Inspection on 02/01/09 for Haven House

This inspection was carried out on 2nd January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Haven House 13/04/10

Haven House 15/12/09

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 16/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Haven House Warwick Road Kineton Warwick Warwickshire CV35 0HN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michelle McCarthy     Date: 0 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 34 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): Haven House Residential Limited Name of registered manager (if applicable) 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 Additional conditions: 0 The Registered Manager must sucessfully complete the Registered Managers Award by April 2007. 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 are two sitting rooms and a dining room, and there is level access to the garden at the rear, which gives access to the car park. The car park is not in use at the present time due to building materials being stored. 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-UponCare Homes for Older People Page 4 of 34 Brief description of the care home 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. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before the inspection, we looked at all the information we have about this service, such as information about concerns, complaints or allegations, incidents and previous inspection reports. We do this to see how well the service has performed in the past and how it has improved. An Annual Quality Assurance Audit (AQAA) was completed and returned to us within the last 12 months, so we did not ask for another one before this inspection. At our last key inspection of this service in July 2008, we identified poor outcomes for Care Homes for Older People Page 6 of 34 people using the service. These related to health and personal care, complaints and protection and management. We sent a warning letter in August 2008 telling the provider we would take enforcement action if the required improvements were not met with in the timescales we set. We undertook a random unannounced inspection on 1st September 2008 because information was shared with us that raised concerns about delays in seeking medical attention when a resident fell, staff and their family living in the unregistered part of the building, staff employed without appropriate checks and staff using poor moving and handling techniques. We made several requirements to improve outcomes for people using the service. A specialist pharmacist inspector visited the home on 9th September 2008 and found the medicine management was poor. Staff did not have the skills to handle medication safely and inadequate systems were in place to make sure that all the residents were administered their medication as prescribed at all times. We made several requirements to improve the medicine management in the home. A pharmacist inspector undertook another random unannounced inspection on 5th November 2008 and found the medicine management had improved to a safe level. The outcome of our random unannounced inspections are contained in this report. Social services suspended admissions to the home for several months since our last inspection because of concerns about the service provided. Admissions resumed in December 2008 when Social Services monitoring were satisifed that the service had improved. Since the last inspection, the manager has been working co-operatively with Warwickshire Social Services to develop an action plan to implement improvements. The manager has sent us copies of the action plan and details of the progress made against the objectives set. We visited the home on Friday 2nd January 2009 between 11.15am and 6.15pm. The home did not know that we were visiting on that day. The manager and deputy manager were present throughout our visit. There were 14 people were living in the home at the time of our visit. We used a range of methods to gather evidence about how well the service meets the needs of people who use it. We talked to people who use the service and observed their interaction with staff. We looked at the environment and facilities provided and checked records such as care plans and risk assessments. We talked to the manager, the deputy manager, the cook and three care staff. Three people using the service were identified for case tracking. This is a way of inspecting that helps us to look at services from the point of view some of the people who use them. We track peoples care to see whether the service meets their individual needs. At the end of the visit we discussed our preliminary findings with the manager and deputy manager. Care Homes for Older People Page 8 of 34 What the care home does well: What has improved since the last inspection? What they could do better: A policy for responding to abuse must be developed and made available for staff. This is to safeguard people using the service. The system for care planning should be reviewed to make sure all documents used in care planning record the same information about what staff have to do to meet peoples needs. This should make sure the information available to staff is consistent, so they can support people appropriately. Care Homes for Older People Page 9 of 34 Environmental risks to the health and safety of people using the service must be identified so management can take appropriate action to minimise any risks. This includes the risk of burns from unguarded radiators and the risk of trips on uneven floors. A programme of redecoration and refurbishment should be developed so that people using the service can be confident they will be provided with a well decorated, maintained and comfortable home. A quality assurance system should be put into place to assist in the identification of shortfalls to enable suitable improvements to be planned and carried out. This should ensure that quality of the service is improved and is kept under constant review. Staffing levels should be kept under review to make sure there are enough staff on duty to meet the needs of people using the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. Evidence: We looked at the case files of two people admitted since the last inspection to assess the pre admission assessment process. Both files contained a pre admission assessment of each persons needs and abilities. The assessment sheet consists of a tick list, which does not always give enough information. For example, there was no details of one persons medication and no details of one persons hygiene needs. Both files contained detailed and comprehensive assessments from other health and social care professionals to supplement the information recorded by the home. Care Homes for Older People Page 12 of 34 Evidence: This means that sufficient information was available so that the home could confirm they could meet each persons needs and develop care plans. We saw evidence that peoples needs are reassessed during monthly care plan reviews. This should mean that any change in peoples needs is identified so that staff can offer appropriate support. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are treated respectfully and are protected from harm by improvements in medicine management. Conflicting information is recorded about what staff need to do to meet peoples needs which could mean that people do not get appropriate support. Evidence: Peoples care files are kept in the office so they can only be accessed by care staff during office hours. Care staff can only access the daily records and the next of kin sheet. The manager has asked the owner to supply a new filing cabinet to allow these documents to be kept somewhere securely, but easily accessible. We looked at the care files for three people identified for case tracking. Care plans and daily records were available for each person. Care plans contained information to tell staff what they need to do to meet peoples needs. This should mean people get the care they need. For example, the care plan to support one person with their personal hygiene needs documented, XXXX needs one Care Homes for Older People Page 14 of 34 Evidence: carer to prompt and help get his clean clothes ready for the day. Can do most of his own personal hygiene tasks, and enjoys doing it. There was evidence that the service could make further improvements to make sure peoples care is person centred. For example, we saw a bath list on a notice board near the kitchen. This does not support person centred care and does not uphold the dignity of people using the service. We saw evidence of monthly reviews of care plans which should mean that care plans are updated if peoples needs change. In one residents file, the monthly review of the care plan recorded that a hoist was needed to support the person to move as they were unable to weight bear. However, the original care plan was not updated to reflect this change in need and recorded that the person uses zimmer to stand, can weight bear but causes distress and pain. This means staff have conflicting information about what they need to do to support the person. We discussed this with the manager and deputy manager and recommended that the system for care planning should be reviewed to make sure all documents used in care planning record the same information about what staff have to do to meet peoples needs. This should make sure the information available to staff is consistent, so they can support people appropriately. We spoke to three care staff. They were familiar with residents needs and abilities, and knew what care they needed. Documentation included a number of risk assessment tools to identify whether people were at risk of falls, poor nutrition and developing pressure sores. This should mean that risks to the health and well being of residents are identified so that staff can take appropriate action to minimise the risk. Peoples records show they are supported to access other health and social care professionals such as GP, optician, district nurses and the community mental health team. This should mean that peoples healthcare needs are met. People have their weight monitored and recorded regularly. The records of two people documented they were sustaining their weight. The record for the third person showed they had not been weighed for several months, because they were unable to use the weighing scales safely. We recommend that the service considers alternative methods of assessing peoples nutritional status if they are unable to weigh them. Care Homes for Older People Page 15 of 34 Evidence: A specialist pharmacist inspector visited the home on 9th September 2008 and found the medicine management was poor. Staff did not have the skills to handle medication safely and inadequate systems were in place to make sure that all the residents were administered their medication as prescribed at all times. We made several requirements to improve the medicine management in the home. A further random unannounced inspection in November 2008 found the manager had been proactive in improving the safe handling of medication and the medicine management had improved to a safe level. We looked at how the home has continued to implement their action plan to improve medicine management. The manager obtained a copy of the Royal Pharmaceutical Society guidelines for the safe management of medicines in care homes and has developed a medicines policy for the home to reflect the guidelines. Medicines are now stored in a separate room in the extension of the building. A sink is available for handwashing, which should minimise the risk of cross infection. Suitable medicine storage cabinets have been fitted, to comply with legislation and a medicines fridge is available. The medicines trolley is stored in this room when it is not in use. There were no records to show that the room and fridge temperatures are monitored to make sure medicines are stored within their recommended limits. We looked at medicine administration records (MAR), which were completed accurately. Photographs of residents are included on the MAR sheets. We observed safe practice when a member of staff administered medicines to residents at lunchtime. For example, the MAR sheet was referred to before the administration of residents medicines and signed directly afterwards. This should make sure that people receive their medication as prescribed and records reflect practice. A quality assurance system to assess staff competence in their handling of medicines has not yet been developed or implemented. The manager is aware that this is outstanding but has been prioritising the actions taken in the improvement plan for the home. Care Homes for Older People Page 16 of 34 Evidence: People living in the home were observed to be treated with respect. For example, personal care was provided in private and residents were spoken to respectfully. During observation of working practice it was evident that staff are knowledgeable about the likes and dislikes of people living in the home and were kind, caring and attentive towards them. People appeared to be well supported by staff to choose clothing appropriate for the time of year which reflected individual cultural, gender and personal preferences. One resident told us, its lovely here - they do everything nicely. I cant think of anything they could do better. Another resident said, Im very happy with my care. I feel safe here. Care Homes for Older People Page 17 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are limited opportunities for people living in the home to participate in meaningful and stimulating activities so their social and recreational needs are not always met. Visitors are welcome to the home at any time so residents can continue to enjoy their enduring relationships. People can choose from a varied menu daily so their nutritional needs and preferences are met. Evidence: The care files of people involved in case tracking recorded information about their interests, life history and enduring relationships. This should mean that staff have information about the cultural preferences of residents. There is no formal activity programme. We spoke to a member of care staff who told us, activities are just as and when staff have time to do them. During the afternoon of our visit, residents enjoyed a piano recital by a staff member. We looked at a sheet for recording daily activities on a notice board, but it was not completed. On the day of inspection, people chose to spend their time in their bedrooms or in the main lounge. Staff spent time chatting with people in the lounge in the afternoon, Care Homes for Older People Page 18 of 34 Evidence: there was relaxed atmosphere and staff and people clearly enjoyed each others company. We talked to residents about how they spend their day; one person told us, The exercise man comes once a fortnight, another person said, I do nothing. I sit around here. Another resident told us that staff supported residents to attend the local Christmas fayre and carol concert. People told us their visitors were made welcome and we observed visitors to the home having tea with residents in the lounge. We joined residents in the dining room for lunch at 12.30pm. Eight residents took their meal in the dining room while others chose to have their meal in their room. Tables were set with tablecloths but these were covered by large, transparent polythene sheets to provide a serviceable, wipe clean surface but which looked unattractive. People were not provided with napkins and we watched one resident wipe their chin on the tablecloth. The days choice of meal was set out on a large table in the dining room and staff served people from here. People could choose from fish, faggots, chips, fried egg, peas and mashed potatoes. People chose their own combination of meal from the food offered. Fruit and custard or chocolate orange cake with chocolate sauce was offered for dessert. The food looked nutritious and appetising. The use of a large table for serving food means people can see what is on offer, but there was no method of keeping it warm. One resident sitting at the table with us said his food was cold. We asked if this was usually the case and were told, Not always. It varies; sometimes its ok. There was plenty of food available and several people had seconds, but it possibly was not as hot as it could have been as it had been sitting out for about 20 minutes. We observed staff giving discreet and sensitive assistance to people during the meal time. This included monitoring what people were eating, prompting people to eat meals, helping people to cut up food and sitting down to feed one person who was unable to eat their meal independently. The meal was a social occasion; residents chatted to each other and to staff. During the afternoon, tea and home made cakes were offered to residents. The kitchen was well stocked with a variety of fresh and long-life foodstuffs. Care Homes for Older People Page 19 of 34 Care Homes for Older People Page 20 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that their concerns will be listened to and acted upon. Staff are aware of signs and symptoms of abuse and the management team understand how to respond to suspicion or allegations of abuse. This should mean people using the service are safeguarded from potential harm. Evidence: The complaints policy is displayed in the entrance hall of the home and is in the service users guide. Residents we spoke to told us the names of staff they would speak to if they had any concerns; they named a range of staff, including the manager, the deputy, the owner and some care staff. One person said, theyd sort it out. This means residents have confidence in the staff caring for them. We have been contacted three times since the last key inspection by people raising concerns about delays in seeking medical attention when a resident fell, staff and their family living in the unregistered part of the building, staff employed without appropriate checks and staff using poor moving and handling techniques. We considered these concerns during our random inspection in September 2008 and made several requirements to improve outcomes for people using the service. The evidence of improvements to meet the requirements is included throughout this report. Care Homes for Older People Page 21 of 34 Evidence: Social services suspended admissions to the home for several months since our last inspection because of concerns about the service provided. Admissions resumed in December 2008 when Social Services monitoring were satisfied that the service had improved. The manager has worked co-operatively with Warwickshire Social Services to improve the arrangements for recognising and responding to abuse so that people are safeguarded from harm. Staff are attending training sessions on abuse awareness. We spoke to care staff who attended the training session in December. They told us the training gave them useful information about signs and symptoms of abuse and what they should do if they suspected it was happening. It was evident from discussion with the manager and deputy that they are now aware of their role and responsibilites in responding to allegation or suspicion of abuse. A copy of Warwickshires Joint Agency Safeguarding Procedures is available in the home for staff to refer to. The manager has published safeguarding contact details on the homes notice board for staff to read. The manager discussed that the homes own policy for responding to abuse needs to be developed and will include this in the homes improvement plan. Care Homes for Older People Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Areas of the home are not well maintained and furnished. This means that although the house is homely and clean, people do not live in a well decorated, maintained and comfortable home. Evidence: The manager discussed with us the improvements made to the environment since our last key inspection. Many of the divan bed bases have been replaced to allow access for people who require a hoist to help them move. There are 2 rooms which have poor outlooks; one room looks over the house next door and another overlooks a brick wall. Information provided in the homes improvement plan tells us the room overlooking the brick wall will no longer be used as a bedroom; the home are considering using it as a store room. We walked around the home with the manager and looked at thecommunal areas and several bedrooms, including those belonging to people involved in case tracking. The bedroom of one recently admitted resident was decorated to a satisfactory Care Homes for Older People Page 23 of 34 Evidence: standard and provided comfortable and homely accommodation, with an ensuite WC and handbasin. New, matching wardrobe, chest of drawers and bedside cabinet were provided and the call bell was accessible. In another persons room we observed the bed was situated against an unguarded radiator. There was no risk assessment available to make sure this was a suitable and safe arrangement for the person accommodated in this room. The floor in this bedroom was uneven; there was a slight incline in the floor beside the bed and some uneven floor boards presented a trip hazard. The person accommodated in this room was identified as having a moderate risk of falls. There was no risk assessment in place to make sure the uneven floor was suitable and safe for the person. The floor in another room was covered with vinyl rather than carpet. We observed that several residents had taken the opportunity to personalise their rooms with their own belongings which means their individual accommodation was homely and easily identifiable as their own. The communal areas in the home are homely and cosy although some of the furniture and decoration looks dated and worn. There were no offensive odours evident in the home throughout our visit; the home was fresh and clean. The home has a new extension built on to the main house, with single accommodation ensuite bedrooms, accessible bathrooms and communal lounge. The owner has not yet applied to have the new extension registered with us. There are communal bathrooms and shower rooms in the main house, but these are not accessible for people who are supported to move using a hoist. People who are supported to move using a hoist are taken to an accessible shower room in the new extension of the home. The bathrooms in the main house have portable bath hoists, but people using these need to have some degree of mobility. We asked to see the certificates confirming that hoists have been serviced and checked for safety as there were no labels on the equipment to indicate they had been checked recently. The manager confirmed there were no current certificates available. We made an immediate requirement for the provider to make arrangements to have all hoists and lifting equipment in the home serviced and checked according to the manufacturers recommendations. The manager contacted us on 5th January 2009 to Care Homes for Older People Page 24 of 34 Evidence: confirm he had made arrangements for this to be done. The dishwasher in the kitchen, which was broken at our last inspection, has been repaired and is working. Systems for managing soiled laundry have been improved since our last inspection. The laundry room is situated in the extension part of the building. Staff have access to it from an outside corridor. The manager told us the commercial washing machine, which was leaking at our last inspection, is now in working order. We saw no evidence of leaks when we visited the laundry during this inspection. We recommended the use of special dissolvable laundry bags should be considered. This should minimise the risk of cross infection for staff removing soiled laundry from peoples rooms to the laundry. Bathrooms and toilets had sufficient hand washing and drying facilities and protective clothing and gloves were available on the day of inspection. Care Homes for Older People Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are not always enough staff on duty to meet the needs of residents. Improved recruitment procedures should mean that residents are safeguarded from the risk of abuse. The development of a training programme should mean staff have the necessary skills to safely meet the needs of people using the service. Evidence: There were 14 people accommodated in the home on the day of our inspection. The manager told us he aimed to have 3 care staff on duty between 7.30am and 9.30pm, and 2 care staff on duty between 9.30pm. The manager said his full time hours are supernumerary and the deputy manager has a variable amount of supernumerary time and time spent working the floor. The managers and deputy managers hours were not included on the duty rota so we could not confirm how the hours were distributed, or which days they worked. We looked at three weeks duty rota between 13th December 2008 and 2nd January 2009 which confirmed that the planned staff complement is not consistently achieved. This means we cannot be certain there are enough staff on duty to meet the needs of residents. Care Homes for Older People Page 26 of 34 Evidence: In the week commencing 13th December 2008, there were 2 care staff on duty for about half of the time. The duty rota showed that where staff numbers were depleted, this was mostly due to unplanned staff absence such as sickness. The manager or deputy work the floor to cover some absences. The manager can call other staff members to work overtime to cover absences, but there is no other contingency if the homes own staff are not available. We spoke with a member of care staff who told us the staff numbers are more than enough to meet the needs of the current residents, but the number of staff on duty was reduced over the holiday period due to sickness. During a period of observation in the communal lounge we observed residents were left for 10 to 15 minute intervals without staff present. One resident became agitated and persistently tried to get up out of their chair. Another resident, seated beside her, reassured her several times and she sat down. When she became agitated again, another resident was concerned so got up and went to the office to get help. This means a resident requiring supervision or assistance was receiving it from fellow residents who alerted staff when they were concerned. We discussed this with the deputy manager, who arranged for the person to be supervised by staff. The manager confirmed that 5 out of 13 care staff employed in the home have a qualification in care at NVQ (National Vocational Qualification) level 2 or above, which, at 38 , falls below the National Minimum Standard for 50 of staff to be qualified. However, other care staff are working towards this award so that people can be confident that they are being cared for by competent care staff. During our random inspection in September 2008 we found two overseas staff with a 14 year old young person were living in the unregistered accommodation and using the registered facilities for cooking, washing clothes and entertainment. During this inspection the manager confirmed that one staff member continues to live in the unregistered part of the building and the other staff member and young person have moved out. At our random inspection in Septemberr 2008 we found one staff member was employed without all checks being undertaken to ensure that they were suitable to work with vulnerable people. Information provided in the homes improvement plan told us the manager has been proactive in addressing issues related to recruitment and employment. These have included a review of staff files, the development of a new induction process based on Care Homes for Older People Page 27 of 34 Evidence: the skills for care guidance, the development of a new application form and a review of the homes systems for making pre employment checks. We looked at two staff files. The information contained in the files had been reorganised for ease of reference. Both files contained evidence of satisfactory checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA 1st) and references. Robust recruitment procedures and pre-employment checks should protect the vulnerable people living in the home. At our random inspection in Septemberr 2008 we found training records were poor and showed that staff had received little training in the past three years. For example, moving and handling Training had not been conducted since 2005. Information provided in the homes improvement plan told us an assessment of training needs was undertaken and a training programme developed to make sure that all staff receive mandatory and specialist training to safely meet the needs of people using the service. We looked at the staff training matrix that has been developed and maintained. This records most staff have had recent training updates including manual handling, health and safety, first aid, food hygiene and abuse awareness. We spoke to staff who told us the training sessions were useful and updated their knowledge and skills. The training matrix identifies gaps in learning for some staff. The manager has made contact with Warwickshires Quality Partnership to access further training resources. Care Homes for Older People Page 28 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Changes in the way the home is managed have resulted in improved outcomes for people using the service but there is no system to keep working practices under review to make sure the improvements are sustained. Evidence: The homes manager was appointed in July 2008. He has not yet applied to us for registration. The manager is supported by a deputy who has worked at the home for several years. We met with the new manager on 17th September 2008 as part of the action plan we developed during a management review of the service, to discuss plans for improving the service and the outcomes for people living there. Since the last inspection, the manager has been working co-operatively with Warwickshire Social Services to develop an action plan to implement improvements. Care Homes for Older People Page 29 of 34 Evidence: The manager has sent us copies of the action plan and details of the progress made against the objectives set. A formal Quality Assurance system has not yet been developed or implemented. The manager is currently working towards completion if the detailed improvement plan developed jointly with social services. He told us he is currently researching an appropriate system for keeping working practices under review to further assist in the identification of shortfalls to enable suitable improvements to be planned and carried out. No individuals personal financial records were checked at this inspection. They were assessed at the previous key inspection and it was found that records and monies kept were accurate. We looked at the schedule of planned supervision sessions for staff which showed that these have started to take place for staff. Staff meetings have been used to make sure staff know the correct procedure to follow in the event of an accident or incident affecting the well being of people using the service. Accidents and incidents are recorded on accident forms and incident sheets which are reviewed by the manager to monitor outcomes and trends. Appropriate regulation 37 notifications are sent to us. The manager has completed a Fire Risk Assessment. Staff have attended Fire safety training since the last key inspection. The fire alarm system is tested weekly. Information sent to us in the AQAA tells us that equipment is serviced or tested as recommended by the manufacturer or other regulatory body. We looked at the lift inspection certificate which confirmed it was inspected in December 2008 and monthly records for monitoring water temperatures, which were within recommended limits. The manager said there were no current certificates available when we asked to see confirmation that hoists and lifting equipment were serviced regularly. We made an immediate requirement for the provider to make arrangements to have all hoists and lifting equipment in the home serviced and checked according to the manufacturers recommendations. The manager contacted us on 5th January 2009 to confirm he had made arrangements for this to be done. Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 13 A policy for responding to 28/02/2009 abuse must be developed and made available for staff. This is to safeguard people using the service. 2 19 13 Arrangements must be made to identify environmental risks to the health and safety of people using the service and action must be taken to minimise risks. This includes the risk of burns from unguarded radiators and the risk of trips on uneven floors. This is to minimise risks to the health and safety of people using the service. 28/02/2009 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. Care Homes for Older People Page 32 of 34 No. Refer to Standard Good Practice Recommendations 1 7 The system for care planning should be reviewed to make sure all documents used in care planning record the same information about what staff have to do to meet peoples needs. This should make sure the information available to staff is consistent, so they can support people appropriately. Alternative methods of assessing peoples nutritional status should be considered if they are unable to use weighing scales safely. The temperature of the medicines room and medicines fridge should be monitored and recorded to make sure medicines are stored within their recommended limits so they remain stable and effective. The arrangements for serving food should be reviewed to make sure food remains hot when it is served to residents. The way meals are presented should be reviewed to make sure it meets peoples cultural preferences. This should include table presentation and the provision of napkins. A programme of redecoration and refurbishment should be developed so that people using the service can be confident they will be provided with a well decorated, maintained and comfortable home. We recommended the use of special dissolvable laundry bags should be considered. This should minimise the risk of cross infection for staff removing soiled laundry from peoples rooms to the laundry. Staffing levels should be kept under review to make sure there are enough staff on duty to meet the needs of people using the service. The managers and deputy managers hours should be included on the duty rota to accurately reflect how their time is distributed. The duty rota should reflect the full name and position of staff on duty to maintain an accurate record of who is working at the home and in what capacity. The manager should apply to us for registration. A quality assurance system should be put into place to assist in the identification of shortfalls to enable suitable improvements to be planned and carried out. This should ensure that quality of the service is improved and is kept under constant review. 2 8 3 9 4 5 15 15 6 19 7 26 8 27 9 27 10 27 11 12 31 33 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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