Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 20/01/10 for Haven Lea Residential Care Home

Also see our care home review for Haven Lea Residential Care Home for more information

This inspection was carried out on 20th January 2010.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

All the care plans viewed had been shown to people who lived there and they had been given an oppetunity to sign that they agreed with the care to be provided.

What the care home could do better:

Medications need to have clear records in place that help staff determine if medications have been given correctly and at the correct times.

Random inspection report Care homes for older people Name: Address: Haven Lea Residential Care Home Shaw Lane Prescot Knowsley Merseyside L35 5BZ zero star poor service 23/10/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Julie Garrity Date: 2 0 0 1 2 0 1 0 Information about the care home Name of care home: Address: Haven Lea Residential Care Home Shaw Lane Prescot Knowsley Merseyside L35 5BZ 0151-430-8434 Telephone number: Fax number: Email address: Provider web address: misslbrown@hotmail.com Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : York Valley Limited care home 30 Number of places (if applicable): Under 65 Over 65 30 0 old age, not falling within any other category physical disability Conditions of registration: 0 30 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability - Code PD The maximum number of service users who can be accommodated is: 30 Date of last inspection Brief description of the care home Haven Lea is a purpose built home which provides personal care (non-nursing) to thirty older people. The service is owned by a company called York Valley ltd and is the only home for the company. Accommodation is on two floors with a passenger lift serving all floors. Havenlea has its own private garden at the rear od the building. Parking is Care Homes for Older People Page 2 of 13 2 3 1 0 2 0 0 9 Brief description of the care home availiable at the fron t of the buiding for visitors. The service in a residential arae of Prescot and is close to Whiston hospital. There are local bus routes and train station within walking distance. Information about the service is in the managers office and is availiable upon request to people wishing to view the service. Fees are charged at the local council rate. Care Homes for Older People Page 3 of 13 What we found: The reason for this random inspection was to make sure that the requirements regarding medication, made in the Statutory Requirement Notice, dated 24th November 2009, had been complied with and theservice were no longer in breach of the regulations. We also checked that you had complied with the requirements from our last visit. A Statutory Requirement Notice is a legal notice, which is sent to the provider and the manager when there has been a breach of regulations. The notice describes which regulations have been broken and what the provider must do to put right the breach. It also gives the date by which this must be done. We then follow up the notice by visiting the service to make sure that actions have been taken to meet the requirements and regulations. The requirements in this notice were made to make sure that people who lived in the services health was not at risk from poor medication practices. A pharmacist inspector together with the lead inspector carried out the visit. The visit lasted approximately eight hours over one day. During which time we looked at records regarding, staff training, care plans, medication records, assessments and the services policy and procedures. We spoke with staff, people who live in the home and their relatives. The manager was unavailable and full feedback on our findings was given to the deputy manager. At the end of the visit we took photocopies of some of the records due to the serious nature of our concerns about the handling of medicines within this service. We found several medications not signed as being given on the current medicines records (MAR). We noticed that one person received painkillers overnight on several occasion but this was not recorded on the MAR. The lack of recording this accurately placed the individual at risk of being given an overdose of the painkillers. Some medicines were not given at the correct time with regard to food and drink intake because staff had not followed the written instructions. One person was recorded as having medications that had to given with or after food at the same time as a medication that must be given 30 minutes before food. This meant that at least one of the medications could not have been given at the correct time. We found that staff had handwritten some records onto the MARs when medicines had been received from hospital. These records did not include all the warnings necessary to give these medicines safely and they had not been checked and signed by another member of staff. One person had been admitted to the service without confirmation of their medications and records were not available for two days of their medications after they moved in. We found that clear explanations had not been recorded when medicines were not given, for example, if they were refused. These issues had all been highlighted at the last two visits. We noticed that the service had put into place a second check of painkillers for at least five people. The second records stated a different time than the record on the MARs. They also indicated a two hour gap between medicines that can be given no more than four hourly. The service has not put into place accurate records. The lack of accurate records can lead to serious mistakes that can place peoples health and wellbeing at significant risk of harm. We looked at how medications were stored and noted that the medicines fridge was not Care Homes for Older People Page 4 of 13 keeping medicines within the correct temperature range (2-8C). Medicines are likely to spoil and may be dangerous to use if they are not kept correctly. We found that not all medication was kept securely. We found some medicines, including items belonging to people who no longer lived at the home, in an unlocked filing cabinet and a large quantity of medicines in open boxes waiting to be disposed of. These stocks were not recorded and could not be accounted for. We were told that old supplies of dressings had been disposed of inappropriately and no records of this had been kept. Staff spoken to were still unsure of the correct procedures for disposing of unwanted medication. Medicines, dressings and other items are likely to be misused and mishandled if they are not kept securely or disposed of safely. We carried out detailed checks of some stocks and records and found that whilst medicines supplied by the pharmacy in special blister packs were usually given correctly, medicines contained in traditional bottles and packets could not always be accounted for. We saw evidence that some medicines had been signed for, but not given, whilst others medicines could not be accounted for due to inaccurate records. We found examples of people being given medication that had not been prescribed for them or recorded on their medication administration records. Two people had daily records that showed that a cream had been applied but there was no evidence that this had been prescribed and was not recorded on the MAR as having been used. At least two people had not received their correct medication as stocks had been allowed to run out. In many cases it was not possible to tell whether or not medication had been given correctly. The health and well being of people living in the home is at serious risk of harm if medicines are not given as prescribed. We saw no improvement in the way medicines and staff competency were audited (checked). There were no robust audits and no evidence that staff had been formally observed giving and recording medicines. There was evidence that only two staff had received training in medicines since 2008 and no evidence that the manager had undertaking medicines training in order to make sure that she was aware of the safe management of medications. This meant that problems had not been found and rectified by the manager. Given the continued mistakes it was evident that some staff still need to have their competency formally assessed to make sure they have the necessary skills to handle medicines safely. We looked at how people who managed some or all of their medications were supported to do this safely. One person manages all of their own medications and a brief assessment was in place. This failed to make sure that they remained able to manage their own medications or to detail how this was supported. We also noticed that at least two other people managed some medications such as creams there was no assessments in place that supported them to do this in a manner that maintained their health and welfare. An audit had been undertaken but this had failed to recognise or action the examples of unsafe practice noticed at this visit and were not effective in protecting people from potential harm. Policies and procedures in the service were insufficient to make sure that peoples health and welfare was being supported correctly. There was no formal arrangements for homely remedies and over the counter products. We noticed that this were not being given correctly and example included a treatment for cold sores, which had been used Care Homes for Older People Page 5 of 13 but there was no evidence as to who to or when. Additionally this had been retained and could potentially have been used on another person and would not support the prevention of the spread of infection. One person frequently stayed out of the home sometimes overnight there was no information available that showed that this had been risk assessed or how the service made sure that the person had the correct medications to take. The lack of proper guidance further prevented the staff from making sure that people living in the home received their medications in a manner that supported their health and welfare needs. We looked at how the service delivered its care. Care plans were noticed at the last inspection to not be available for anyone living in the service. At this visit all but one person had care plans available. When we reviewed this plans we noticed that they were not sufficient to maintain the health and welfare of people living in the service. One persons plan had conflicting information the plan stated that the persons appetite was normal but a risk assessment and daily records stated that she was not eating or drinking well in a six day period she refused a meal on four occasions. Another two people had been assessed as having a high risk of developing pressure ulcers but there was no plan in place that informed staff of what actions they needed to take to monitor and prevent the formation of pressure ulcers. One person developed a chest infection and no plan was ever put in place to provide the appropriate support. Of the five plans we viewed one had been reviewed monthly the others not having been done in one case for over three months. Without clear and accurate guidance staff will not be able to meet peoples health and welfare needs. We looked at how peoples health and welfare needs were meet. One person had developed diarrhoea and the staff continued to give them senna during this period without taking medical advice. Additionally their care plan contained no details about this issue. This action placed their health and welfare at risk. Another person developed a sore bottom and staff applied cream from an unknown source without taking medical advice as to whether it was suitable. Additionally their care plan contained no details about this issue. The cream used can not be used with incontinence aids and the person it was used on required incontinence aids. This action placed the person at higher risk . A further individual had developed bleeding this went on for over two weeks without any evidence that it was addressed. The person was then admitted to hospital and discharged without any record as to what they were admitted for. Additionally none of this information was included in their care plan. Were peoples condition changes staff need to access appropriate medical advise and action any directions. One person was admitted to the service as an emergency. Staff did not undertake their own assessment prior to admission or receive a copy of social services assessment until two days after the person moved in. The assessment when received was three months old and as such was out of date. Staff had admitted someone to the service without knowing if they could meet their needs. When we looked at the care plan for the person we noticed that none of the risk assessments for the person or the care plan had been completed four days after they were admitted. An immediate requirement was issued to the deputy manager to make sure that a care plan was in place. This was received two days after the visit. The lack of a proper assessment and a care plans will prevent staff from making sure that they can meet individual needs. When we looked around the home we noticed that several fire doors were wedged open. This practice was noticed at the last site visit and had not been addressed. We issued an Care Homes for Older People Page 6 of 13 immediate requirement that the fire risk assessment be updated to reflect this practice. Advice was also given to the deputy manager and manager that they contact the local fire service and include their advice in staff training. The manager did not forward us a copy of the updated fire risk assessment. Without proper arrangements for the prevention of the spread of fire people living in the service are placed at risk of harm. Records in the service showed that some people needed bed rails overnight. There were no risk assessments in place to show that bedrails were suitable for the people that were using them. We discussed this at length with the deputy who was not aware of the legislation in place from the HSE in 2003. An immediate requirement was issued that appropriate risk assessments were put into place. The manager forwarded this two us over a week later. Without proper checks on bedrails people using them can be at risk of significant injury. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 16 The environment needs to be 14/01/2010 reviewed and arrangements made to prevent the spread of fire and infection. To maintain the safety of people living in the service. 2 35 A quality assurance system 26/02/2010 that regularly audits (checks) the service such as accidents, care plans, medications and environments as an example needs to be in place. Stakeholders views of the service need to be found out and used to determine what actions the service intends to take to increase the quality of its service. People who live in the home are safeguarded by a service that supports their individual needs, choices and preferences. 3 3 14 All people moving into 11/12/2009 Havenlea need to have an assessment done by suitably qulaified staff from the service before they do so. The manager and the staff need to assured that they Care Homes for Older People Page 8 of 13 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action can meet the persons individual needs before they move in. 4 7 15 All people living in the 11/12/2009 service need to have a care plan that informs staff how to meet individual needs. The plan needs to be reviewed and updated monthly. We possiable the individual for whom the care plan is written needs to be consulted and agree to the support to be provided. In order to meet individual needs in a manner of their choosing. 5 9 13 All staff who have 01/12/2009 responsibility for administering medication must have medication training and must be assessed as competent in all aspects of handling medication. To make sure that peoples health is not at risk. 6 9 13 All records about medication 01/12/2009 must be clear and accurate. To show that medication is given properly and can be accounted for. 7 9 13 All medicines must be stored 01/12/2009 safely, securely and hygienically at all times, this includes the storage of creams. Page 9 of 13 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action To make sure that people living in the home are not at risk. 8 9 13 Effective medication audits must be put into place. To make sure medication is handled safely at all times by all staff. 9 9 13 Full details of how to 01/12/2009 administer medication must be recorded, this must include risk assessments for medication which is looked after by individuals themselves, for covert administration, or when special arrangements are made so that medication can be taken outside the home. To make sure that people living in the home have their health needs protected 10 9 13 People living in the home 01/12/2009 must be given medication as prescribed at all times and special directions must be fully followed. To make sure that peoples health is not at risk. 11 9 13.2 A record must be made of any drugs that leave the home or are disposed of so that a clear audit trail is available of all medication that enters the home 01/02/2008 01/12/2009 Care Homes for Older People Page 10 of 13 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 12 29 19 All staff recruited need two 01/12/2009 verified references, CRB and POVA first before they start working in the service. Where staff have worked for a long time the service needs to review their recruitment and determine if they are fit to work in the service. In order that staff who are suitable to work in the service are safely recruited. 13 33 26 The owner of the service needs to make monthly unannounced visits that determine the views of people who live in the service, the staff and the environment. A written copy of this needs to be made available to the manager. This needs to be in place in order to recognise areas of quality and maintain a service that meets peoples needs. 01/12/2009 14 33 37 All incidents determental to the care of people living in the service need to be reported to CQC. This is to provide clear information about the ability of the service to recognise and appropriately deal with improving the qulaity of the service. 27/11/2009 Care Homes for Older People Page 11 of 13 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 13 of 13 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!