshire CV35 0HN zero star poor service 15/12/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sandra Wade Date: 1 3 0 4 2 0 1 0 Information about the care home Name of care home: Address: Haven House Warwick Road Kineton Warwick Warwickshire CV35 0HN 01926641714 01926641714 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Haven House Residential Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 20 Number of places (if applicable): Under 65 Over 65 20 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is: 20 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 20 Date of last inspection Brief description of the care home 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 is a sitting Care Homes for Older People Page 2 of 15 1 5 1 2 2 0 0 9 Brief description of the care home room and a dining room, and there is level access to the 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. There are also two doctors surgeries, a chiropodist, an optician and a dentist nearby. There is a limited bus service to Stratford-Upon-Avon, Banbury, Leamington Spa and surrounding villages. Nursing care is not provided. People in need of attention from a nurse have access to the community nursing service, as they would in their own homes. At the time of this inspection the fees for the service were not published. Details of the fees should therefore be obtained by contacting the service direct. Care Homes for Older People Page 3 of 15 What we found: This random unannounced inspection was undertaken to check compliance with the requirements made during a key inspection to the home on 15 December 2009. We (the Commission) visited the home on Tuesday 13 April 2010 between 8.45am and 4.25pm. The manager and provider were both present during the inspection visit. We looked at actions taken to address the 12 requirements issued at the key inspection. These are detailed below under the appropriate headings. CHOICE OF HOME/ADMISSION The service was required by 31 January 2010 to:1. Make sure they do not provide services to people requiring specialist dementia care. The Improvement Plan forwarded to us by the manager following the key inspection to the home stated:We are going to ensure we carry out our assessments correctly so as not to take any residents which fall outside our category. 1. We found that no new admissions had been accepted by the home since the last inspection and therefore this requirement was being met. HEALTH AND PERSONAL CARE The service was required by 31 January 2010 to:2. Make sure the care needs of people are effectively reviewed and any changes or deterioration in health clearly recorded and addressed by staff as appropriate. 3. Undertake regular and frequent reviews of care plans and update care plans in light of any changing needs so that staff have access to information they need to support the person appropriately. The Improvement Plan forwarded to us from the service stated:We are revamping all care plans to include all relevant information regarding the residents. We were told by the manager that nobody in the home had any sore areas, pressure areas or wounds and that nobody was being seen by the district nurse. We asked the manager for two care files and asked for all information in relation to these people to be made available to us. Both care files indicated that these people had sores on their skin. A member of staff stated that one of these people did not have a pressure sore despite records stating that they did. It was evident the care plan file had not been updated to reflect changes that had occured although it was identified this person was at risk of Care Homes for Older People Page 4 of 15 pressure areas and did require pressure relief. One care plan file viewed contained a care plan pressure sore risk assessment which indicated the person had a sore and they were to be turned two hourly and fluids were to be given two hourly at night. The care plan listed records to be completed to demonstrate this was happening which included a turn chart, food chart and fluid chart. We asked to see these records and were told there were no charts to show this person was being regularly repositioned. We asked staff if the person was being regularly repositioned and were told No because the mattress does it for you its a ripple mattress. A care plan for Bed and Chair Bound indicated that staff were to lift the person every two hours to relieve any pressure to avoid pressure sores. There were no records indicating this was happening. A member of staff spoken to confirmed they were not doing this but the person did spend periods of time lying down on their bed. This was not indicated in the care plan risk assessment relating to pressure sores. During a discussion with the person who was sitting in the lounge they stated that they were in pain at the bottom of their spine. The pressure sore care plan did not state what kind of sore the person had, how big this was or how it was being managed. A wounds and Dressings Care plan only mentioned a wound on the persons arm and made no reference to a pressure sore. On observation of the person they did have a dressing on the area which the pressure sore was indicated to be and staff confirmed that the district nurses were attending to this. If records are not up-to-date and do not give clear information on the changing needs of people this could mean people may not receive the support they require in meeting their needs. During the last inspection we found that a person had lost a significant amount of weight and that the service had not taken appropriate actions to address this. A significant loss of weight can place people at risk of deteriorating health. The service acknowledged during our last inspection that they should have been monitoring this persons food/fluid intake and weight more closely. As this had not happened we issued a requirement stating that the service must ensure any deterioration or changes in the health of people is clearly recorded and acted upon by staff as appropriate. We looked at the care file for this person again during this visit to identify if any changes in practice had taken place and to determine if this persons health and weight was now being monitored more closely. The weight record charts in the file were blank. We asked if there were any other records available and were given a weight book and a record from the persons old care plan file. Records showed that following the key inspection visit in December 2009 the person had only been weighed twice, once in December 2009 and once in March 2010. Although the Care Homes for Older People Page 5 of 15 person had increased in weight in December, the recorded weight for March 2010 indicated they had lost weight again and they were again of a very low weight. It was evident that the service had not been monitoring this persons weight more closely as advised during the last inspection visit. We asked if any action had been taken to monitor this persons food and fluid intake since we last visited such as recording how much food and fluid the person was having each day. We were told that information on xs good days goes into the daily report book and on the sleepy days in a food journal. We asked to see the food journal but this could not be located and the manager confirmed this had not been completed. A member of staff did find two sheets which they stated were part of the food journal but these only indicated the fluids that the person had taken, there was no information about any food intake. Daily records completed by staff included statements to say whether the person had eaten well or not. These did not contain sufficient information to determine if the person was eating and drinking a sufficient amount on a daily basis to maintain their health. The home had sought advice from the Dietician following the last inspection visit and advice had been given to the home which included staff assisting the person with eating and drinking little and often and encouraging them to drink the food supplement. There was no evidence to show whether snacks or meals were being made available as suggested little and often. Staff told us that they found it difficult due to the persons health to sometimes feed the person and get food into them. A relative of the person advised that they did manage to successfully ensure the person ate solid food even on the persons sleepy days. Medication records showed that the food supplement was not being given as prescribed. Staff spoken to seemed unclear about how often this should be given. One person felt it should only be given when the person was not eating and another stated it was to be given once a day but then they checked the records and stated it was twice a day. It was clear that staff were not carrying out the actions required of them to monitor this persons weight and this could have contributed to this person again losing weight. In view of the findings from this visit, people who use the service cannot be confident that their needs will be met. The two requirements regarding reviewing care plans and taking appropriate action to record and address any deterioration in health therefore remain outstanding. Requirements 2 and 3 not met. The Service was required by 31 January 2010 to:4. Make sure medicines prescribed are only used for the person they have been prescribed for. 5. Ensure medicines are given as prescribed. This includes ensuring the person receives Care Homes for Older People Page 6 of 15 their medicine within the timings stated by the GP. The Improvement Plan forwarded to us from the service statedNew audits have been created and checked weekly, new count sheets are in place for tablets to be checked each time they are given, staff have been informed that they must double sign and report any discrepancies. We audited the medication records for three people and found that all medicines prescribed had only been used for the person they had been prescribed for. 4. This requirement was met. Medicines had been given as prescribed with the exception that:The medication records for one person showed that they were prescribed a food supplement to be given twice a day. Records showed this was not being given twice a day. Staff were recording on some occasions the code N which means offered PRN not required but this had not been prescribed to be given as required. This had been prescribed to be given twice a day and therefore should have been given. Records for a second person showed that a medicine had been signed for but did not appear to have been given. 5. This requirement was not met. COMPLAINTS AND PROTECTION The service was required by 31 January 2010 to: 6. Ensure a written record of any complaints received is kept as well as any actions taken to resolve the issues raised. The Improvement Plan forwarded to from the service us stated: We have set up a complaints procedure and new posters have been put up to include names and addresses of who to write to. We have a book in the office for all complaints to be recorded. We asked to see complaints records and were given a folder containing correspondence relating to complaints. This contained details of a complaint received and a copy of a letter of response written. There was no book detailing the complaint, what investigations had been carried out, the response to the complainant, what action had been taken or indicating any monitoring mechanism to prevent a recurrence. We looked at the complaints procedure which contained details of the Commission but did not contain contact details of the manager, provider or the Local Authority should a complainant wish to put their complaint in writing or have their complaint investigated independently from the home. As the service had a written record of the complaint received, this requirement was Care Homes for Older People Page 7 of 15 met. However, a recommendation has been made in regards to record keeping and complaints management. 6. This requirement was met. The service was required by 31 January 2010 to:7. Ensure any allegation of potential abuse such as rough handling is reported to the Local Authority in accordance with the local arrangements for safeguarding to obtain guidance on what, if any, action is required which then must be carried out. The Improvement Plan forwarded to us stated: If any abuse is found to be happening the manager will make full enquiries into the matter and report to safeguarding immediately. Since the last inspection there have been no allegations of abuse for this service. The manager stated she was familiar with the process for managing abuse and she was able to explain how she would manage any allegations of abuse reported to her or observed. The manager was aware of the need to refer any allegations of possible abuse to the Local Authority. 7. This requirement was met. ENVIRONMENT The service was required by 31 January 2010 to:8. Make sure the home is maintained in a clean condition consistently. This includes attention to ensure surfaces are dust free as well as the removal of unpleasant odours. The Improvement Plan forwarded to us stated:We have employed a full time cleaner and laundry lady and are advertising for another so we can ensure all days are covered and the home is kept clean and fresh. During the visit the manager told us that they now have two members of staff who complete cleaning between them seven days a week. We viewed some of the bedrooms and communal areas and found these to be clean with no unpleasant odours. 8. This requirement was met. STAFFING The service was required by 31 January 2010 to: 9. Ensure the duty rota included the full name, staff designation and start and finish times of staff so there is an accurate record of who is working at the home and in what capacity. This included the manager and deputy manager. The Improvement Plan forwarded to us from the manager did not make reference to Care Homes for Older People Page 8 of 15 actions taken to address this. We looked at the duty rotas for a four week period. We found that all staff had been listed with their designation, start and finish times. 9. This was requirement was met. We did note from viewing the rotas that some staff were working what may be considered to be excessive hours. This included a member of staff working a day shift followed by a night shift. If staff work long hours without suitable breaks between shifts this could result in staff not working as effectively as they should and result in peoples needs not being suitably met. The manager agreed to review this. The service was required by 31 March 2010 to:10. Ensure all staff complete statutory training including food hygiene and fire safety within the timescales required and ensure required timescales are demonstrated. The Improvement Plan forwarded to us from the manager did not make reference to actions taken to address this. We asked to look at training records and these showed that all staff had completed moving and handling training but some staff had not completed Food Hygiene and Fire training as required. The manager had however made arrangements for this training to take place in April 2010 to enable staff to complete this training. Required timescales for training were not demonstrated and the manager was advised to address this. 10. This requirement was met and although this was not within the timescales allocated, the new manager had taken actions to organize this training as soon as possible. MANAGEMENT AND ADMINISTRATION The service was required by 28 February 2010 to:11. Make sure the person carrying on the management of the care home submits an application to be registered with the Care Quality Commission. The Improvement Plan forwarded to us stated that the service had employed a manager since 5 March 2010 and she had sent off registration documents necessary to make an application to become registered. During the visit the manager confirmed that she had commenced working at the home on 2 March 2010 and she was in the process of getting her employment records together to be able to submit an application. The above requirement was made in regards to the previous manager in post who has since left the home. 11. As the manager had taken actions to pursue her registration. We consider this Care Homes for Older People Page 9 of 15 requirement to be met. The service was required by 31 January 2010 to:12. Make sure all accidents which involve medical intervention and which impact on peoples health and wellbeing are reported to the Care Quality Commission. The Improvement Plan forwarded to us stated We have created a new system for reporting accidents and all staff have been trained on how to use the new system and reportable incidents will be dealt with by the manager. Accident records were viewed and it was evident that some of the accidents had been reported to us but there was one which had resulted in the person being admitted to hospital which had not been reported to us as required. 12. This requirement was not fully met. What the care home does well: What they could do better: 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 2. Care Homes for Older People Page 10 of 15 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 12 The care needs of people 31/01/2010 must be effectively reviewed and any changes or deterioration in health clearly recorded and addressed by staff as appropriate. This is so people can be confident their health will be appropriately managed. 2 7 15 Regular and frequent reviews 28/02/2010 of care plans must be undertaken and care plans updated in light of any changing needs so that staff have access to information they need to support the person appropriately. This is to ensure peoples needs are met. 3 9 13 Medicines must be given as 31/01/2010 prescribed. This includes ensuring the person receives their medicine within the timings stated by the GP. This is to ensure the medicine is effective in maintaining or improving the persons health. 4 37 37 All accidents which require medical intervention and which impact on peoples 31/01/2010 Care Homes for Older People Page 11 of 15 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action health and wellbeing must be reported to us. This is so we can be sure the service is taking appropriate action to safeguard people. Care Homes for Older People Page 12 of 15 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, 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 7 12 The care needs of people 13/04/2010 must be effectively reviewed and any changes or deterioration in health clearly recorded and addressed by staff as appropriate. This is so people can be confident their health will be appropriately managed. 2 7 15 Regular and frequent reviews 13/04/2010 of care plans must be undertaken and care plans updated in light of any changing needs so that staff have access to information they need to support the person appropriately. This is to ensure peoples needs are met. 3 9 13 Medicines must be given as 13/04/2010 prescribed. This includes ensuring the person receives their medicine within the timings stated by the GP. This is to ensure the medicine is effective in Care Homes for Older People Page 13 of 15 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 maintaining or improving the persons health. 4 37 37 All accidents which require 13/04/2010 medical intervention and which impact on peoples health and wellbeing must be reported to us. This is so we can be sure the service is taking appropriate action to safeguard people. 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 1 16 There should be a clear written register of complaints kept within the home showing timescales of receipt and any action takens to resolve any issues identified as appropriate. The manager should ensure that staff do not work excessive hours. This includes reviewing staff working day shifts followed by a night shift which could impact on staff effectiveness in caring for people safely and appropriately. Training records for staff need to show the timescales when statutory training must be completed by as well as the dates when training has taken place. This is so it is clear which staff are suitably trained and which staff require training to help ensure they care for people safely and appropriately. It is advised that prompt actions are taken to pursue the registration of a manager for the home so that people can be confident the service is being managed by a suitably competent person. 2 27 3 30 4 31 Care Homes for Older People Page 14 of 15 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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