Inspection on 23/10/09 for Haven Lea Residential Care Home

This inspection was carried out on 23rd October 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Haven Lea Residential Care Home 20/01/10

Haven Lea Residential Care Home 15/01/08

Haven Lea Residential Care Home 08/03/07

Haven Lea Residential Care Home 07/10/05

Haven Lea Residential Care Home 12/05/05

Haven Lea Residential Care Home 09/09/04

Haven Lea Residential Care Home 06/05/04

Haven Lea Residential Care Home 04/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Haven Lea Residential Care Home Shaw Lane Prescot Knowsley Merseyside L35 5BZ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Julie Garrity     Date: 2 3 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 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: Name of registered provider(s): Type of registration: Number of places registered: misslbrown@hotmail.com York Valley Limited care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: 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 to thirty Older People. It is registered to provide care to service users who have physical disabilities. It is owned by a company called York Valley ltd. Accommodation is on two floors. It has its own private garden and is situated close to Whiston hospital. Public transport links are good therefore it is easy to reach. 0 30 Over 65 30 0 Care Homes for Older People Page 4 of 33 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: zero star poor 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 visit to the home started at 10.00 and finishing at 21.00. We spoke with a total of six people who live in the home, five members of staff, two relatives, the manager. and the deputy manager. The home completed a document known as an Annual Quality Assurance Assessment (AQAA). This documented is completed and sent to us by the home before we visit. The AQAA tells us what the home does well and what their plans are to increase the quality of the home. We sent surveys to people living in the home, none were returned. When we visited the home we looked at many of the records these included care records, staff records, medications, policies and procedures, menus, duty rota, staff training and activities records. We received information from the Primary Care Trust with serious concerns regrading medications. As a result a specialist pharmacy inspector was included in this visit. Care Homes for Older People Page 5 of 33 The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the home used to determine individual needs, promote independence and support them to make informed decisions in line with their choices. Care Homes for Older People Page 6 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The service has not developed any active plans that look at the quality of the support provided. The service will find it difficult to increase the quality without making sure that the manager is aware of the areas that need to be improved. Policies and procedures available to the staff team are out of date and do not reflect the correct guidance that staff need not. Other documentation such as information to people wishing to move into the home is out of date. Training for the staff is in need of further development and there is no evidence that staff members that have had training to keep them up to date. Not all the staff are fully checked before they start working in the service and this places individuals at risk. Some people moving into the home are not offered the opportunity to have an assessment before they do so. Assessments are essential in order for the manager to determine if they can meet peoples needs. Care plans that describe to staff how to meet the needs of people living in the home are not available none of the records viewed contained a plan that would describe to care staff how to meet individualised assessed needs. A lack of clear instructions to staff places people living in the home at risk of receiving incorrect care. The management of medications was unsafe. We noted that records were not always clear and staff had not given medications out correctly on several occasions. The service had received guidance from the PCT but had not actioned the points raised. The service does not always notify us of incidents that are detrimental to the health and welfare of people living in the service. The home owner has not completed a Care Homes for Older People Page 7 of 33 written record of monthly unannounced visits to review quality in the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 33 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 9 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information in the home and assessments are not sufficent to make sure that people wishing to move into Havenlea can be confident that the service can meet their individual needs. Evidence: The AQAA for the service told us that, The registered manager or senior member of staff, would carry out a Daily living and needs assessment. This is done prior to any admissions to determine service users needs, this covers 15 elements of care. Following this assessment service user are also offered to spend a day within the home so that they can be observed by the care team. We looked at five peoples assessments (a review of peoples needs), all had received the opportunity to have their needs reviewed before they moved into Havenlea. This is done in order for the staff to decide if the individuals needs can be met by the service. Care Homes for Older People Page 10 of 33 Evidence: Assessment documentation seen did include the opportunity to look at peoples social needs and food choices. In all of the assessments looked at these details were very brief and did not cover equality and diversity needs such as did they wish to manage their own medications or take into account changes in practice such as the Mental Capacity Act. The assessments did not clearly detail which people needed nursing support and which did not. Of the five records viewed two had not had an assessment from the home. The manager told us that they did not do assessments on people who came for respite but relied on the assessments from social services. This is not best practice as it is up to the management of the home to determine from a comprehensive assessment if they can meet peoples individual needs. We spoke to people living in the home about the information they received before they moved into the home. None of the six people we spoke with could recall being given any written information. This information known as a statement of purpose (what services Havenlea will provide) had not been updated but had been made available to people living in the service or their supporters. When we reviewed this information we noticed that this several sections were unclear such as an explanation for the circumstances that a person can be admitted to Havenlea, the arrangements for emergency admissions and a clear detail of room sizes and staff skills. We also looked for information known as a service users guide (how these services are to be provided). Copies of these are available to people living in the service. These were not available in formats such as large print for people who are visually impaired. Care Homes for Older People Page 11 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People health and welfare needs are placed at risk by a lack of effective management of medications and a lack of written instructions to staff. Evidence: We spoke to people living in the home. The majority told us that they were happy living in the home. Some told us that not all their needs were meet. One person with a skin condition told us that staff were not always careful when supporting them and on occasions this had cause minor injuries to their skin. We looked at care records for six people living in the service. These records were used to give information to staff about how to support people living in Havenlea. We noticed that none of the records contained care plan. This meant that staff had no written guidance on how to meet people living in the services assessed needs. The AQAA from the manager stated, All service users have their own indivdual care plans. This to ensure that all old and new staff are aware of all service users needs. We discussed with the manager and the deputy the lack of care plans availiable. The service had bought a care records system this did include a form for writing care plans. The management team had not realised that this form was the care plan and had not completed it for any of the people whose Care Homes for Older People Page 12 of 33 Evidence: care records we looked. Risk assessments that identified areas that needed further planning such as risk of falls, development of pressure ulcers and moving and handling were not always correctly completed. On at least two occasions peoples risks were identified as at risk of falling but the moving and handling assessment stated that there was no risk. As there was no care plans there was no instructions available to staff on how to reduce any risks. Other assessments identified that at least one person was at risk of developing pressure ulcers. There was no instructions available to staff on what actions too take to help prevent the development of pressure ulcers. During the visit the specialist pharmacist inspector looked at how well medicines were handled. We had received information from the Primary Care Trusts (PCT) Medicines Management Team who had found practice in the home was unsafe. We looked at how medicines were stored and found that most medication was stored safely and securely. We noticed the fridge that held medication requiring cold storage was dirty and had mould growing round the seals. This fridge could not be locked and as such the medications could not be stored safely. The room used to store medicines in was not tidy and we found some old unwanted medication from May 2009 in a bag on the floor. Other medications were found on the top of the cupboard and on the window ledge that had not been locked away. There was some old medication for people who either no longer lived in the home or who no longer needed it, stored in the cupboards, trolley and fridge. This medication had not been returned to the pharmacy for destruction. The manager had been told about how to dispose of medicines during the PCT visit. We also found that creams were stored in peoples own bedrooms but were not locked away, nor had checks had been made to show that it was safe for people to keep these medicines in their bedrooms. When we looked at information that would tell staff how to use creams we noticed that this information was not available. The lack of proper storage and instructions of these medications placed people living in the service at risk. Records about medication looked at. These records did not show that people had been given their medication correctly. Staff had changed the dates on many of the record sheets making it difficult to check exactly what medicines had been given each day. Sometimes staff signed for medication that had not been given or did not sign for medication which had been given. We found that staff had altered medication records during the visit to show that medication had been given when it had not been. When records are inaccurate it is not possible to check if all medicines are accounted for or Care Homes for Older People Page 13 of 33 Evidence: have been given as prescribed. There was no information for staff that informed them when to give medicines which were prescribed when required or as a variable dose. There was also no information recorded in care plans to show how some people liked to take their medication or what individual arrangements were made for people to take their medicines such as when they were away from the home. If staff do not have clear information to guide them people are placed at risk of being given their medication incorrectly. We also found that people living in the home were not always given their medication as prescribed. We found that some people could not be given their medication because there was none available them. Other people living in the home were not given their medication properly because staff failed to follow the special directions on the label such as take with food or take before food. One person were not given medicines as prescribed because the staff had not read the label on the bottle properly, resulting in only half the prescribed dose being given. If directions are not followed the medication may not work properly and peoples health is placed at risk. We looked at the way the home audited, checked, on how medicines were managed. The audit done in October 2009 showed that there were no shortfalls however during our inspection we clearly highlighted a number of significant shortfalls in the management of medication. Audits done by the management team were not accurate and had failed to identify areas of improvement or take appropriate action. During the visit we found that staff had moved tablets from sealed blister packs and re sealed them into different blisters. Staff had combined the same medication from different boxes or bottles into a single one. This activity is called secondary dispensing and is classed as a very high risk activity, as only people specially training in dispensing medication have the skills to do this task safely. The manager had been told that it was unacceptable to move tablets from one container to another in a written report from the PCT, but had failed to take appropriate action to prevent this unsafe practice. Some senior care staff had had recent medication training, however no staff had been tested to show that were competent at handling medication safely. The manager informed us that she not had recent medication training and was therefore not up to date in the safe management of medications. The home had had a great deal of help and guidance form the PCT medicines management team in September 2008 and September 2009. Their reports and visits Care Homes for Older People Page 14 of 33 Evidence: highlighted many areas of medicines handling which needed to be improved and advice was given to then to help them. During our visit we found that few significant changes had been made and that medication handling was unsafe and peoples health was placed at potential risk from harm. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily routine in place in Havenlea do not always meet peoples personal preferences or choices. Evidence: All people moving into the home have their nutritional needs looked at. There is no record of what their particular choices of food are. There are nutritional risk assessments but for at least one person these have not been reviewed and updated. One person returned from hospital with a significant weight lose and no referral to a dietician was made. Fortunately since their return they have not lost any further weight nor were they more closely monitored to make sure that they were not at risk. People in the home are asked on admission about some of their preferences and choices, social activities are not always looked at. The AQAA for the service told us We have ongoing entertainment going on within the home, we also have a hairdresser who comes into the home every week.. People spoken with told us that they enjoy the trips out, one person told us that trips out did not suit their needs and that they could, occasionally get very bored. we were unable to identify a social care plan records available showed what activities people had been involved in but did not show what there choices were. Care Homes for Older People Page 16 of 33 Evidence: When we observed staff during the day one person was offered a bib to wear. This is not a phrase appropriate to older people and does not maintain their dignity. Another person had an apron put on her by a member of staff who neither explained what she was doing or asked the person if they needed protective clothing. We watched a member of staff assist an individual to eat without any conversation. The person was not asked what they would like to eat nor was the food on the plate explained to them. Other people were asked what parts of the meal they would like such as potatoes. The menu did not show alternative diets such as a diabetic. Assessments for the home showed that some of the people living in the home had special diets as part of their assessed needs. Staff spoken with told us that breakfast and supper is available. This information was not available in any format to people living in the home to meet their needs. A notice board was completed detailing the meal available just before lunch but the inspector found that they were unable to read this due to poor handwriting. The menus in the service do not show a choice of food and do not provide people living in the service with the opportunity to make a choice. The staff told us that they ask people what they would like to eat and record this on a wipe clean board. They do not keep records of what peoples choices are that would help them decide on future menus. On the day of the visit people living in the service told us nobody has asked what we want today. We spoke to two people who said they would prefer to have their main meal in the evening. Havenlea has the main meal at lunch time, they commented you have to get used to it. We discussed this with the manager and deputy who said they would look at ways to meet their preferences. We discussed with staff and the manager how activities and menus were decided on. Neither the menus nor the activities were put into place taken from the choices, preferences and needs of people living in the service. There was very few records available in the service that detailed what people personal preferences and choices were. Care Homes for Older People Page 17 of 33 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. People living in the service and their families are supported to raise their concerns. Evidence: We looked at how the service investigated concerns. The AQAA from the service told us that they had received three complaints in the last 12 months and a safeguarding issue that had occurred. We looked at the three complaints and noted that these had been recorded and details of actions that were to be taken were briefly included. In one case there was no investigation but staff had discussed the issue at a meeting. There was no records shown to us about actins taken from te safeguarding complaint. A recent incident had occurred in the service that the management team were aware of. During discussion both the manager and deputy stated that they thought that this incident although minor should have been logged and addressed as a complaint. There is a copy of the complaints policy readily available to people living in the service. In discussion with people who live in the home, their relatives and staff all were confident that concerns if raised with the management would be addressed. Two members of the staff team have recently undertaken additional training in safeguarding and are putting into place a project to make sure that all staff are aware of recognising serious issues and how to manage with them. We spoke to staff working in the home the majority were aware of how to recognise serious concerns and what actions would be taken to maintain the safety of people working in the Care Homes for Older People Page 18 of 33 Evidence: service. Care Homes for Older People Page 19 of 33 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. Havenlea is presented in a warm and welcoming manner. There is failures in maintaining the safety of the people living in the service including the prevention of the spread of fire and potential infections. Evidence: We toured the service to look at the environment. There is a dining room which is large enough to accommodate everyone at mealtimes should they wish to eat in the dining room. There is a separate lounge which is well used by the people living in the service. A separate conservatory is also available at the front of the building. The AQAA from the service told us, Our establishment consists of 22 single rooms and 4 twin bedrooms, 3 out of 4 are used as single bedrooms. All bedrooms are fully furnished, but service users are given a choice if they wish to bring some of their own furniture they can do to make it homely for them home from home. We looked at peoples bedrooms with their permission. The majority contained personal items that made the bedrooms very much the persons own space. We noticed that none of the bedroom doors were locked and recently one of the people living in the home had gone into someone elses bedroom and eaten some of their personal food. People living in the service told us that they liked their bedrooms, its my space, we were offered a choice of bedrooms and chose the ones we liked and its a nice welcoming home. Several bedroom doors were wedged open. The Care Homes for Older People Page 20 of 33 Evidence: manager informed us that this was not a practice that she was happy with and that she would address this with staff. Wedging open fire doors is unsafe practice and places people living in the service at risk. We looked at bathrooms and found that two of these were damaged and stained. In particular the baths had chipped enamel and the bath hoists were stained. The washing and hand drying facilities were not suitable. In one bathroom there was no facility to wash and dry hands. In another bathroom there was no disposable towels and hard soap only. These presented a significant risk to infections being passed on. The manager told us that she was aware of the issues with the bathrooms and was waiting for these to be addressed by the owner. There was no firm date as to when these and other areas of refurbishment would be done. Care Homes for Older People Page 21 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment is not sufficient to make sure that people living in the home are fully safeguarded. Evidence: On the day of our visit we noticed that service had care staff, the manager a cook and a cleaner available for seventeen people. People living in the service told us that there is plenty of staff, that the staff are really nice and its a nice place to live. Staff told us that they thought that they had plenty of staff available and that they did not have to rush people living in the home. We looked at the staff files to see how staff were recruited. Of the five staff files we looked at none had full checks in place. The manager said that many of the staff stay for so long that they were recruited under a previous manager. Although this was reflected the records there was no evidence that the service had assessed the staff to make sure that they were fit to work in the service given that there was checks such as police checks and references not available. We looked at the recruitment of the most recent member of staff. We noticed that they did not have two references and the reference that was available was a personal reference and not from a previous employed. Gaps in the working history and issues with the police check had not bee explored. Staff working within the service need to be fully checked in order to determine that they are suitable to work with people living in the home. Care Homes for Older People Page 22 of 33 Evidence: We asked to see the training of the staff are told that there was a matrix (a checklist to show training), this was not shown to us during the visit. We looked at the staff files and could not locate records for all staff that they had received an induction. The AQAA from the service told us that they intended to complete national vocational training (NVQ, a training programme specific to care staff) for the majority of staff and that currently there was twenty six staff employed by Havenlea. Of the twenty six staff employed the AQAA stated that twenty had a NVQ level two or above, three staff had been trained in nutritional assessment, seventeen staff had food hygiene and eighteen staff had received training in the prevention of the spread of infection. We were unable to evidence this from our visit, certificates were not always available to confirm this. At least one member of staff had not received training in safeguarding and evidence was not available that confirmed that all staff were up to date in moving and handling. We looked at training specific to the needs of people living in the service such as diabetes, we were told by staff that they had not received training in this area. The AQAA for the service told us that all staff receive an induction, we were unable to locate records in the home that showed that staff had received an induction in line with the assessed needs of people living in Havenlea. Care Homes for Older People Page 23 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The qulaity of the service has not been maintained. Significant araes such as medications, staff recruitment and policies and procedures are not robust enough to maintain the safety of people living in the home. Evidence: The manager is registered with CQC. People living in the service, staff and relatives expressed confidence in her a told us that they found her very supportive. The manager does not have up to date training in medications and needs this in order to effectively support the staff. There is a deputy in post who undertakes a number of activities. The deputy and manager communicate well with each other in order to provide a good supportive team. The manager told us that as the home is not part of a group she finds it occasionally difficult to keep up to date. She is part of a local group designed for managers and finds this a supportive group to work with. The manager submitted an AQAA to us. When we looked at this there was very few plans on what areas that they wished to improve and some areas such as staff Care Homes for Older People Page 24 of 33 Evidence: recruitment were not reflective of what we found at our visit. The AQAAs plans for improvement in management was To work alongside any outside agencies, to ensure any changes are done in recommended timescale. This was not specific and gave us no plan as to how the service was to maintain or improve its service. We asked for copies of the monthly unannounced visit from the homeowners none were available as part of checking and maintaining the quality of the service the provider needs to make monthly unannounced visits. We looked at the notifications that the service sent to us the AQAA told us that the service has had 14 incidents that were notifiable to us including emergency admissions to hospital and medication issues. We were informed about eight of these incidents as such the service has not notified us of all incidents within the service. The manager discussed with us how they manage peoples funds. They hold small amounts of money only. There are clear records in place regarding this. When the person has more funds the service feels comfortable to hold the funds are given to a relative to put in a bank account. There is no written permission with the individual or evidence that this is in accordance with their wishes. We looked at policies and procedures in the service as noted that these are all dated over three years ago. The manager told us that they were in the process of reviewing these policies in order to bring them up to date. The service does do audits on some areas to increase quality this includes medications. The audits for medications had not identified a number issues and were not effective in recognising and increasing quality. There was no written evidence that any other audits were in place. We looked at the accident records in the service there was no evidence that these had been regularly audited. On more than two occasions injuries had occurred to people by wheelchair use. There was no evidence that this had been recognised and action taken to prevent a re-occurrence. As part of the quality role the home owner needs to make unannounced monthly visits to the service. We asked to see the records of these visits but none were available. The people living in the service told us that staff were very kind and that they liked the home. We asked to see minutes of meetings with people who live in the service none were provided to us. There were no copies of surveys made available to us that are sent to people living in the service from the home that helps them recognise and increase the quality of the service. Care Homes for Older People Page 25 of 33 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 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 Care Homes for Older People Page 26 of 33 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 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. 2 16 The environment needs to be reviewed and arrangements made to prevent the spread of fire and infection. To maintain the safety of people living in the service. 14/01/2010 Care Homes for Older People Page 27 of 33 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 3 14 Each person living in the 25/12/2009 service needs to have a care plan that instructions staff on how to meet individuals assessed needs. Without good care plans staff will not provide care that meets peoples individual needs in a manner that they have agreed too. 4 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 can meet the persons individual needs before they move in. 5 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 wriiten needs to be consulted and agree to the support to be provided. In order to meet individual needs in a manner of their choosing. Care Homes for Older People Page 28 of 33 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 6 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 7 9 13 Effective medication audits must be put into place. To make sure medication is handled safely at all times by all staff. 01/12/2009 8 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. 9 9 13 Secondary dispensing must cease. To make sure that peoples health is not at risk. 12/11/2009 Care Homes for Older People Page 29 of 33 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 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 All records about medication 01/12/2009 must be clear and accurate. To show that medication is given properly and can be accounted for. 12 9 13 All medicines must be stored 01/12/2009 safely, securely and hygienically at all times, this includes the storage of creams. To make sure that people living in the home are not at risk. 13 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. Care Homes for Older People Page 30 of 33 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 In order that staff who are suitable to work in the service are safely recruited. 14 33 26 The owner of the service 01/12/2009 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. 15 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. 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 27/11/2009 1 1 Information in the service including the statement of Page 31 of 33 Care Homes for Older People 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 purpose and service users guide needs to be updated, include the necessary information detailed in schedule 1 of the Care Homes Regulations 2001. It also needs to be in formats that meet peoples assessed equality and diversity needs. 2 12 The service needs to review its menus and arrangements for meals in order to make sure that they meet peoples individual choices and preferences. Bathrooms need to be repaired and refurbished to prevent the spread of infection. Training for staff needs to reviewed and actions put into place to make sure that all staff have up to date mandatory training and up to date training in the assessed needs of people living in the service. A clear record needs to be kept of staff induction including what the induction covered over the six week induction period. Policies and procedures need to be reviewed and updated in order to give staff clear guidance. 3 4 26 30 5 30 6 33 Care Homes for Older People Page 32 of 33 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. 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