Inspection on 03/07/08 for Haven House

This inspection was carried out on 3rd July 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 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

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Haven House Warwick Road Kineton Warwick Warwickshire CV35 0HN Lead Inspector Jo Johnson Unannounced Inspection 3rd July 2008 08:45 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 DS0000004321.V368021.R01.S.doc Version 5.2 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 DS0000004321.V368021.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Haven House 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 Manager post vacant Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th January 2008 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 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-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 as quoted by management range from £358- £412 per week, this is subject to change and an updated fee should be requested from this service. Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience Poor quality outcomes. The focus of inspections undertaken by us is upon outcomes for people who live at the home and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. This report uses information and evidence gathered during the key inspection process, which involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. The deputy manager supplied the commission with an AQAA (Annual Quality Assurance Assessment) in November 2007. Information from this has been used to make judgements about the service, and have been included in this report. Surveys were sent to ten people who live at the home and ten staff. Three surveys from people and their relatives and one staff survey was returned. The findings of these surveys have been included in the report. This inspection visit was unannounced (we did not let the home know that we were coming) and took place on 3rd July between 8.45 am and 4.30 pm. The owner arrived at the home after 9.30am and the deputy manager came in for an hour at the request of the owner. The inspection involved; • Observations of and talking with the eight people who live at the home, relatives and the staff on duty and the owner and briefly the deputy manager. Four people were identified for close examination by reading their care plan, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’, where evidence is matched to outcomes for people. A tour of the environment was undertaken, and home records were sampled, including staff training and recruitment, health and safety, and staff rotas. DS0000004321.V368021.R01.S.doc Version 5.2 Page 6 • • Haven House We would like to thank the people who live at the home, the owner, deputy manager and staff for their hospitality and cooperation during the inspection visit. What the service does well: What has improved since the last inspection? When people’s needs have changed, any risks have been reassessed. This means staff have up to date information and know what action to take to minimise and manage any risks. Any creams prescribed by the doctor have been applied as directed. This makes sure that people have cream applied as prescribed and so they can be referred back to the doctor if the treatment is not working. The Fire Service and Building Control officer have been consulted about the new means of escape in the kitchen and have approved it. This means that there is adequate means of escape from a fire in the kitchen. Once a month the staff checking in the medication is now supernumerary to the rest of the staff. There has been new carpet purchased in the main corridors and some bedrooms have been decorated. Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 7 The cleanliness of bedrooms has improved. What they could do better: Since the last inspection, there has been deterioration in the quality of the service provided by the home and on the outcomes and the safety of the people who live there. The ongoing assessment process for people must identify when the home is not able to continue to safely meet their needs. This is so people whose needs have increased or changed move to a more appropriate care setting. The right medicine must be administered to the right person at the right time and at the right dose as prescribed and records must reflect practice. This is to ensure that the clinical needs of the people are fully met. Staff must move people in a safe way, using moving and handling equipment where needed. More moving and handling belts should be purchased. This is so people and staff are not injured and to ensure that safe moved and handling techniques are used. All allegations of abuse must be referred to the local authority and the commission. This is to make sure that any allegations are appropriately investigated and actions taken to safeguard people living at the home. All staff including the manager must be trained and or be made aware of how to recognise the types of abuse, the signs and symptoms of abuse and how and to whom any allegations must be reported to. This is to make sure that people living at the home are protected from harm and abuse. Staffing levels provided at the home must be based upon the individual needs of the people who live there, and not based upon the number of residents. This is to make sure that there are sufficient staff to meet the personal, physical, social and psychological care and support needs of the people at the home. Risk assessments specific to staff member’s roles and responsibilities must be completed for any staff that have criminal convictions. This is to make sure that any risks have been assessed and that staff are suitable and safe to work with vulnerable people living at the home. The owner must demonstrate and provide evidence to the commission that the home is financially viable. This is so that the future care of the people living at the home is safeguarded. Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 8 The management of the home must improve, and develop effective ways of assessing and monitoring the quality of the service. This is so that shortfalls are identified, are improved on and the quality of the service is kept under constant review. Good practice recommendations have also been made. 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. The summary of this inspection report can be made available in other formats on request. Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 9 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 DS0000004321.V368021.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. People’s needs are assessed before moving in so that they can be sure the home can meet their needs. It is not clear whether all people’s needs are reassessed so that staff can continue to meet their changing needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four peoples assessments were seen including the last two people who moved into the home. One of the people had moved into the home the week of the inspection. The assessment seen covered all identified needs. Local authority and health assessments were also available for the new people. For one person whose health needs have changed over the recent months had an up to date assessment and plan in place completed by the home. Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 11 One person who has dementia and has lived at the home for a number of years has recently had their needs reassessed by the local authority. Their needs have increased recently, they now require two carers for transfers and their assessment, and care plan has been update to reflect this. The deputy manager had completed Pre admission assessments before the two people moved into the home. The service user guide was being reviewed at the time of inspection. Both people who had recently moved in were not sure if they had received a copy of the guide or any information about the home. Both people said that someone had visited them in hospital before they moved in. They told us that they had not looked at the home themselves but their relatives had chosen the home for them. One person was in a ground floor bedroom that looks directly on to a brick wall of the new extension. They said that they had not been offered a choice of bedroom although there are eight bedrooms free at the home. When this was raised with the deputy manager, she said that the individual’s social worker and relatives had wanted a ground floor bedroom for the person. The individual has not been consulted on their choice of room. The subject of recent complaint was the about the home’s ability to meet an individual’s changing needs and behaviours due to their dementia. This person has now moved in to a dementia care nursing home. The home did ensure that the individual was reassessed by health professionals but did not identify early enough that they were not safely meeting this person’s needs and the impact that this person’s behaviour had on other people living at the home. These issues should have subsequently been identified as safeguarding referrals. These were not made by the home but by the local authority and by us once we were aware of them. This is a matter of serious concern and is referred to under the complaints and protection section of this report. Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. The health care that people receive is based on their individual needs. People living at the home are treated respectfully. The shortfalls in medication management put people at risk of harm from non-administration or misadministration of medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four people’s care records were looked at. Since the last inspection, the care records apart from the daily records are kept locked away in the new extension. This means that they are not accessible to staff. It is particularly important for staff to see the assessment and care plan whilst there are new people moving into the home. This is so they are aware of people’s needs. It is also recommended that each individual’s last monthly care plan review is kept with the daily records as it gives a good overview of each person’s current needs. Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 13 Care plans are developed from the assessment and life history completed by the home. There were risk assessments in place for each person including, moving and handling, nutrition, pressure areas and falls. They were all of a suitable standard and staff spoken with were aware of people’s needs that had been at the home for a number of years. Care plans and risk assessment had been reviewed on a monthly basis including one of the people who had moved in recently. Only one person had signed their care plan review, they said that they always read and agreed with the monthly reviews. One other person who had recently moved in was not sure if they had seen their care plan and they had not signed it. People or their relatives should sign their care plans and monthly reviews where possible to show that they have been involved in the process. There was evidence of improved practice for one person who had a number of falls. Their plan and risk assessment had been reviewed to reflect that they fluctuate between needing one and two carers to transfer. A referral to the falls clinic was considered but was not made following enquiries because the individual has dementia. One person who has lived at the home for a number of years has developed significant health problems over the last twelve months. They told us the home had been “excellent” at supporting them through their treatment. This person has a large file that includes all of their records since they moved into the home. It was very difficult to locate the current information in the file. It is recommended that people’s care records include their current assessment, care plan and risk assessments so that any new staff can easily access information about individuals. Peoples’ preference of gender of staff is identified on their assessment and as there is a mixed staff group, they are able to meet people’s preferences. People spoken with confirmed that they are asked their preferences but do not mind either gender of staff as they know them all well. There was evidence in people’s care records that they have good access to health care and relevant health care professionals such as GP, dietician, dentist and specialist consultants and chiropodist. People spoken with and three surveys told us that they ‘always’ receive the medical support they need. On the day of inspection, a private chiropodist was visiting people at the home. One of the people who had recently moved in was seen. Whilst sitting in the lounge talking with people, we observed two staff ‘drag’ lift on person to transfer them from a wheelchair to a chair. When staff were asked if they had a moving and handling belt they confirmed that there was Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 14 one in the home. Staff were not sure where it was initially and it was then found in the entrance hall. Staff acknowledged that one moving and handling belt was insufficient for the current needs of the people at the home and that they did not always use the belt to move people. This poor practice places people and staff at risk of injury if they are not moved using safe handling techniques. The staff confirmed that there were enough hoists at the home and there were sufficient slide sheets. From talking to people at the home, staff and by observation, there are at least four people living at the home that need two people to assist with moving and handling. Three surveys from people show that people ‘always’ or ‘usually’ receive the care and support they need. People spoken with said that sometimes they have to wait when the staff are busy. Staff spoke with said that there were times when they had to leave people unsupervised or they had to wait for care because there were only two if them on duty. They gave an example of the previous evening that they had to leave people during the evening meal to assist another person to the commode who is being barrier nursed. Since the last inspection, the staff member responsible for checking in the medication each month is supernumerary on the rota. The medication and the records for the four people being case tracked were seen. There was a message in the staff communication book that referred to one person not having any ‘Movicol’ for one week. There was further evidence of non and/or misadministration of medication for the person who had moved into the home that week. The medication administration records showed that 3 ‘Simvastatin’ tablets had been administered and there was one gap in the record and there were only 2 tablets missing. This means that staff have signed for medication that has not been given. The records also showed that ‘lactulose’ and ‘Movicol’ had been administered. However, there was none of this medication in the drug trolley for this individual. There was one box Movicol that had been prescribed for another person and a bottle of lactulose prescribed for another person so it was impossible to assess whether it had been administered. The medication records for another person identified that they were having eight 5mg prednisilone a day. However, the amount of tablets received from the pharmacy had not been checked into the home on 26/06/08 and there Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 15 were no prednisilone in the drugs cupboard at the time of checking so a stock balance could not be made. This medication was signed on the medication administration record as being given despite none being available. It is not clear how the home is auditing whether medication is being administered correctly. People were generally well groomed and cared for. People spoken with said that staff always take care to make sure people are well dressed and their appearance is cared for. Staff spoken with had a good understanding of recognising people as individuals and respecting their privacy and dignity. They were observed respecting people’s privacy and dignity, by knocking on their doors and offering personal care discreetly and in private. Staff observed had good relationships with the people living at the home and were patient and encouraging. People spoken with and surveys told us that staff treat them well and that carers listen to and act on what they say. Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate People who use this service are able to participate in social activities and are given choices including choice of meals provided to maintain their quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 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, there was relaxed atmosphere and staff and people clearly enjoyed each other’s company. Staff were able to spend some quality time with people after additional staffing was brought in by the deputy manager for the afternoon and evening shift. People in the lounge were given a choice of activities but they chose to spend time talking with the staff and us. People spoken with told us that the visiting activity worker still comes once a fortnight for music and movement sessions. Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 17 People told us that they had not had any ‘residents meetings’ recently and the resident who was the ‘chair’ had recently passed away. They were not sure what was going to happen in terms of further meetings. People told us that they like to spend time chatting with staff, music and movement, going out and Bingo. They said that staff do activities with them if they have time. People’s surveys tell us that there are ‘usually’ or ‘sometimes’ activities arranged by the home that they can take part in. People spoken with said that their visitors were made to feel welcome whenever they visited. The inspector joined people for lunch. Two choices were offered to people just before lunch and the cook said that they would cook something else if people did not want what was on offer. People spoken with said they enjoy the meals and stated that they are always offered choices. One person said “ there’s always plenty to eat and if we don’t like anything there is a choice”. The surveys from people tell us that they ‘usually’ or ‘sometimes’ like the meals. Staff were observed to sit with people and assist them to eat where needed. The support given was relaxed, sensitive and discreet. Staff spoke to people through out the meal about what they were eating and offering choices. The kitchen was well stocked with a variety of fresh and long-life foodstuffs. Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is poor. People living in the home can be confident that their concerns will be listened to and acted upon. The staff’s failure to recognise what constitutes abuse and lack of understanding of how to refer an allegation of abuse puts people living in the home at risk of not being protected from potential harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints policy is displayed in the entrance hall of the home and is in the service users guide. All of the people spoken with, except the person who had moved in that week, were confident about who they could talk to if they were unhappy or wanted to make a complaint. One person said, “If I’d got a complaint I would talk to xxx (owner)”. The three surveys show that people and relatives know who to speak to if they are not happy and know how to complain. The surveys included the comment; ‘my family know how to make a complaint for me if I need to make one’. Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 19 There have been ongoing anonymous concerns raised with us. The complaints related to the care of one person who has since moved out of the home. Within these complaints, a number of serious issues were hi-lighted including: • A person going missing from the home and being returned to the home by a member of the local community. The family and we were not informed. The home did not report incidents of abuse between people who live at the home to social services or us. There was no action taken when an individual with dementia made an allegation of rape to staff in December 2007. The deputy manager told us that she was not aware of the allegation at the time and it was not recorded in the records. Staff had informed the family of the allegation. We referred this matter to social services immediately and the police investigated the allegation. • • The deputy manager and owner told us that there has been one formal complaint made to the home since the last inspection. This was from a relative; they had complained that a male member of night staff had been rough whilst providing personal care to their relative. The owner investigated the complaint and the staff member no longer provides care and support to that individual. However, the matter should have been referred to social services under adult safeguarding procedures for them to make the decision as to how it should have been investigated. Telephone contact was made with the deputy manager before the inspection regarding the incidents of abuse between people living at the home. She is now aware that such incidents must be reported to social services. Staff spoken with were not all clear as to what constitutes abuse. Two of them said they have not been given any guidance on how and to whom they can report any allegations. All staff must be trained and made aware of the signs and symptoms of abuse and how they can report any allegations. The one staff survey tells us that do not know what to do if a service user, relative, or friend has concerns about the home. Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is adequate. 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We toured the home, looked in vacant bedrooms, and saw other people’s bedrooms with their permission. Some of the vacant bedrooms have been redecorated. There are rooms that have badly fitted vinyl floor coverings in the bedroom and en suite areas. The furniture in the bedrooms is worn and in some cases broken. In the bedroom of the person who moved in that week the desk that a television was on was broken, the white veneer was peeling and the furniture was worn. Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 21 The owner later accompanied us on a tour of the building and acknowledged that people would be reluctant to choose to come and live in a home with old, unsafe and worn bedroom furniture. He agreed to purchase new bedroom furnishings for the existing parts of the home to match the new furniture he has purchased for the new extension. New carpet has been purchased for the corridors throughout the home. Since the last inspection, the downstairs toilet door has been repaired; a radiator cover has been fitted to the radiator that was lagged in blue foam. The home was clean and fresh. A concern had been raised with us about the standard of cleanliness of people’s bedrooms and their en suite bathrooms. All of the en suite bathrooms seen were clean. From information on a survey and from a complainant we were made aware that the lift was broken for a number of days and people were not able to come downstairs of their meals. Staff, the deputy and owner told us that the lift did keep breaking down but that it now has a new inner door and is in full working order. The surveys from people tell us that the home is ‘usually’ fresh and clean. Comments included, ‘family feel the bedroom is not very clean’ and ‘home is old and tired’. The owner told us that the new extension is now complete and that he has building control approval. The owner has not yet applied to have the new extension registered with us. As identified earlier in the report, people should be offered a choice of bedrooms whilst there are a number of vacancies rather than use the bedroom that looks out onto a brick wall. Efforts should be made to make sure that the outlook from this bedroom is improved. The washing machine was leaking on the day of inspection. Staff told us that this had been like this for over a fortnight. The laundry floor was flooded with water from the machine. This presents an infection control risk and it was not clear how the electrics could be safely isolated if necessary. One person is being barrier nursed and there is a risk of cross contamination if their laundry was washed with other peoples. Staff told us that the person’s Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 22 laundry is stored in carrier bags then washed separately. Special dissolvable laundry bags should be used to ensure good infection control and prevent staff from handling this soiled laundry once it leaves the person’s room. The fact that the washing machine is leaking during the wash cycle presents further infection control risk in regard to this person’s soiled laundry. The dishwasher was not working on the day of inspection. From discussion with staff, this has been out of order for two weeks and staff have needed to wash up by hand. At breakfast and at lunchtime the cook has been doing this. At teatime, the staff have been preparing tea and washing up. No additional staffing has been provided to cover this task. As this coincided with the staffing reduction in the afternoons and evenings this is having a negative impact on the staff’s ability to care for people safely. The owner told us that the engineer was coming on the following Monday for both the washing machine and dishwasher. No consideration had been given to the impact of these essential items not working properly on the smooth and safe operation of the home. A majority of staff have completed a distance learning ‘Infection Control’ course. They were able to go through how they have improved their practices and how informative the course was. They confirmed that protective clothing and hand washing facilities are always available and kept stocked up. All of the bathrooms and toilets had sufficient hand washing and drying facilities and protective clothing and gloves were available on the day of inspection. The kitchen was clean and tidy. The cook told us that there is a cleaning schedule in place. This now includes the regular cleaning of cupboards. The kitchen had an Environmental Health inspection in December 2007. Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. There are not always enough staff on duty to fully meet the needs of the people living at the home. This means that people are not receiving the best possible care. The poor recruitment practices at the home potentially place people at risk of harm from staff that are unsuitable to work with vulnerable people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection there were 12 people living at the home. Staff rotas were seen for a two-month period. The rotas from 21st June show that the staffing was reduced from four staff in the mornings to three staff, and from three staff from 5pm to 9pm to two staff. From 7th June to 21st June, the staffing levels fluctuated between two and three staff in the evenings. There are two waking night staff every night. There has been a long history of the home reducing staffing when their occupancy levels are reduced. A statutory enforcement notice was issued in 2005 in relation to short staffing at the home. The owner does not consider the individual needs of the people who live at the home when deciding on the number of carers required. Although there are less people living at the home Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 24 the dependency and care needs have increased. From information gathered from staff, people at the home and examination of the care plans there are four people who need two staff to assist them with transfers. At least two of these people use the hoist and one person needs total staff support to eat and drink. This means that in the afternoons and evening there will be periods of time when staff are assisting these individuals, others are left unsupervised and or have to wait for personal care. In addition to providing personal care and supporting one person to eat and drink, they are also expected to prepare the evening meal and drinks, do the laundry and at the time of the inspection do the washing up. A long-standing staff group work at the home. Agency staff are not used and therefore staff cover holidays and sickness between them. From discussions with staff, they told us that they are committed to providing good care to the people that live there despite the reduction in staffing. When staffing was raised with the deputy manager, she immediately took action to reinstate three staff in the afternoons and evenings. By the end of the inspection, there were three staff on duty for the remainder of the day and for the rest of the week. However, this is what happened at the last key inspection in January 2008 and yet again, staffing levels have been reduced without any consideration for the needs of the people living at the home. Four staff records were looked at including the last two recruited members of staff. A staff file for a recently recruited member of staff only included one reference and no reference was sought from their last care home employer (which is in the same village). Another staff file had two references but neither was from their last employer. One staff member who has been working at the home has a standard Criminal Records Bureau (CRB) check on file that shows convictions. There is a risk assessment completed in 2005 for this individual to work only in a specific role at the home. From discussion with the individual, staff rotas and the owner, this person has worked as a care assistant covering care staff shortages from 19th April 2008 to 7th June 2008, working 30 shifts. This is a matter of serious concern because no new enhanced CRB and POVA (Protection of Vulnerable Adults) checks have been sought. Neither was a new risk assessment completed with the appropriate professionals for this role. The person is no longer working as a care assistant at the home. When we twice asked the owner whether the individual had been working on the care rota he did not answer honestly until we informed him that we had seen the staff rotas. Another member of staff has been recruited without a CRB check or references from their last employer. The person had not indicated on their application form that they had a criminal conviction. There was no record of discussion with the individual or any risk assessment completed to assess whether they pose any risk to the vulnerable people living at the home. Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 25 The application form that the home is using should be reviewed and updated. This is because it only requests a five-year working history and does not ask for the names and contact details of referees. A full adult life or working history should be requested and any gaps in employment explored. This information should be obtained to make sure that staff are suitable and safe to work with vulnerable people. There was no contract of employment seen for the most recently recruited members of staff. There is no way of easily assessing what training staff have completed apart from going though each staff file. It is recommended that a training matrix be produced so it is clear and the management can ensure who has received training and when they need updates. From discussion with staff and from staff records seen staff have not had any moving and handling training since 2005. New staff appointed in the last year have not received any moving and handling training. A majority of staff have achieved a certificate in dementia care. Staff told the inspector that they have now completed distance learning infection control since the last inspection. There has been no fire training or fire drills for staff as identified at the last inspection. This matter has been referred to the Fire Service who are responsible for enforcement action in relation to fire safety. Staff recruited since the previous manager left in October 2007 have not had any induction since starting work at the home. As previously, identified in the ‘complaints and protection’ section of the report, two staff spoken with have not had any training or information about the protection of vulnerable adults. Staff told us that there are staff meetings every month. There was a staff meeting booked for the week following the inspection. Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34,35,38 Quality in this outcome area is poor. People who live at the home do not benefit from or live in a well managed and safe home that is run in their best interests or that has effective monitoring systems. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The owner has now appointed a new manager for the home who is due to start in the middle of July. The deputy manager has been covering the roles since the previous manager left in October 2007. Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 27 We have received some information from an anonymous complainant that there have been delays in paying staff wages and that there may be issues with the financial viability of the home. This was discussed with the owner who explained that he had taken steps to ensure the financial viability of the home. The owner must provide evidence to the commission of his financial viability to ensure continued care for the people living at the home. There has been no formal quality assurance undertaken since the previous manager left ad this needs to be a priority for the new manager to identify the ongoing shortfalls at the home. No individual’s personal financial records were checked at this inspection. They were assessed at the last key inspection and it was found that records and monies kept were accurate. The accident book was seen. Accurate records were kept that corresponded with peoples’ daily records and evidence in their care plan reviews. It was recommended at the last inspection that falls be monitored on a monthly basis. The owner was not aware if this had been completed so the recommendation is made again. At the last inspection, there was a requirement that a fire risk assessment be completed and this has not been done. The fire officer has assessed the new fire escape following the last inspection and has written to us to confirm that it is suitable. The fire service undertook an inspection 24th June 2008 and reported that the written fire risk assessment was not in place and that weekly staff briefings were to be recorded in the logbook. From discussion with staff, examination of the fire logbook and discussion with the owner it was found that this has not been actioned. Staff still have not completed a fire drill or received any fire training. This was a requirement at the last inspection. These matters have been referred to the fire service, as they are responsible for enforcement action in relation to fire safety. Since the last inspection, all of the electrics have been made safe and a certificate was seen to confirm this. Information sent to us in the AQAA (Annual Quality Assurance Assessment) in November 2007 tells us that equipment is serviced or tested as recommended by the manufacturer or other regulatory body. Evidence of this was seen at Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 28 the Key inspection in January 2008. No specific checks were made at this inspection. The acting manager and staff would still benefit from health and safety and risk assessment training as identified at the last two inspections. It is strongly recommended that this training be provided as a matter of priority. Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 29 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 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 1 2 x X X X X x 2 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 1 3 x x 1 Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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 12(1), 14 (2) Requirement The ongoing assessment process for people must identify when the home is not able to continue to safely meet their needs. This is so people whose needs have increased or changed move to a more appropriate care setting. The right medicine must be administered to the right person at the right time and at the right dose as prescribed and records must reflect practice Timescale for action 01/10/08 2 OP9 13(2) 01/08/08 3 OP10 12(1), 13(5) This is to ensure that the clinical needs of the people are fully met Staff must move people in a safe 01/08/08 way using moving and handling equipment where needed. More moving and handling belts must be purchased. This is so people and staff are Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 31 4 OP18 12(1), 13(6) not injured and to ensure that people are always moved using safe handling techniques. All allegations of abuse must be 01/08/08 referred to the local authority and the commission. This is to make sure that any allegations are appropriately investigated and actions taken to safeguard people living at the home. All staff including the manager 01/10/08 must be trained and or be made aware of how to recognise the types of abuse, the signs and symptoms of abuse and how and to whom any allegations must be reported to. This is to make sure that people living at the home are protected from harm and abuse. Staffing levels provided at the 01/09/08 home must be based upon the individual needs of the people who live there, and not based upon the number of residents. This is to make sure that there is sufficient staff to meet the personal, physical, social and psychological care and support needs of the people at the home. 01/09/08 Risk assessments specific to an individual’s roles and responsibilities must be completed for any staff that have criminal convictions. This is to make sure that any 5 OP18 12(1), 13(6) 6 OP27 18(1)(a) 7 OP29 12(1), 13(c) Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 32 risks have been assessed and that staff are suitable and safe to work with vulnerable people living at the home. 8 OP34 25(1)(2) The owner must demonstrate and provide evidence to the commission that the home is financially viable. This is so that the future care of the people living at the home is safeguarded. A quality assurance system must be put into place to assist in the identification of shortfalls to enable suitable improvements to be planned and carried out. This will ensure that quality of the service is improved and is kept under constant review. 01/10/08 9 OP33 24 (1) 01/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP7 OP7 OP7 Good Practice Recommendations Peoples assessments and care plans should be accessible to staff. This is so they are aware of people’s needs. People’s last monthly care plan review should be kept with the daily records as it give a good overview of people’s current needs. People or their relatives should sign their care plans and monthly reviews to show that they have been involved in the process. ‘Residents meetings’ or other means of involving people in DS0000004321.V368021.R01.S.doc Version 5.2 Page 33 4 OP14 Haven House 5 OP19 the running of the home and choosing how they spend their time should continue. This is to make sure that people views are listened to and acted upon. An audit of the bed bases should be completed and any worn bases should be replaced. This is to make sure that people have a good quality beds to sleep on. People should be offered a choice of bedrooms whilst there are a number of vacancies rather than use the bedroom that looks out onto a brick wall. Efforts should be made to make sure that the outlook from this bedroom is improved. 6 OP24 7 8 OP24 OP26 8 9 OP26 OP27 Any broken bedroom furniture should be replaced. This is so that people have suitable fittings and furnishings in their bedrooms. The washing machine needs to be repaired urgently. Arrangements need to be made to make sure that the laundry for the home is washed safely. Infection control measures should be in place for the separate washing of soiled or contaminated laundry. The dishwasher should be repaired as a matter of urgency. This is so the crockery and cutlery is washed at a suitable temperature to prevent cross infection. Evidence of how staffing levels are calculated should be produced and constantly kept under review by consultation with and observation of people as to whether their needs are being met and discussions with staff. Written references need to be obtained before staff start work at home. This is to establish whether people are suitable to work with vulnerable people. Any inaccurate declarations on an application forms should be followed up before confirming employment. This is to clarify the honesty of person completing the application. The application form should be reviewed and updated to include: A full adult life or working history should be requested so that any gaps in employment can be explored The names and contact details of two referees. This is to make sure that staff are suitable and safe to work with vulnerable people and referees correspond with their working history. 10 OP29 11 OP29 12 OP29 Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 34 13 14 15 16 OP29 OP30 OP30 OP33 Staff should be given a contract of employment. Staff should be trained in moving and handling. This is so they can safely move people who live at the home. Staff should be given an induction at the home. This is to make sure that they have the skills and knowledge to work at the home and with the people who live there. The formal monitoring of falls or accidents should be part of the quality assurance system. Falls in particular should be reviewed on a monthly basis to establish the times, causes and frequency, and whether they relate to staffing or health factors. 17 OP38 The manager and staff should be provided with health and safety and risk assessment training. To make sure that they have the skills and knowledge to be able to identify and manage risk to prevent risk to the service users. All staff should be trained in fire safety and undertake fire drills. A fire risk assessment needs to be completed for the home. 18 19 OP38 OP38 Haven House DS0000004321.V368021.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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