CARE HOMES FOR OLDER PEOPLE
Haven Lodge Haven Lodge 54 Terrace Road Plaistow London E13 0PB Lead Inspector
Seka Graovac Unannounced Inspection 10:20 18 November 2005
th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Haven Lodge Address Haven Lodge 54 Terrace Road Plaistow London E13 0PB 020 8472 3032 020 8470 8959 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Pridegold Ltd Dhunraz Ramjeawon Care Home 15 Category(ies) of Dementia - over 65 years of age (15) registration, with number of places Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 27th July 2005 Brief Description of the Service: Haven Lodge is a registered care home for older people, including those who suffer from dementia. The home provides both respite and permanent care. The home has thirteen single and one double room. The building is located in a quiet residential area in Plaistow, close to public transport and other amenities. Car parking is unrestricted on the road. The proprietors are Pridegold Ltd. Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and lasted approximately three and a half hours. The main aims of this inspection were to check the home’s compliance with the requirement that had been made at the previous inspection and also to assess the home’s performance against the key National Minimum Standards that had not been inspected on the previous occasion. The inspector exchanged greetings with all service users and had more indepth conversations with five of them. She individually interviewed one staff member and spent some time in the office talking with the Responsible Individual and the Registered Manager. The following records were examined: service users’ individual files, duty roster, complaints procedure and log, protection of vulnerable adults procedure, food related records and fire-safety-log. The inspector also conducted a partial tour of the home. She was accompanied by a staff member or a service user when visiting this persons’ bedroom. What the service does well: What has improved since the last inspection? What they could do better:
The inspector was concerned that the outstanding requirement from the previous inspection had not been successfully actioned. On this occasion, also fourteen new breaches of regulations were identified pointing out that the quality of service provision had significantly worsened
Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 6 since the previous inspection. The Registered Persons suggested that this might have been contributed to by the home’s difficulties in successfully recruiting senior staff. Find the list of requirements that the home must do within the targets set in this report. The Registered Persons must ensure that each service user has an individual care plan agreed that identifies all the care and support needs of that individual and how they are going to be met by the home. The correct information must be available to service users on the information boards so as to aid reality orientation rather then spread confusion. Service users must be given opportunities and be supported to engage in the activities outside of the home. All food related records, such as menus must be kept as required. All parts of the kitchen (including the hood-extractor above the cooker) must be kept clean and the records must be available to confirm that. The appropriate measures must be put in place to minimise the identified risks connected with hot food being carried through the corridors. The Registered Persons must ensure that all complaints are recorded and also all the actions taken to resolve them. There must be an appropriate procedure on Protection of Vulnerable Adults available so that all staff are aware of the home’s obligation to refer all protection issues to Local Authority and this must be fully implemented. All areas of the home (including the garden shed) must be risk assessed and the appropriate control measures must be put in place in order to minimise the risks. The garden shed must be kept locked if used as storage facilities. Registered Persons must ensure that a screen is available in shared bedrooms. The appropriate waste management arrangements must be put in place. The incontinence waste must be kept locked while awaiting collection. Correct duty roster records must be kept at all times. There must be a training plan for the home that is based on the appraisal of the individual staff training needs. Service users’ and other stakeholders’ satisfaction survey must be carried out and results must be made available. Gas appliances must be tested annually and the records must be available to confirm that. The inspector recommended that the service users and their families are encouraged to personalise the service users’ bedrooms so as to enhance feelings of one’s individuality. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 0. Not inspected on this occasion. EVIDENCE: The key standard was assessed as met at the previous inspection. Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8. The service users’ health needs were met. They were satisfied with the care received, but the care-planning system was inadequate. EVIDENCE: Although some service users told the inspector that they suffered from depression or had to live with physical pain, they looked well and were smiling while talking with the inspector. The inspector was shown summary action plans for each service user that the Registered Manager was in process of reviewing. However, when the inspector asked to see a full care plan for one of the service users that had been living in the home for a year, the individual care plan was not available. The other care plans that the inspector saw were not comprehensive and did not cover emotional and social care and support needs. (See more information under the next heading: Daily Life and Social Activities.) Each service user must have an individual care plan agreed that identifies all the care and support needs of that individual and how they are going to be met by the home.
Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 10 The examined service users’ files contained evidence of good liaison between the home and primary health services. Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 15. Care planning that encompasses daily life and social activities (including external ones) must be improved. Food records were also unsatisfactory. EVIDENCE: The service users were generally satisfied living in the home. They were comfortable watching TV in the main lounge or reading and chatting with each other in the conservatory when the inspector visited. Their friendship and care for each other were evident. The inspector was concerned to see that the activities board in the conservatory was dated 03rd of September and described weather as being hot, 25 degrees Celsius, on a cold November’s day with freezing temperature. Some of service users have been diagnosed with dementia and the information provided on the board was definitely unhelpful. Further more, the information board in the dining room was also out of date (2 days) and was showing meatballs for breakfast! The Registered Persons must ensure that correct information is available to service users on the information boards so as to aid reality orientation rather then spread confusion. An activities daily plan was displayed and the inspector was informed that an activities co-ordinator had been appointed since the previous inspection. The
Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 12 service users confirmed that some activities were organised but also expressed their wish to go out more often. One service user was very pleased that she went out and bought herself some clothes (including a gipsy-style skirt for a coming X-mas party). She told the inspector that it was her first “outside” shopping in 18 months. Some service users commented that in the other care homes that had previously lived in they were able to use a mini-bus and go out. One person said that she “heard that there was a nice park over there, but we never go out”. The Registered Person confirmed that no group outings have been organised for service users and agreed to look into it. Other thing that concerned the inspector was that family contacts, social care needs and support needed to manage finances did not form part of the care planning process, and no written information was available in regards to it. This was discussed with the Registered Persons and the requirement was made regarding care planning process in the home. A minister of religion (Eucharistic) visited the home on the day of the inspection. The service users told the inspector that another “lady-minister” comes on Sundays. Some service users were escorted to church. Again, the service users’ spiritual needs were not identified in their care plans. One service user was Hindu. The Responsible Individual was able to converse with her in her mother tongue (Tamil language). She was also able to converse in English. Service users had varying opinions about food in the home and were aware that people had different tastes and told the inspector that “it is difficult to please everybody”. One person stated that the home used “too much frozen food”. However, on the day of the inspection (Friday), people were happy to have fish and chips. The examined food related records contained gaps, i.e.: no menu records between 25th of October 2005 and 07th of November 2005. The extractor hood above the cooker appeared greasy. The cook stated that it was cleaned on a weekly basis. However, the last cleaning record available for inspection was dated 15th of June 2004! Examined fridge and freezer records were satisfactory. The Registered Persons must ensure that all food related records are kept as required. This included cleaning records. The previously made health and safety requirement regarding hot food being carried by staff through the corridor was not resolved. The existing related risk assessment did not list all appropriate control measures in place while the management was looking into purchasing a food-trolley. The related requirement was repeated. Some service users also told the inspector that hot food was sometimes served not hot enough, especially potatoes. Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Service users were not safeguarded by the home’s procedures on dealing with complaints and protection issues. EVIDENCE: The previous inspection report identified that the home was dealing with a complaint that was also a protection issue. The Registered Manager told the inspector that the complaint had been resolved following an investigation by the home. However, the complaint-log was blank and no related records were available for the inspection. The Manager also stated that a relevant Social Worker was informed but no records were available to confirm and give further details. The complaint was not referred to the appropriate protection Department of Social Services. The viewed Protection of Vulnerable Adults Procedure was not clear regarding protection issues having to be referred to Local Authority. The Manager stated that staff watched a training video regarding protection of vulnerable adults. Requirements were made regarding the home’s dealing with complaints and protection issues. Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 24 and 26. The home’s major improvements since the previous inspection were regarding the environment. However, some issues were identified regarding shared bedrooms, waste management and safety. EVIDENCE: The inspector was informed that all interior of the building had been repainted since the previous inspection. The flooring in the dining room had been newly laid and new chairs had been purchased. The blinds in the conservatory had been fixed. New security lighting had been put in place outside of the building. The service users seemed comfortable in the home when the inspector visited. The inspector also saw some bedrooms that were well maintained. Some bedrooms were personalised, but the inspector noted that one lady who was sharing the room did not have any pictures, artefacts or memorabilia related to her identity. The screen that might provide some feeling of privacy in shared room was not available and a requirement was made relating to this. The home was clean apart from already mentioned extractor in the kitchen.
Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 15 The Commission for Social Care Inspection was notified by a member of public that the home’s management of waste was not satisfactory. On the day of the inspection, the yellow bin in the front of the house, containing incontinent pads, classified as potentially infectious waste, was not locked. The related requirement was made. The garden shed was used for storage purposes. On the day of the inspection, it was found unlocked thus creating potential risks for service users. . The related risk assessments were not available. The Registered Persons must ensure that all areas of the environment are risk assessed (including garden shed) and that the appropriate controls are put in place. The garden shed must be kept locked if used as a storage. Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30. Staff had good professional relationship with service users, but the home must keep correct roster records and plan staff training better. EVIDENCE: In their conversations with the inspector, the service users described the staff as: “very nice”, “lovely people”, “always helpful”… There were two care staff on duty and a cook at the time of the inspection. The Responsible Individual and the Registered Manager were also available in the building. The staffing levels seemed appropriate. However, the inspector noted that a duty roster for that and the previous day did not correspond to actual staff that worked. The Manager explained that this was due to one of the cooks not turning up for work without letting anybody know. The Registered Persons must ensure that correct duty roster records are kept at all times. Although the individual staff training records were available for inspection, the training plan for the home was not. The Registered Manager stated that he left it at his personal home as he was working on it. The requirement was made in respect to that. The inspector was told that out of eleven staff five had achieved a National Vocational Qualification in care and more staff were working towards it. Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 and 38. The home was not always run in the best interest of service users. Fifteen breaches of Care Homes Regulations were identified on this inspection. EVIDENCE: The Responsible Individual took keen interest in the running of the home and often visited. His monthly reports were sent to the Commission for Social Care Inspection on a regular basis. However, the inspector was informed that the management is yet to conduct a survey of the service users’, relatives’ and other stakeholders’ satisfaction with the service. The related requirement was made. The Registered Manager stated that the service users and relatives meetings were held every two months. The inspector checked the contents of the safe and found that the records were appropriately kept. This standard was assessed as partly met as the
Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 18 home did not include assistance with the management of finances needed in its care planning system. The inspector viewed the home’s fire-safety log that indicated that the appropriate checks were carried out as required. There were 3 fire-drills in the year preceding the inspection. The gas-certificate shown to the inspector was out of date (June 2004) and other issues with incomplete risk assessments have been identified earlier in this report. The requirement was made regarding regular testing of gas appliances. Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 X X 2 2 x 2 STAFFING Standard No Score 27 2 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 2 X X 2 Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The Registered Persons must ensure that each service user has an individual care plan agreed that identifies all the care and support needs of that individual and how they are going to be met by the home. The Registered Persons must ensure that correct information is available on the information boards so to aid reality orientation rather then spread confusion. The Registered Persons must ensure that service users are given opportunities and supported to engage in the activities outside of the home. The Registered Persons must ensure that all food related records, such as menus are kept as required. The Registered Persons must ensure that all parts of the kitchen (including the hoodextractor above the cooker) are kept clean and that the records are available to confirm that. The Registered Persons must
DS0000028357.V259015.R01.S.doc Timescale for action 31/01/06 2 OP12 12 30/11/05 3 OP12 16 31/12/05 4 OP15 16 31/12/05 5 OP15 16 31/12/05 6 OP15 16 31/12/05
Page 21 Haven Lodge Version 5.0 7 OP16 22 8 OP18 13 9 OP20 13 10 11 OP23 OP26 23 16 12 13 OP27 OP30 17 18 14 OP33 24 ensure that all appropriate measures are put in place to minimise the identified risks connected with hot food being carried through the corridors. The previously set target expired on 27th October 2005. The Registered Persons must ensure that all complaints are recorded and also all the actions taken to resolve them. The Registered Persons must ensure that the home’s procedure on Protection of Vulnerable Adults is amended so that it clearly stated the home’s obligation to refer all protection issues to Local Authority and this procedure must be fully implemented at all times. The Registered Persons must ensure that all areas of the home (including the garden shed) are risk assessed and that the appropriate control measures are put in place in order to minimise the risks. The garden shed must be kept locked if used as storage facilities. The Registered Persons must ensure that a screen is available in shared bedrooms. The Registered Persons must ensure that the appropriate waste management arrangements are put in place. The incontinence waste must be kept locked while awaiting collection. The Registered Persons must ensure that correct duty roster records are kept at all times. The Registered Persons must ensure that there is a training plan for the home that is based on the appraisal of the individual staff training needs. The Registered Persons must
DS0000028357.V259015.R01.S.doc 30/11/05 30/11/05 31/12/05 30/11/05 30/11/05 30/11/05 28/02/05 28/02/05
Page 22 Haven Lodge Version 5.0 15 OP38 23 ensure that a satisfaction survey is carried out and results are made available. The Registered Persons must ensure that gas appliances are tested annually and that records are available to confirm that. 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP24 Good Practice Recommendations The inspector recommended that the service users and their families are encouraged to personalise the service users’ bedrooms so as to enhance feelings of one’s individuality. Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Haven Lodge DS0000028357.V259015.R01.S.doc Version 5.0 Page 24 - 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!
