Inspection on 30/05/07 for Haven House

This inspection was carried out on 30th May 2007.

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

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

Other inspections for this house

Haven House 13/04/10

Haven House 15/12/09

Haven House 02/01/09

Haven House 05/11/08

Haven House 03/07/08

Haven House 08/01/08

Haven House 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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Haven House Warwick Road Kineton Warwick Warwickshire CV35 0HN Lead Inspector Mrs Cathy Moore Key Unannounced Inspection 30th May 2007 07.55 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.V341481.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.V341481.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 Robert Edward Hutchcox Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Manager must sucessfully complete the Registered Managers Award by April 2007. 11th May 2006 Date of last inspection Brief Description of the Service: Haven House is a conversion of three period houses in the large village of Kineton. There are twenty single bedrooms, nineteen of which have en-suite facilities. There is a shaft lift as well as two staircases, one at each end of the home. There are two sitting rooms and a dining room, and there is level access to the 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 during the inspection range from £358- £412 per week. Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced inspection on one day between 07.55 and 18.55 hours. A separate inspection was carried out by a Commission pharmacist on 16.5.2007 findings from this inspection are included in this report. Inspection time was spent in the lounge and dining room where I could observe staff and service user contact and general daily routines. I spoke to five service users’ one relative and three staff. The owner, manager and deputy were involved in the inspection processes at different times during the day. I partly observed breakfast and lunch mealtimes . I looked at service user records to judge the standard of assessment of need and admission processes, care plans and medical care. I looked at medication systems and service certificates for equipment. I looked at staff records paying attention to recruitment and training. I viewed parts of the home which included; four bedrooms, the lounge and dining room, bathrooms and toilets, the kitchen, laundry and garden. What the service does well: What has improved since the last inspection? The staff team have received or are finishing a dementia care course. Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 6 All windows and doors have been replaced with UPVC frames. Records have improved regarding money held in safe keeping for service users. The practice of using wedges to prop open doors has stopped. What they could do better: The priorities of the owner are concerning as they are based on the extension proposed to provide care to people with dementia and filling empty beds. Although service users’ spoken to complimented the staff and food, they did not offer anything else positive about the home. The home is knowingly breaching Registration Regulations by offering new service users who have dementia a place when they are not registered to provide care to people with this diagnosis. Care plans need further work so that personal needs such as religion are included. The medicine management must improve to safeguard the health and wellbeing of people who live in the home. Activity provision within the home is infrequent and inadequate. Staffing levels have been inadequate preventing staff having quality time with the service users’. At times service users’ are alone in the lounge with no supervision potentially placing them at risk. There is little consideration to the enhancing of orientation by use of colour schemes and signage. The home has many redecoration and replacement of furniture needs. The home was seen to be inadequately clean in a number of areas; corridors, the laundry, kitchen and one service users’ bedroom particularly. The homes risk identification and management of health and safety is poor, the garden was full of unsecured building materials, access out of the kitchen is by way of a plank of wood , radiators are not suitable guarded, risk assessment processes are inadequate these issues potentially place service users at risk. Kitchen processes are inadequate in terms of cleanliness and some food labelling. Self assessment and in-house monitoring of practices, processes and systems is virtually non existent. Due to staffing levels and health and safety concerns that the Commission has issued a concern letter for improvement. Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 7 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.V341481.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4 Quality in this outcome area is poor. The homes admissions process gives no consideration to the specialist care needs of the prospective service users’, or the impact new admissions may have on the lives of existing service users’. The admissions process is one based on ‘ filling beds’ rather than the homes ability to meet needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Basic assessment of need information was available for one new service user and, one service user to be admitted the following day. It is positive that the home had gained information regarding these two service users’ from relevant agencies to give them a clear idea of the needs of these people. However, it is concerning that the home gave no consideration to the information obtained Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 10 ( as stated below) in terms of them being able to meet these peoples’ needs. “Currently an informal patient on the older adults psychiatric ward. Admission to hospital was triggered by a deterioration leading to risky behaviour like wandering. Has been diagnosed with Alzheimer’s and vascular dementia”. and “Cognitive impairment due to multi- infarct dementia”. The owner told me “For a long time we have had 4 empty beds, its hard. I need to speak to your management. We need to have people with dementia, no one else coming forward. ‘I’m loosing money”. Whilst it is positive that seven of seventeen care staff are receiving or have received dementia care training .The home is not registered to provide dementia care . Concerns were raised during the inspection about the homes ability to provide care to service users’ in a number of areas examples being; poor identification of risk and staffing levels. One service user said; “ Not enough staff”. All levels of staff said; “ Not enough staff, staff rush”. There was no written acknowledgement on these service user files concerning meeting needs which means; it has not been confirmed to them that the home can meet their needs or how their needs will be met. Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor . The home is not fully monitoring of healthcare needs or accessing needed healthcare services for service users’, which could place their health and welfare at risk. The home acknowledges the need to comply with safe handling of medication processes however, current medicine management systems are poor and place service users’ at risk. Staff, are aware to treat individuals with respect and to consider dignity when delivering personal care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: I looked at three service user files to see the standard of the care plans. It appears from reading the last inspection report and viewing care plans that some improvement has been made. The deputy manager confirmed that she Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 12 had done a lot of work on the care plans. However, I identified that there was little consideration given to religious or spiritual needs. The deputy set out to address this straight away. Care plans are only updated every few months or when changes occur I was told by the deputy that this was frequent enough. There was a lack of evidence to confirm that service users are aware of their care plan. I asked a service user if he was aware of a care plan and explained that this was a ‘written document which shows his needs, wants and goals’. His response was; “ No I haven’t seen anything like that”. I saw that risk assessments were in place for nutrition and tissue viability which is good as this means that the staff have a tool to work with to identify risk, deterioration and improvement . However, further work is needed as the tissue viability assessment does not have a overall risk range to refer to which means that there could be the possibility of staff not identifying concerns early enough. And there was a lack of weight records preventing proper use of both the nutritional and tissue viability assessment. I asked why regular weights were not carried out and was told; “ We can’t as we only have stand on scales and a lot of service users’ can not stand”. I saw records of health care professional visits. One service user told me; I’ve seen the optician recently and had some new glasses. A relative told me; “ Yes she is seen by the chiropodist”. I saw records to show that service users’ see their doctor when needed and also for reviews. A record in one service users’ notes said that she had attended the doctor’s surgery for a blood test which is good as this shows that attempts are made to retain community contact. I did not see evidence of regular dental screening for service users’. The manager told me that the dentist does come when there is a problem but is not offered as routine for all. This means that service users’ miss the opportunity of early diagnostic identification of mouth problems. The pharmacist inspector visited the home on a separate occasion to the main inspection. It took two and a half hours. Seven medicine charts and their corresponding medication were audited together with three care plans and daily records. One care assistant was spoken with and two people who live in the home All feedback was given to the manager and deputy manager. The storage facilities were poor. The home had one medication trolley, which was dirty and needed to be cleaned. It was too small to store all the current medication and some medicines were kept in a locked room but had not been held in a locked cabinet due to lack of space. The home had no Controlled Drugs cabinet that complied with the National Minimum Standards and held any CDs in a portable locked cash tin. This was kept in a locked cabinet. As the home is due to increase the number of people who will live in the home, storage facilities must significantly improve to safely hold medication. The purchase of a second trolley for the administration of medicines for people who live on the first floor was discussed. Many old and obsolete medicines were found in an unlocked filing cabinet. These had not been returned to the supplying pharmacy for destruction. Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 13 The home does see the prescriptions prior to dispensing but has no system to check the dispensed medicines and medicine charts received from the pharmacist into the home. Staff do record the quantity of medicines they receive but do not record any balances carried over from previous cycles. This resulted in difficulty in undertaking audits to demonstrate that the medicines had been administered as prescribed. Medicines dispensed in a Monitored Dosage System supplied by the pharmacist had been administered and staff had record the transactions accurately. However medicines dispensed in traditional boxes and bottles were not always administered as the doctor intended. This indicates that staff are not referring to the medicine chart before each administration to check what is to be administered. Many medicines found in the trolley available for administration had not been recorded on the medicine chart. Some were no longer needed and had not been returned to the pharmacist for destruction. For others it could not be demonstrated if they were needed or not. Concern was raised why some medicines were still available when they are usually prescribed on a 28 day cycle so should have all been administered during the 28 days. Conversely some medicines were recorded on the medicine chart to administer but not available in the trolley to administer. In one instance the staff had recorded that they had been refused, but if they were not available to offer they could not be refused, indicating that records did not always reflect practice. A few gaps were seen on the medicine charts were the medicine had been administered but not recorded as such or not administered and the reasons for non-administration not recorded. One medicine had not been administered for a period of 14 days but the daily records or care plans did not support why it had been stopped and then restarted when, according to the care plans, her condition remained unchanged and no healthcare professional had reviewed the drug regime. Loose tablets were seen in the trolley that were not in a pharmacist labelled container. All medicines should be administered for a labelled container to ensure the correct medicine is administered to the correct person at the right dose. The doctor had stopped one medicine and this was detailed in the daily records. However it was still available in the medicine trolley to administer and may be given inadvertently as staff do not always refer to the chart before administration. It could not be demonstrated whether it had been or not. Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 14 Care staff had written some medicines on the medicine chart. One seen had not been dated so information recorded was meaningless. One person’s medication was administered covertly (without her knowledge). The tablets were crushed and put in a cup of tea. The doctor had written that her medicines were fine to be administered covertly as she lacked capacity to make decisions about her medication. Concern was raised about the stability of the medicines disguised in a hot drink and what happens when she fails to drink all the tea. Some medicine had been prescribed on a when required basis. There were no supporting protocols detailing their use. People who live in the home are encouraged and supported to self-administer their own medicines if they wish to. One risk assessment was found but this was four years old and the person had not been routinely reassessed. There was no evidence of any compliance checks. However care plans detailed the self-administration. Some good practice was seen. All the controlled drugs balances were correct and the CD register reflected administration on the medicine chart. The care assistant spoken with had a very good understanding of the medicine she handled. She had undertaken a brief accredited training course and was keen to extend her knowledge further. She had a good rapport with the people who live in the home and this was commended. The manager was keen to improve the practice to meet the standards and was to immediately address the issues found. On the day of this inspection 30 May 2007 I was concerned to see the medication trolley open and unattended in the dining room. The staff member told me; “ I just had to go and fetch something for one on the service users’ “. As this unsafe practice places service users’ at risk, I reported the incident to the deputy manager straight away. Records showed that the preferred form of address for each service user is identified . I heard staff using preferred names during the inspection. It is positive that the home has both male and female carers which allows service users’ some choice of who provides their personal care. One service user told me; “ I don’t mind if I get a male carer, both are good, one very good”. Staff observed during the inspection were polite when speaking to service users’. Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 15 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. Activity provision is limited, is not well resourced and does not provide enough stimulation. Due to inadequate staffing levels daily routines are at times dictated by staffing numbers rather than service user needs. The homes encourages service users’ to maintain contact with family and friends. Food in the home is of a satisfactory standard and well presented. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Activity provision is not offered regularly. One service user said; “ We sometimes do bingo and skittles”. There was evidence in records that service users’ had recently been out to a nearby pub for a meal however, they had paid for their meals themselves. Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 16 Generally activity and stimulation provision is inadequate. I saw service users’ for long periods without contact from staff. Feedback from staff and service users’ about activity provision included; “ I would like to do more- get out”. “ Don’t do anything, get bored at times”. “ Activities, there just is not any apart from bingo and skittles”. “ Movement to music every two weeks. This was stopped then started again as the residents’ were cross”. “ Don’t think the equipment we have is right for these”. “ Activities are limited. Not enough staff, equipment not suitable”. Inadequate staffing levels have had a negative impact on some service users’ daily routines. One service user said; “ Not enough staff. Two or three to do the lot have to wait”. “ Can get up and go to bed when want but have to wait”. From talking to service users’ and staff it is apparent that visiting times are open and visitors are encouraged. One visitor said; “ They always make me feel welcome”. A service user said; “ My daughter visits me regularly”. Advocacy information was on display in the front entrance giving service users’ the opportunity to access this independent resource if they wish. All bedrooms I looked at held a range of service users’ personal effects demonstrating that they can bring their own things in to make their room feel homely. Before lunch I saw and heard a staff member going around asking service users what they would like from two choices. That offering meal choices was a daily occurrence; was confirmed by service users’ as follows; “ Couple of different things each day”. “ They will be round soon to ask us what we want”. I saw that the dining room is fairly comfortable and had a nice atmosphere. At lunch time tables were laid and salt and pepper available, staff were on hand to give assistance. The main meal; cheese and ham quiche or fish in parsley sauce with carrots, cabbage and potatoes looked and smelt very nice. Food was nicely presented. A staff member noticed that he had not eaten and asked if he wanted anything else. I then saw that he enjoyed a large portion of fruit and ice cream. I noted that most other service users’ ate their meal, which a number told me they enjoyed. I saw that fresh fruit was available in the dining room and in the kitchen. There was also fresh vegetables and salad in the fridge. Service user views about food were all positive and included the following; “ The food is always good here”. “ Food good ”. Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 17 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): 16,18 Quality in this outcome area is adequate . The home has a complaints procedure which is on display in the entrance hall. The procedure is up to date but not available in other formats. Staff have some knowledge of the types of abuse but lack formal abuse awareness training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaints have been received about this home. It is positive that the home has a complaints procedure, which is on display in the entrance hall. However, it has only been produced in written form, which may make it difficult to understand for some service users’, who have poor eye- sight or dementia. No incidents or allegations of abuse have been received about the home which is positive. However, staff have not received formal abuse awareness training which could limit their understanding. A relative confirmed. “ No I’ve never seen anything concerning when I visit”. A service user told me; “ No I’ve never been shouted at or hurt”. All staff spoken to confirmed that they were not aware of any concerns. They said; “ No concerns at all, nothing between residents”. “ Sometimes minor Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 18 verbal disagreements between residents- nothing physical or bad. Nothing staff wise- no concerns”. Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 19 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): 19,20,24, 25,26 Quality in this outcome area is poor. The physical environment although homely, needs major refurbishment work and does not always meet the specialist needs of people who use the service. Communal space is limited preventing service users’ having choice when receiving visitors and for privacy. The management have not recognised or responded to environmental hazards potentially placing service users at risk. The home is inadequately clean in a number of areas, infection control processes are weak, potentially placing service users and staff at risk from infection transmission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 20 It has been highlighted in previous reports that the home has redecorating needs yet little has been done to improve the situation apart from the replacement of windows and doors and the redecorating of a bedroom. Many areas are in need of redecoration examples being; bedrooms, corridors and landings. The home also has replacement of furniture needs for example; the small table in the lounge was unsteady and could have been dangerous if sat on. Someone told me “ It could do with a lick of paint and a clean”. I was surprised that the manager was not aware of any planned maintenance and renewal programme. He said; “ It’s the owner and maintenance person who deal with that”. The deputy however, showed me at least five pages of redecorating and replacement needs she has identified and recorded , which she intends to share with the owner. The physical environment with its numerous corridors and doors, lack of colour co-ordination and signage may cause problems for people who are confused and lack orientation. I saw two service users’ wandering near the kitchen unsupervised, at potential risk, as there is no means to restrict access to the kitchen where hot solutions are available and sharp objects stored. I discovered that due to an extension being built, the small lounge that was previously used for privacy and visiting by the service users’ has been turned into a temporary office and has been like that for sometime. I was told; “ The inspectors said that this could not be done, but its been done anyway”. I was also surprised to be told that bedroom number 20 has been demolished to have the extension built. The resident ( who has dementia) was moved out of this bedroom into the small lounge for a while, before it was turned into the temporary office. Outdoor space, due to the extension build has also been reduced. When I arrived on site the whole garden, with the exception of a very small square area near the back door, was covered in building materials, which made it unusable and unsafe. I was told by many people; that the garden had been like that for some considerable time. The home does not have any shared bedrooms. All but one bedroom has ensuite facilities which is positive as this means that the privacy and dignity of service users’ is enhanced. Bedrooms seen were of varying standards. Two bed bases were in a very poor state of repair. One bedroom carpet was stained and an en-suite room held a strong odour. Although prompted, no service user spoken to made any compliments about their bedrooms. One service user said; “I would like a new carpet, the hoist gets stuck and I am scared”. From speaking to management it appears that there has been an incident with the hoist and this service useryet the problem and risk remains. There seems to be little recognition of risk within the home, I saw wardrobes that were not secured, first floor windows that opened out full , numerous radiators throughout the home including bedrooms, that were not guarded. A staff member said; “ Concern, in the winter they get very hot”. I also saw exposed hot, copper, pipe work in toilets and bathrooms. Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 21 The manager could not provide me with evidence of adequate risk management processes for the hazards identified. The home was very dirty in some areas for instance; one bedroom had a heavy coat of dust on skirting boards, furniture and carpet. This was also the case in corridors. The dust was so bad it resembled a ‘snow fall’ when touched . These areas were shown to the manager and owner. The manager said; “ They are obviously not doing their jobs properly”. I was told that the maintenance man is also the cleaner, yet his name was not on the rota and he does not work every day. The manager could not tell me if cleaning schedules were in place to show the frequency of cleaning. The laundry was dirty, the floor and sink stained. Liquid soap and paper towel dispensers were empty. I saw that there is only one sink in the laundry preventing inadequate hand washing processes. This made worse by the lack of washing machine, disposal bags to prevent staff having to handle soiled linen or clothing. I did not see any protective clothing in the laundry, or near to bathrooms or toilets on the first floor. I did not see any appropriate prompts in toilets and bathrooms for people to wash their hands after using the toilet. These poor infection control processes place service users and staff at risk from potential infection transmission. It is positive however, that arrangements have been made for staff to receive infection control training. Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 22 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 adequate. Staffing levels do not always meet the needs of people using the service, having an impact on their health and welfare. However, it is evident that care staff are totally committed to doing their best for the people in their care within the limited resources available. The services recruitment practices meet Regulations, the use of agency staff is avoided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Despite a statutory notice being issued by the Commission to the owner in July 2005 because of inadequate staffing levels, inadequate staffing levels continue to be a cause for concern. From conversation with the owner it was clear that staffing levels are assessed only on the number of service users’ in the home. He said; “ We have had four empty beds for some time so have reduced staff”. No consideration has been given to individual needs, health and safety or the size and layout of the home. Consequently this has had a negative impact on the service and service users’. Whilst I was on site I sat in the lounge from 10.15 to 11.25 the only time staff entered the lounge was to bring service users’ in who had just got up. This Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 23 meant that seven service users’ at least two of who have dementia care needs, were left unsupervised. People spoken to confirmed that staffing levels have been inadequate; “ Not enough staff. Have to wait 2 or 3 people to do the lot”. “ short at times, have to wait “. “ Not enough staff. Staff rush around. Sometimes evenings there are only two”.“ Need more staff, no time for quality time with the residents”. “ Not enough staff. No time to talk to residents and they are missing that”. Care staff hours are reduced further as they have to attend to catering duties at tea time and all laundry tasks. I was told that staffing levels would be increased from the following day. A new rota was produced however, there is little confidence from past and present evidence that adequate staffing levels will be provided consistently. It was clear from observing staff, talking to them and speaking to service users’ that the staff work hard and try to do their best within the limited resources available. They are well thought of by the service users’. Service user comments about the staff included; “ The staff are kind”. “ Staff helpful all kind”. “ Staff, oh pretty good all of them”. Staff comments included; “ I love it “, residents are happy”. “ I love the residents, all the staff get on well”. Nearly 50 of staff have achieved NVQ level 2 or above. An additional four staff are currently undertaking NVQ training. Three staff files were looked at to assess recruitment processes. All, including a very new staff members, held the required records including written references, Criminal Records Bureau disclosures and official identity which means that as far as recruitment is concerned the service users are safe. I looked at induction processes and saw that staff do receive in-house induction. However, It was unclear if this was to the required standard, the manager and could not confirm that it is. Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. Quality in this outcome area is poor. Management arrangements in the home are not effective with the owner working to his own agenda and not always informing the manager of his plans. Although it is very positive that processes are in place to gain the views of service users’ and others, the home does not have in place processes for ‘self assessment’ or the auditing of practices and systems which, leave the service users’ at risk. Health and safety hazards are not adequately acknowledged, potentially placing service users’ at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 25 The manager has been registered by the Commission and is working towards his Registered Managers Award, which is positive. However, a condition for registration was imposed when the last registration certificate was issued stating that; ‘ The registered manager must successfully complete the Registered Managers Award by April 2007 ‘. As the manager has not yet completed the award and it is the end of May 2007 this condition has not been met. By talking to the manager and the owner it appears that the working relationship is not always positive and effective. The owners’ priority at the present time as shown in the first section of this report for example, is the extension and filling beds. The manager is not always informed about the owners plans and has concerns about some decisions made such at the recent admissions, limiting lounge and garden space and is not provided with financial resources needed. An example of this is the badly stained bedroom carpet I highlighted to the owner during the inspection which according to people spoken to, has been in that state for some time. The owner told me; “I will get new flooring. It will be ordered at the same time as the flooring for the extension. It will cost more money if I order only one piece”. I reminded the owner that the needs of the service users’ come first, not the extension or money. I was shown copies of service user and other questionnaires used in the home and found it positive that regular service user meetings are held. One service user is the chairperson. This demonstrates that a forum is put in place for service user views to be heard. Although I asked for, I was not provided with any evidence to confirm the managements’ self assessment of the service or regular auditing of the home, processes and practices against regulations and the National Minimum Standards for Older People. The manager confirmed that this is not done. Further, the manager confirmed was he was not aware of any business or development plan for the home. Everyone spoken to including management, staff and service users’ confirmed that the owner does visit the home very regularly, at least twice a week, which is good as it shows that he has some interest and knowledge of its functioning. However, I did not see any Regulation 26 reports. The manager confirmed that he had never been given one of these. The manager, when I asked, confirmed that he was not aware of this Regulation. That self- assessment and auditing processes are poor, is reflected by concerns raised in this report and feedback from the various sources. A process of regular self –assessment and audit would identify non- conformance and prevent Regulators identifying these major, high risk shortfalls. I looked at four service users’ money held in safe keeping and accompanying records. The amounts of money were correct against record balances. Receipts were available to confirm transactions. I did note that records were not confirmed by two signatures which if happened ,would safeguard processes further. Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 26 Staff files viewed all had written evidence to confirm recent supervision which was structured and comprehensive. Throughout this report I have given examples of risk to service users’ caused by lack of auditing, unsafe practices and environmental issues. The garden was another example. I saw that it was covered with building materials which included, wood and stacks of bricks there had been no regard to the health and safety of the service users’. I was provided with a risk assessment for the building work dated June 2006 but this did not mention risk to service users’ or that the service users’ garden would be used as a ‘builders yard’. Although the garden was tidied somewhat before I left, it was confirmed by people spoken to that it had; “ been like that for some considerable time”. The only area left for service users was a small square outside of the back door. This area was also unsafe, as it is paved by slabs that are not level, a potential tripping hazard to service users’. The owner told me; “ We do not let service users’ go outside unless they are with a staff member”. He did not answer when I asked him; “ What if they want to go out alone without a staff member for privacy”? I randomly looked at service certificates and maintenance checks and was pleased to see the following; Fire alarm service certificate dated 16/1/07, Lift service 22/1/07. I was not provided with evidence of a five year fixed electrical wiring test. The manager confirmed he had never heard of that. There was no gas land lords safety certificate available either. Staff, including the manager have not received health and safety or risk assessment/ management training this confirmed by the lack of certificates, lack of mention to health and safety training on the staff training matrix and by the manager. This lack of training possibly contributes to the poor identification of hazards and risk management in the home. I assessed the kitchen in the presence of the manager. We both saw a number of potential hazards. The new back door had not been glazed, the gap where the glass should have been was partly covered by polystyrene allowing flies and insects through. Cupboards looked at were dirty. Drinking glasses that the manager told me were used for juice in the morning were very discoloured. One mug taken from the cupboard was stained a dark brown colour inside. Cheese taken from its original container had not been date labelled. Pepper in tubs available in the food cupboard had an expiry date of 2005. The manager told me that every other Saturday he does the cooking in the home. When I asked, he was not able to provide me with a food hygiene certificate and confirmed verbally that he had not received food hygiene training. Under the sink in the kitchen were two, five litre containers with fluid that had a caution sign attached. These were not in a locked cupboard. Neither had the kitchen door making these solutions accessible to service users’ and another potential hazard. I went out of the kitchen door accompanied by the manager. The only way to get out of the kitchen due to building work was to walk on wooden planks which were wet and slippery due to the rain. This an obvious hazard to staff Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 27 but also service users’ as there was no means to restrict access through the kitchen which could allow them to exit this door. Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 28 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 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 1 2 x x x 2 1 1 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 x 2 3 x 1 Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1) (d) Requirement The registered person must confirm in writing to the resident that the home is suitable for the purpose of meeting the resident’s needs in respect of his health and welfare. Timescale of 31/07/06 not met. 2 OP4 14(1)(a) Not provide accommodation to a 30/05/07 service user unless their needs have been assessed by a suitably trained person. Not admit new service users to the home who have needs that fall outside of the category shown on your registration certificate OP. The owner and manager were told of these requirements during the inspection. A concern letter was issued by the commission in which these issues were included. Timescale for action 30/06/07 Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 30 3 OP7 13 & 15 The registered provider must ensure that care plans are completed in sufficient detail to ensure staff can meet the needs of the residents. The care plans must be person centred and include all elements of the standards. Timescale of 30/06/06 not fully met. 30/06/07 4 OP9 13(2) 5 OP9 13(2) 6 OP9 13(2) All medicines must be held in a locked cabinet or medication trolley at all times to ensure the safety of service users who live in the home. This includes medicines that are awaiting return to the pharmacist for destruction. All medicines that are no longer required must be returned to the pharmacist for destruction and records must record this to maintain audit trail. All medicines must be fully accounted for at all times. The medicine chart must record the current drug regime as prescribed by the doctor, be dated and all medicines must be available to administer for each service user. The quantities of all medicines received and any balances carried over must be recorded to enable audits to take place to demonstrate that the medicines have been administered as prescribed. 30/06/07 30/06/07 30/06/07 7 OP9 13(2) 8 OP9 13(2) The right medicine must be 30/06/07 administered to the right service user at the right time at the right dose and records must reflect practice. A quality assurance system must 30/06/07 DS0000004321.V341481.R01.S.doc Version 5.2 Page 31 Haven House be installed to confirm to staff competence in the administration of medicines and records. 9 OP9 13(2) The medication trolley must not be left open and unattended at any time to reduce risk to service users’. The manager was told about this concern during the inspection. The registered person must consult with residents about their social interests and make arrangements for them to engage in local, social and community activities The registered person must also consult with the residents about the programme of activities arranged by or on behalf of the home. Timescale of 31/08/06 not met. 11 OP26 13 (3)16 (J & k) The registered person must ensure that the laundry room is run in a clean and orderly manner that reduces the risk of cross infection. The registered persons must ensure that all areas of the home are free from offensive odours. Timescale of 30/06/06 not met. 12 OP26 13(3) Protective clothing must be 30/06/07 made available in all high-risk areas to prevent infection risk to service users and staff. The registered persons must 30/05/07 ensure that there are sufficient numbers of suitably qualified and DS0000004321.V341481.R01.S.doc Version 5.2 Page 32 30/05/07 10 OP13 16 (2) (m & n) 01/07/07 30/07/07 13 OP27 18 (1) (a) Haven House competent staff on duty to meet the needs of the residents. Timescale of 30/06/06 not met. As this requirement had not been met a concern letter has been sent to the registered persons. Must be able to demonstrate that staff numbers at all times are adequate to meet the needs of the service users’ and be able to provide evidence of how you are assessing the number of staff required. 14 OP38 13(4) The registered person is required to ensure that the information required in compliance with the Control of Substances Hazardous to Health (COSHH) Regulations is available for all chemicals held or used at the home. Timescale of 31/07/06 not fully met. Ensure unnecessary risks to the health and safety of service users’ and so far as possible eliminated. Risk identification and risk management processes must be in place concerning all areas of risk examples being; building works, building materials, hot water pipes, tripping hazards, fire hazards and health and safety hazards within and external to the home to include safe access points. A concern letter was issued in which these requirements were included. Copies of the following valid and DS0000004321.V341481.R01.S.doc 30/06/07 15 OP38 13(4)( c) 13/06/07 16 OP38 13(4)( c) 05/07/07 Page 33 Haven House Version 5.2 current certificates must be provided to the CSCI; Five year fixed electrical wiring test. Gas landlords certificate. This is to ensure that the gas and electric wiring are safe and do not present a risk to service users’. The manager and staff should receive appropriate and suitable health and safety and risk assessment training. To equip them with the skills and knowledge to be able to identify and manage risk to prevent risk to the service users’. 17 OP38 13(4)( c) 01/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations It is recommended that the home refers to Care Homes Regulations 2001: Care Homes for Older People: National Minimum Standards 3.2 and 3.3 for detailed guidance regarding the type of information the home should be requesting from placing agencies or private referrals. 2 3 OP9 OP9 4 OP9 The purchase of a controlled drug (CD) cabinet that complies with the Misuse of Drugs ( Safe Custody) 1973 is recommended to safely store CD’s within the home. It is recommended that a system is installed to check the prescriptions prior to dispensing and to check medicine chart and medicines prior to dispensing and to check the medicine chart and medicines upon receipt against the original document. It is advised that alternative formulations of medication is sought to avoid crushing tablets and advice is sought to DS0000004321.V341481.R01.S.doc Version 5.2 Page 34 Haven House 5 6 OP9 OP9 7 8 9 OP9 OP9 OP29 ensure the best way to administer medicines if there are alternatives available. It is advised that all medicines prescribed on a “ when required” basis have supporting protocols detailing their administration. It is advised that regular risk assessments and compliance checks are undertaken and are fully documented to ensure that service users who self administer their own medication safely do so. It is strongly advised that staff receive safe handing of medication training preferably training that is accredited. It is strongly advised that where staff hand write medication records that these are checked and signed by two staff to confirm that the information is correct. It is recommended that photocopies, taken by the home of documents such as proof of identity and birth certificates, are signed and dated by the person verifying the documents. Haven House DS0000004321.V341481.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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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