Inspection on 18/11/08 for Haven House (Knaphill)

This inspection was carried out on 18th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Haven House (Knaphill) 06/11/07

Haven House (Knaphill) 10/01/07

Haven House (Knaphill) 15/12/05

Haven House (Knaphill) 04/07/05

Haven House (Knaphill) 11/11/04

Haven House (Knaphill) 15/06/04

Haven House (Knaphill) 08/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Haven House (Knaphill) Haven House Limecroft Road Knaphill Surrey GU21 2TH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kenneth Dunn     Date: 1 8 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Haven House (Knaphill) Limecroft Road Haven House Knaphill Surrey GU21 2TH 01483489197 01483489337 philip.stow@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Mr Kreshna Kumar Poonyth,Mrs Elizabeth Mary Poonyth The registered provider is responsible for running the service care home 19 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Of the 19 service users accommodated all 19 may fall within the category of either MD or MD(E). The age range of service users will be: 50 years and over Date of last inspection Brief description of the care home Haven House is a large detached property set within its own grounds. The home is within walking distance of local facilities. Accommodation is provided for up to nineteen adults and is based on two floors. Two people share one double sized room. The communal areas are spacious and consist of a dining room, main lounge, a smaller lounge and a large kitchen, which is accessible to residents. There is a conservatory and large garden, which has a summerhouse and is accessible to all the residents, Care Homes for Older People Page 4 of 28 Over 65 19 19 Brief description of the care home particularly residents who smoke. The manager stated that the weekly fees for the home range from #375 to #500. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. The Commission for Social Care Inspection (CSCI) undertook an unannounced site visit on the 18th November 2008 using the Inspecting for Better Lives (IBL) process. Regulation Inspectors Mr Kenneth Dunn undertook the site visit. The registered manager was present during the site visit. People living at the home prefer to be known as residents, therefore this term of reference is used throughout his report. The inspection process included a tour of the premises, direct observation of practise and sampling of residents care plans and risk assessments. Other documents sampled Care Homes for Older People Page 6 of 28 included the menu, records of medication and health an safety records. The inspectors had discussions with the manager and staff. The Annual Quality Assurance Assessment (AQAA) completed by the manager of the care home has been used as a source of evidence in this report. What the care home does well: What has improved since the last inspection? What they could do better: The registered manager must ensure that risk assessments are appropriately undertaken, reviewed regularly and appropriately stored. The registered manager must ensure that medication is securely stored. The registered manger must ensure that the health and safety of the people who live at the home is not impeded by failure to install radiator covers throughout the home. In addition window restrictors must be fitted to all areas in the home and risk assessed. The service partially met a requirement from the previous inspection report 06/11/2007 requiring all radiators throughout the home be appropriately covered. The registered manager must ensure that all mandatory training is offered and undertaken by staff working at Haven House. The registered manager must ensure that the health and safety of the people who live at the service are not impeded by a failure to undertake appropriate environmental and individual risk assessments. The registered manger should ensure that all policies and procedures are fully reviewed Care Homes for Older People Page 8 of 28 and are representative of the service and the people who use the service. The policies and procedures should be based upon appropriate National Minimum Standards for the predominate age range of the residents. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their relatives have the sufficient information to enable them to choose a home, which will meet their needs. The residents are safeguarded by the in depth pre admissions assessments undertaken by the home. Evidence: The service has a statement of purpose, which is informative and detailed. The information the document contained should enable prospective residents with sufficient evidence about the home and the service it provided to make an informed decision as to the suitability of Haven House in respect to their individual needs. The contact details however of external agencies was found to be out of date and therefore it is recommended was made. It was stated that all people that are admitted into the home have a pre-admission assessment. A random sample of five files provided evidence that pre admissions Care Homes for Older People Page 11 of 28 Evidence: assessments are fully completed and detailed. The documents sampled were clearly developed in conjunction with the service, external health professionals and the resident. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at the service benefit from comprehensive care plans and detailed risk assessments in place, that ensure their needs are met. Evidence: As part of this site visit five care files were sampled for the purpose of case tracking. These provided evidence that care plans and risk assessments had been completed, and wherever possible the residents have signed them. The manager stated that the residents are engaged where possible in the design of their care plans. The care plans are developed to ensure that the lifestyle and quality of life expectations of each individual is fully discussed and fully recorded. The care plans sampled included information in regard to physical health, personal care, social skills and leisure. The care plans provided evidence that the service places great importance in supporting the residents to take control of their own lives with minimal intrusion by staff. The sampled demonstrated that annual reviews had been undertaken by the service, with additional monthly reviews between residents and their key workers. Care Homes for Older People Page 13 of 28 Evidence: During discussions with a random group of residents it was confirmed that they were aware of their care plans and that they where included in the revision of these plans. One resident stated that he was asked what he would like to do and supported to make decisions about his life including activities, leisure and meals. The manager stated that some residents require support when making decisions, and risk assessments for certain activities are in place. Risk assessments were evidenced in the care plans sampled, and had been reviewed on a regular basis. However the sample demonstrated that there was still a need for the manager to expand the risk assessments to ensure that appropriate documentation is in place to safeguard the residents. In addition a percentage of the assessments sampled had not been reviewed for some considerable time and therefore the information they contained may no longer be accurate. The arrangements in place to meet the health care needs of the residents are satisfactory. All the residents are registered with a local GP. The Community Psychiatric Nurse (CPN) visits the home regularly. The home has medication policy in place and all staff who administer medication are familiar with this policy. The medication recording charts (MAR) were seen and are well maintained. The systems in place for the safe storage of medication was discussed with the manager during the site visit. The service stored all medication centrally in a locked dispensary. However once inside the dispensary room the individual wooden cabinets where the medication was being held were not locked likewise there was no locks on the large window within the room which could be a potential area of concern. During the site visit residents were treated with dignity and respect. Staff were observed to interact with residents in a caring and professional manner. In discussion with the manager/staff and a review of staff training records it was clearly demonstrated that no diversity awareness training has been undertaken by the staff group. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the service are encouraged by staff to participate in a range of appropriate activities both within the home and the local community. A healthy and balanced diet is provided for residents. Evidence: The manager stated that the residents are encouraged and supported by staff to be as independent as they are able. The residents participate is a verity of activities including social clubs, day centres, shopping, restaurants and one resident enjoys the social interaction with placing a small bet at his local bookmakers. Since the previous site visit by the CSCI one resident of Haven House celebrated their 100th birthday, which was celebrated by the home with a large party in their honour. The manager stated that the party include not only friends and relatives of the person but people from the local community and the Mayor of Woking. During discussions residents informed the Inspector they enjoy the activities they do both in the home and at the day centres, and they can choose whether or not to partake in them. The deputy manager stated that the residents are enabled to make choices in regard to activities, and are supported as and when required. A random of sample of documentation demonstrated that clear records of the activities undertaken by residents are Care Homes for Older People Page 15 of 28 Evidence: maintained. There was clear evidence contained within the residents files that staff support individuals to maintain contact with their families and friends, and that visitors are always welcomed at the home. The manager stated that residents are encouraged and supported to make and maintain appropriate personal relationships, with only minimal and appropriate staff support. During the site visit residents were observed to have access to all communal parts of the home, which includes the lounge, kitchen/dining area, and a large garden. A member of staff stated that they promote residents privacy and dignity through treating them as individuals, calling them by their preferred names, promoting their independence and knocking on bedroom doors. This was confirmed during discussions with residents and observations during the site visit. Menus were sampled and seen to be varied and well-balanced. The lunchtime meal was taking place during the visit and the food was presented in an appetising manner. During discussions staff and residents stated that the food is always good and balanced with meat and fresh vegetables. Food was found to be appropriately stored in the kitchen area, and records of fridge/freezer and cooking temperatures were evidenced. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints process is satisfactory, the policies and procedures are readily available to staff, service users and or their representatives. The arrangements for the protection of service users are well developed all staff have now completed training in safeguarding adults to ensure the welfare of service users. Evidence: The home has a complaints and compliments folder. There had been no records of any complaints being received at the since the last inspection. The manager stated that in the event of a complaint being made he or his deputy would respond to it on an individual basis. A resident commented that if they had a concern or a complaint, they felt that they could easily and confidently go to the manager or the staff and that it would be satisfactorily dealt with. There have been no vulnerable adult issues since the last inspection in November 2007. The home uses the Surrey Multi Agency Procedures. It was noted however that the contact details contained within the complaints policy was out of date and therefore a requirement was made to ensure that the residents have access to accurate information. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises were generally satisfactory the residents live in a well maintained and comfortable environment. The residents have access to spacious and comfortable communal facilities. The bedrooms are well furnished and appointed. Heating and lighting is satisfactory. The arrangements for control of infection were good Evidence: On the day of the inspection the home was clean nicely presented and well maintained with a good standard of decoration. The grounds were private secure attractive and accessible to the residents. The Communal lounge was large spacious airy and relatively well furnished. As part of the site visit a random selection of bedrooms were reviewed. The bedrooms were on the whole nicely decorated and personalised with adequate heating and ventilation. However the bedrooms on the first floor have still not had radiator covers fitted as required by a previous CSCI inspection completion date for this was set at 06.12. 2007. Therefore this requirement is only partially met. In another bedroom the bed had collapsed. The manager tested the bed and agreed that the frame was broken and that it would be replaced. A review of the daily records however demonstrated that this had not been reported by staff when the bed had been made up on the morning of the site visit. Care Homes for Older People Page 18 of 28 Evidence: The home had policies and procedures in place dealing with infection control. Observations confirmed staff practised infection control measures and used gloves and washed their hands regularly. One resident stated the home is very clean and tidy and its a pleasant place to have to live in. Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are supported by sufficient staffing levels to enable them to participates effectively within the home and in the community. Evidence: The staff rotas reflected that the residents are supported by the effective allocation of staff throughout the day and night. There is a limited amount of ancillary support for the home, and the catering is managed completely by staff with assistance from the residents. The staff spoken to had a good understanding of the residents needs, and their care plans. They also had a good understanding of their roles and responsibilities. The home has a recruitment procedure in place. This is designed to protects the residents living in the home it is however recommended that the registered manager reviews the policy to ensure that it is fully compliant to current employment law. A selection of three staff files were randomly sampled as part of the site visit. These are well maintained and included all the required documents required for employment legislation, including two written references, an employment history, and a CRB (Criminal Records Bureau) disclosure number. The review of the staff demonstrated that there are gaps within the mandatory training required to be undertaken by all staff employed in a care home. During Care Homes for Older People Page 20 of 28 Evidence: discussions with registered manager and the staff on duty it was apparent that there was confusion as to what training was appropriate. Staff had not received training in manual handling or in privacy and dignity. The records provided evidence that staff training updates were also out of date. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The day-to-day management of the home is generally good. Systems are in place to undertake quality assurance ensuring the home is run in the best interest of residents. The policies and procedures at the home have had some updating and reviews. The arrangements for safe working practises need to improve to promote the safety of residents and staff. Evidence: The manager has introduced a quality monitoring system. The quality monitoring reviews all areas of the home bedrooms, communal areas, kitchen and the food provided. The manager stated that the residents are asked to participate in the quality monitoring with staff to ensure that the home is meeting their needs and expectations. A part of this site visit the policies and procedures were randomly sampled. The documents have clearly been reviewed and updated by the registered manager. Care Homes for Older People Page 22 of 28 Evidence: However in areas the policies still refereed to the previous manager as a contact and on other policies there was incorrect contact details of external agencies. In addition the policies made no reference to the National Minimum Standards for Older People. A good practise recommendation was made to ensure that the policies and procedures are fully representative of the service and the residents. The service has a health and safety policy and staff have all had training in health and safety, fire safety, first aid, food hygiene and infection control. However gaps in mandatory staff training were identified during the site visit manual handling and privacy and dignity training had not been offered to staff. The training files also demonstrated that some staff training was out of date and required to be updated. The home has not fitted window opening restrictor to the bedrooms on the ground floor; this was discussed with the manager during the site visit. The manger should ensure the safety of the residents and complete individual risk assessments on all residents currently living on the ground floor. Care Homes for Older People Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 The registered manager must ensure that risk assessments are appropriately undertaken, reviewed regularly and appropriately stored. To ensure the residents and the community are protected and safeguarded. 05/01/2009 2 9 13 The registered manager 05/01/2010 must ensure that medication is securely stored. To safeguard the service and to protect the medication. 3 19 23 The registered manger must 05/01/2009 ensure that the health and safety of the people who live at the home is not impeded by failure to install radiator covers and window restrictors to all areas in the home. Care Homes for Older People Page 25 of 28 To ensure that unnecessary risks to the health and safety of the residents are eliminated. 4 30 18 The registered manager must ensure that all mandatory training is offered and undertaken by staff working at Haven House. The ensure that the people who live at the service are supported by a staff group that is effectively trained to met their individual and group needs. 5 38 13 The registered manager 13/01/2009 must ensure that the health and safety of the people who live at the service are not impeded by a failure to undertake appropriate environmental and individual risk assessments. To ensure that the health and welfare of the people who live at the service is being effectively protected and promoted. 05/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 1 29 The registered manager should ensure that the statement of purpose is current and reflective of the service provided. he registered manager should make regular reviews of the recruitment policy to ensure that they are fully compliant to current employment law. Care Homes for Older People Page 26 of 28 3 37 The registered manger should ensure that all policies and procedures are fully reviewed and representative of the service and the people who use the service. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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