Inspection on 24/01/06 for Haven Lodge Nursing Home

This inspection was carried out on 24th January 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Haven Lodge Nursing Home 05/07/07

Haven Lodge Nursing Home 07/08/06

Haven Lodge Nursing Home 27/06/05

Haven Lodge Nursing Home 07/12/04

Haven Lodge Nursing Home 16/06/04

Haven Lodge Nursing Home 16/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Haven Lodge Nursing Home Reckitts Close Holland Road Clacton on Sea Essex CO15 6PG Lead Inspector Ray Finney Unannounced Inspection 25th January 2006 09:00 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 Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 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 Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Haven Lodge Nursing Home Address Reckitts Close Holland Road Clacton on Sea Essex CO15 6PG 01255 435777 01255 475680 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) Care UK Community Partnerships Limited Mrs Pauline Teresa Goh Care Home 50 Category(ies) of Dementia (24), Dementia - over 65 years of age registration, with number (24), Physical disability (26), Physical disability of places over 65 years of age (26), Terminally ill (3) Haven Lodge Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. Persons of either sex, aged 60 years and over, who require nursing care by reason of a physical illness (not to exceed 26 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 26 persons) Persons of either sex, aged 60 years and over, who require nursing care by reason of dementia (not to exceed 24 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of dementia (not to exceed 24 persons) Persons of either sex, aged 55 years and over, who require general palliative care (not to exceed 3 persons) One person, under the age of 60 years, who requires care by reason of dementia, whose name was made known to the Commission in April 2003 The total number of service users accommodated in the home must not exceed 50 persons 27th June 2005 Date of last inspection Brief Description of the Service: Haven Lodge is a purpose built, two-storey nursing home set in its own grounds. It provides care for up to 50 service users. The home is divided into two distinct units. Lanemile Ltd owns Haven Lodge and is part of the national company Care UK. The home is situated in a quiet residential cul-de-sac, approximately a mile and a half from Clacton town centre. The local bus services pass at the end of the drive and the railway station is half a mile away. The sea front is a short walk from the home. Speedwell, the first floor unit, cares for up to 26 service users over the age of 60 who require nursing care for a physical illness or disability and includes up to 3 service users over the age of 55 who require general palliative care. Mayflower, the ground floor unit, cares for up to 24 service users over 60 who require care for a progressive mental disorder. Haven Lodge Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report was compiled from information gathered during an unannounced inspection on 24th January 2006 that lasted nine hours and an additional telephone conversation with the registered Manager, Pauline Goh. On the day of the inspection the manager was away and the inspector was given every cooperation from the admin manager and other staff. The inspection included discussions with staff, residents, relatives, two visiting health professionals and an environmental health inspector. Observations during a tour of the home and samples of records examined were also taken into account. The atmosphere in the home was welcoming and residents appeared happy and relaxed. Interactions between residents and staff were observed to be good. What the service does well: What has improved since the last inspection? What they could do better: Information on notice boards such as menus and activities could have been displayed in a more eye-catching format to ensure residents were aware of what was available. In Mayflower some of the toilets had clear pictorial signs Haven Lodge Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 Page 6 but the home would benefit from extending the use of similar signage to improve orientation for residents with a progressive mental disorder. The home had asked for the views of relatives and staff through questionnaires. However the quality assurance and monitoring system needed to be further developed to take into account the views of residents. Also, the resulting information needed to be collated and presented in a report that should be made available to residents, their representatives and other interested parties. Staff enrolled on NVQ courses needed to complete their awards in order to meet the National Minimum Standard. The home’s procedures around the administration and storage of medication was on the whole good, although open boxes of medication should be clearly marked with the date of opening. 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 Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 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 Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 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): 3 and 4 The home ensured that the needs of residents moving in to the home were assessed. Overall the home met the needs of residents, although improvements needed to be made in the environment to ensure the specialist needs of people with dementia were met. EVIDENCE: Six residents files were examined. There were comprehensive assessments using the BASOLL scale and also pre-admission assessments. Other assessments were carried out using the Clifton Assessment Procedures for the Elderly (CARE), the Barthel Index to assess levels of dependency and a Mental Status Questionnaire. All assessments were undertaken by qualified nursing staff. A visiting G.P. spoken with on the day of the inspection was complimentary about the positive approach the home had to supporting people with a progressive mental disorder. However, the environment in Mayflower needed improvements if the specialist needs of people with dementia were to be met. Paintwork in the corridors was bland, making it difficult for residents to Haven Lodge Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 Page 9 distinguish different areas. In addition brighter pictures and different colour schemes in different areas would assist with orientation. Information on notice boards such as menus and activity planners could have been displayed in a more eye-catching format using pictures and large print. This would help residents to be aware of what was available. In Mayflower some of the toilets had clear pictorial signs but the home would benefit from extending the use of similar signage to other doors and corridors to improve orientation for residents with a progressive mental disorder. Haven Lodge Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 Page 10 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): 8 and 9 The healthcare needs of residents were met. Residents were protected by the home’s policies and procedures for dealing with medicines, although this would be improved by ensuring that opened medication was dated. EVIDENCE: Information around healthcare was provided by qualified nursing staff on duty on the day of the inspection. A visiting G.P. spoken with said that the home provided a good standard of care and mentioned in particular the positive approach to dementia care in Mayflower. A visiting physiotherapist spoken with was also very positive about the care provided by the home and the cooperation between the home and other health professionals. Residents’ files examined showed risk assessments and care plans in place. Files examined showed a range of assessments relating to health needs such as manual handling, nutrition, diabetes and continence. There was a comprehensive range of care plans linked to the assessments. At the time of the inspection there were very few instances of pressure sores. Nursing staff informed the inspector that one resident had been admitted from hospital with pressure sores but these had now healed and only one other Haven Lodge Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 Page 11 person had a small break in skin tissue that was being dealt with appropriately. The home used the services of the tissue viability nurse to ensure appropriate procedures around prevention and treatment of pressure sores. Records examined showed that there was training in place around wound care. The home used the services of other relevant healthcare specialists including district nursing services, optician and audiology. A chiropodist visited the home every six weeks. The home used glycerine sticks for oral hygiene and a dentist made both regular and ad hoc visits. Nursing staff said that there were very few incidences of falls and that they completed risk assessments and identified appropriate mobility aids. Residents’ psychological health was monitored and the home used a Mental Health Assessment tool. On the day of the inspection it was observed that staffing levels appeared good. Food charts were completed for the first month after a resident was admitted and these were continued if a resident was ill or vulnerable. Residents’ weights were recorded regularly and the home had recently purchased new electronic scales. The G.P. visited weekly on a Monday, but also came in when requested in response to any issues that arose. There was a medication Policy and Procedure in place. The home used a monitored dose system (MDS). At the time of the inspection there were no residents self-medicating. All medication was administered by qualified nursing staff although care staff also received training from the providers of the MDS. The storage of medication was examined. All drugs were stored in either locked metal cupboards or a locked fridge. Records were examined of fridge temperatures and found to be appropriate. The controlled drugs cupboard only had one lock but it was secured to the wall and the treatment room door was locked. The controlled drugs stock and record book were examined and found to be in order. A contractor was used for the disposal of unused medication. Medicine Administration Records (MAR sheets) were examined and found to have been completed appropriately and contained residents’ photographs. Although medicines were clearly labelled, opened medicines that were examined did not have a date of opening on them. Nursing staff spoken with said that training updates on specialist needs like PEG feeds were available. The home consulted with specialists such as the ‘SALT’ team around swallowing and Macmillan nurses. Staff spoken with said that medication was not given in a covert manner, for example hidden in food or drink. The medication room was clean and there were hand-washing facilities available. Haven Lodge Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 Page 12 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, 14 and 15 Residents’ social and recreational interests and preferences were met by the home. The home encouraged contact between residents and family, friends and the local community. Residents were supported to make choices and retain control over their lives. The home provided residents with a wholesome, appealing and balanced diet that was served in pleasant surroundings. EVIDENCE: Since the last inspection, an additional activities co-ordinator was in post, making three activities staff and doubling the number of activities hours being used. Activities co-ordinators were undertaking a City & Guilds award around Activities. Some new games had been purchased for the upstairs unit. There was a large notice board upstairs and a smaller one downstairs, both containing a variety of information for residents and visitors. The home would benefit from having the information displayed in a more eye-catching format, particularly downstairs in Mayflower where residents may have had difficulty in understanding written information. The home ensured visitors were welcome. The inspector observed admin staff informing relatives on the telephone that there were no restrictions on visiting and they could come at any time. The activities co-ordinator informed the Haven Lodge Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 Page 13 inspector that the home tried to maintain community links by arranging outside activities such as theatre visits. On a tour of the premises the inspector observed a variety of personal possessions, pictures and ornaments in residents’ rooms. Information about individual’s ability to make choices was recorded in residents’ files. It was documented in the care plans examined whether or not residents had an understanding of finances or if finances were managed by an appointee, solicitor or family. Records examined showed an inventory of personal possessions was on file. On the day of the inspection the kitchen was inspected by the food hygiene inspector, who informed the CSCI inspector that overall things were good in the kitchen. The chef was spoken with and menus were examined. There was a choice of two hot meals at lunchtime, but the chef said that kitchen staff were flexible and would always provide an alternative to the menu on request. There was evidence of a good variety of fresh foods, fruit and vegetables. The inspector observed that staffing levels over mealtimes on the day of the inspection were very good. Interactions between care staff and residents were also seen to be good. Haven Lodge Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 Page 14 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 The home listened to concerns and complaints and there was an appropriate complaints procedure in place to ensure that views were acted upon. EVIDENCE: The home had a comprehensive complaints Policy and Procedure with a flowchart to guide you through the process. Timescales were clearly set out for the acknowledgement and response to any complaint received. No recent complaints had been received but records were examined of past complaints that had been dealt with and their outcomes. Records of complaints were stored in a locked filing cabinet. Haven Lodge Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 Page 15 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): These standards were not examined on this occasion. EVIDENCE: No evidence was examined at this inspection. However, all these standards were met at the previous inspection on 27th June 2005. Evidence relating to these standards may be found in the Inspection Report for that inspection. Haven Lodge Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 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): 28 and 29 Overall staff had the skills to ensure residents were cared for safely, although additional care staff needed to complete an NVQ qualification to ensure the recommended 50 was achieved. The homes’ recruitment policy and practices ensured that residents were supported and protected. EVIDENCE: Records examined showed that of a total of 28 care staff, 7 had completed NVQ at the time of the inspection. This was approximately 25 of care staff, which did not meet the 50 set out in the National Minimum Standard. However, the manager informed the inspector that a further 7 staff had almost completed NVQ level 2 and a further 4 staff had almost completed level 3. The manager believed that these would be completed by the end of March 2006, which would raise the number of staff with an NVQ qualification to 18 bringing the total up to nearly 65 . Since the last inspection the Personal Identification Numbers of registered nursing staff were being checked more frequently and a register of these checks was being kept. Haven Lodge Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 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): 31, 33, 35, 36 and 38 The home was run and managed appropriately. Overall the home was run in the best interests of the residents, although the home would benefit from reflecting residents’ views through a quality assurance system. The home ensured that the financial interests of residents were safeguarded and staff received appropriate supervision. The home ensured the health, safety and welfare of residents and staff were promoted. EVIDENCE: On the day of the inspection admin staff informed the inspector that the home manager was doing the Registered Manager’s Award. The manager said that she was in the process of completing the award and many of the units were being verified. In addition, the manager was a qualified nurse (RMN). Questionnaires had been sent out to relatives and members of staff. In the past relatives’ meetings had been held, the last one in May 2005. To try to Haven Lodge Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 Page 18 encourage more relatives to get involved, the home was arranging more ‘social’ type forums for residents and their relatives and friends to attend. Two garden parties and a fete were planned. The home operated an ‘open door’ policy so that residents could speak to the manager at any time. However, information obtained from consulting with relatives and families had not been collated into a report and the results made available to current and prospective residents, their representatives and other interested parties. A copy of any report compiled through a Quality Assurance programme should be made available to the Commission for Social Care Inspection. At the time of the inspection only one resident managed their own finances. A number of residents were subject to Power of Attorney or Guardianship. Records were examined of the management of residents’ personal allowances. The admin manager kept receipts and records of monies in and out. Personal allowances were stored individually in the home’s safe. Residents had lockable drawers in their rooms to safeguard valuables. Savings were invested in individual Saver Plus bank accounts. Local advocacy services were used. Since the last inspection staff supervision had improved. Records examined showed that staff received regular supervision that met National Minimum Standards. A mentor chart was examined which showed who was responsible for supervising who. The home provided evidence of a comprehensive range of policies and procedures to ensure the health and safety of residents and staff. There was a weekly Health & Safety check and a fire drill carried out. The home had a maintenance schedule that was appropriately recorded. Staff spoken with said new staff received an induction pack from their mentor and maintenance staff gave them a Health & Safety induction. New staff signed to say they had read the health and safety policy. Maintenance records were examined and showed up to date checks had been carried out on baths, hoists, lift and there was a gas safety certificate. Haven Lodge Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 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 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 2 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Haven Lodge Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? No 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 OP4 Regulation 12 (1) 23 (2) (a) Requirement The registered manager must ensure that the home meets the needs of residents. This refers to ensuring the environment is appropriate for people with dementia. The registered manager must ensure that staff adhere to procedures around the handling of medication. This refers to ensuring the date medication is opened is recorded on the medication. The registered manager must ensure that an effective quality assurance system is in place and that the annual development plan for the home reflects the aims and outcomes for service users. Timescale for action 30/06/06 2. OP9 13 (2) 31/01/06 3. OP33 24(1)(a) (b)(2)(3) 30/06/06 Haven Lodge Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 Page 21 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 OP28 Good Practice Recommendations The registered manager should ensure that care staff who are enrolled for NVQ complete the awards. Haven Lodge Nursing Home DS0000015324.V274869.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. 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