Inspection on 04/08/09 for Haven Rose Rest Home

This inspection was carried out on 4th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Haven Rose Rest Home 28/01/10

Haven Rose Rest Home 28/10/09

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Haven Rose Rest Home 33 Landguard Road Southampton Hants SO15 5DL     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: Mick Gough     Date: 0 4 0 8 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 34 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 34 Information about the care home Name of care home: Address: Haven Rose Rest Home 33 Landguard Road Southampton Hants SO15 5DL 02380322999 02380366228 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Haven Rose Residential Care Home Limited Name of registered manager (if applicable) Mrs Shahnaaz Joommun Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 16 The registered person may provide the following category of service only: Care home only (PC)to service suers 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 (OP) Mental disorder, excluding learning disability or dementia (MD) Dementia (DE) Date of last inspection 16 16 0 Over 65 0 0 16 Care Homes for Older People Page 4 of 34 Brief description of the care home Haven Rose is a large detached property situated in Languard road in Southampton. It is located in a quiet residential area and is close to local shops and amenities. The registered provider is Haven Rose Residential Care Home Limited and the registered manager is Mrs Shahnaaz Joommun. There are 8 single rooms and 4 double rooms and the home is registered to provide accommodation for up to 16 older people both male and female who have mental health and dementia. Fees at the home depend on the type of room and the support that is required. Full details of current fees are available from the home. Care Homes for Older People Page 5 of 34 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: This report details the evaluation of the quality of the service provided at Haven Rose Rest Home and takes into account the accumulated evidence of the activity at the home since the home was registered in April 2009. The inspection took into account the homes Annual Quality Assurance Assessment (AQAA), which arrived when we asked for it and was completed satisfactorily. The AQAA is a self assessment tool that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Prior to the site visit we sent out surveys to service users, staff and health care professionals to obtain their views on how the home was meeting the needs of service users. We received responses from seven users of the service and all the responses were positive and comments included; they look after me well, I get all the help I need and I have no problems. Care Homes for Older People Page 6 of 34 Two health care professional also returned surveys and when we asked the questions, are peoples social and health care needs properly monitored, reviewed and met, Does the care service support people to live the life they choose wherever possible and does the care service respond to the diverse needs of individual people, the responses were Always or Usually to the questions asked. Comments included The residents are happy and relaxed in their environment and the home manages difficult behavior fairly well. Another comment was Haven Rose provides care to patients with enduring mental health problems, they are tolerant and accepting of idiosyncratic and unusual behaviours. They are flexible in meeting residents needs and respect their individuality and promote independence and offer support to meet their needs. When asked what the home could do better they both told us that there was a lack of privacy to meet service users and the home would benefit from an allocated room for private meetings and interviews. Included in the inspection was an unannounced site visit to the home, which was conducted on the 4 August 2009 between 0930 and 1415. For part of the visit a specialist pharmacy inspector visited the home to look at the medication arrangements. For this visit we involved 5 users of the service and 2 members of staff who we spoke with on the day of the visit and this provided us with information about the home we also had the opportunity to speak with a visiting health care professional. Other evidence for this report was obtained from reading and inspecting records, including pre admission assessments, plans of care, medication records training and recruitment records and records relating to health and safety and quality assurance. We also looked at how the home deals with any complaints and issues regarding the protection of vulnerable adults. We looked at some of the homes policies and procedures and throughout our time in the home we also observed the interaction between staff and users of the service. We were assisted through the visit by the manager of the service. The home is registered to provide support for 16 residents and at the time of the inspection there were 10 people living at the home, with 2 in hospital. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: There were 8 requirements made as a result of this visit and other points, which need to be addressed to help improve the service provided for residents are contained within the main body of the report, general observations were; All service users had a plan of care, however they did not set out in detail the action neededs to ensure peoples changing needs are met by care staff. More information is required in care plans to ensure that staff have the information they need to provide the care and support that service users need and in the way they prefer. Recording procedure also need to be improved in the daily and monthly recording to show that service users care needs are met. We saw that were risk assessments in care plans but these did not always provide information for staff on the identified risk and the action they should take to minimise any risk. More detailed information in risk assessments will help protect service users from the risk of harm. We found that the National Minimum Standards regarding medication were not met and there were a number of issues regarding medication recording and administration which must be reviewed and these are contained in the main body of the report. These issues put people at risk of not receiving their medication safely and must be addressed. When we looked in the kitchen at the home we found that the hot water boiler was not secured in place and this placed service users and staff at risk. The Laundry at the home was in need of refurbishment as at present none of the surfaces in the laundry room were readily cleanable and the home lacked a clear Care Homes for Older People Page 8 of 34 procedure and guidance for staff with regard to washing any soiled items and there were no hand washing facilities. This presented a risk of cross infection. Although staff are provided with training we found that not all staff have received training with regard to medication and none of the staff have received training with regard to mental health issues. The home must ensure that staff receive training so that they have the skills and knowledge to provide the care and support service users need. We looked at financial arrangements for service users and found that 2 service users have their finances managed by the home. The current arrangements are not satisfactory and the registered person must ensure that any money held on behalf of service users is not held in an account used by the registered person in connection with the carrying on or management of the care home This will ensure that both the home and service users are protected. 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 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All new residents have a needs assessment undertaken prior to them moving into the home this allows both the home and the resident to see if the home can meet the assessed needs. However as no new residents have been admitted to the service it is not possible to assess if the home is meeting this outcome area in practice. Evidence: There have been no new service users admitted since the new organisation took over the home. We spoke with the manager who told us that any potential new service users would have their needs assessed before they moved into the home and that potential new service users would be able to visit the home before moving in. Existing residents had assessments in their plans of care and the homes completed AQAA also told us that a full assessment would be undertaken before anyone moved into the home to ensure that the home could meet their needs, however as no new resdients have been admitted to the service it is not possible to assess if the home is meeting Care Homes for Older People Page 11 of 34 Evidence: this outcome area in practice. The home does not provide intermediate care. Care Homes for Older People Page 12 of 34 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. All service users have a plan of care but these are not in sufficient detail to show that peoples care needs are being met. Risk assessments need more information to ensure that service users are protected from avoidable risks. Service users are not receiving their medicines as prescribed by thier GP and the medication recording procedures at the home did not provide a clear audit trail and the medication procedures at the home were putting service users at risk. Service users at the home have their rights respected and are treated with dignity and respect Evidence: Care plans were seen for 3 service users and they all had information on; mobility, general well being, relationships and social contacts, memory, routines and preferences. All care plans had information under the same headings but did not always explain what care was required. There was information such as needs help with dressing, requires staff assistance and give support but plans did not provide staff Care Homes for Older People Page 13 of 34 Evidence: with information on what assistance was needed or how the resident would like this support to be given. Care plans stated - has mental health problems but did not expand on this and did not provide clear information for staff on how the person needed to be supported, therefore it was difficult to see if care needs were being met. All of the care plans seen had a lot of old information and it was difficult to see what plan was being used. All care plans need to be reviewed and updated to provide clear information for staff to ensure that peoples care needs are met. All care plans contained a personal history profile and this gave staff good information on the person past history. Daily recording takes place at the end of each shift and provides some information on how the person has been throughout the shift. Recording in care plans had information such as - had a good day, or all care given, however records did not provide evidence of care delivery. Recording needs to be in sufficient detail to show that peoples changing needs are identified and met. We saw that care plans are reviewed monthly but the records do not give any evaluation of how the care plan is working for the individual, there is good information recorded about how the service user is feeling about the home and the food provided but no information on how the care plan is working or if any changes are required. All care plans contained risk assessments however there were a number of old risk assessments which had been superceded and these need to be removed so staff can be clear on what risk assessment is currently being used. Some risk assessments were about service users medication and were in place to remind staff to administer the medication as prescribed. This information should be contained in the medication administration record. One risk assessment seen said the person suffered from a mental health problem but there were no details of what this meant nor were there any specific issues recorded, the risk assessment went on to say - if mental health gets worse contact GP. We found that risk assessments were not in sufficient detail to give staff the information they needed on the identified risk, nor was there sufficient information for staff to minimise the identified risk and this means that service users are not always protected. We spoke to service users and they told us that they were very happy with the care they received, comments included - they look after me well, I get all the help I need and I have no problems. However records show that care staff are not well informed and the lack of information could put people at risk. Service users at the home are registered with a number of different surgeries in the area and there were records in care plans of GP appointments. There is a visiting optician service and dental checks are carried out at a local NHS surgery. Community nurses visit the home when required and provide support to staff and some residents Care Homes for Older People Page 14 of 34 Evidence: have the support of Community Psychiatric Nurses (CPN). We spoke to one visiting CPN who told us that the home is good at contacting them and asking for assistance if they have any concerns about residents. Access to other health care professionals is through GP referral. All residents spoken to and the comments received in surveys were very positive about the care received at the home. They all said that staff were helpful, and friendly and stated that they were always treated with dignity and respect. We observed staff interacting with service users throughout the visit and this confirmed that residents and staff get on well together and staff were to treat service users with dignity and respect and staff knocked on residents doors before entering and used their preferred form of address when talking to them. Comments received from 2 heath care professional who visit the home also told us that the residents were happy and relaxed in their home and that staff promote independence and respect their individuality. One consistent comment was the need for the home to provide a private area for meetings with residents or for conversations with staff as at present the working office is situated in the dining area of the home and residents are free to wander in and out and this impacts on confidentiality. The safe handling of medicines was assessed by a Commission specialist pharmacist inspector. They looked at the medication records and medicine supplies for six people, they looked at the care plan for one person, the homes medication policies and procedures for medication handling and they also talked to staff. The records and medicines supplies were not able to show us that all of those people case tracked were receiving their medicines as they were prescribed by their doctors. This was mainly due to the poor standard of record keeping in the home. Whilst the home keeps complete records of all of the medicines they receive the records kept when medicines were given to people were confused. Some medicines were listed on the medication administration record charts more than once when they were printed by the supplying pharmacy. This could lead to staff giving someone their medicine twice. The charts also listed several medicines that were not being given. The manager told us that these were old medicines that people were no longer prescribed. A meeting with the supplying pharmacist had already been arranged by the manager to discuss these issues so that clear medication administration records charts can be provided in the future. The records did show us that one person who was prescribed to have one of their medicines twice each day was being offered it three times daily and had been given it three times on six occasions in the last three weeks. People must be given their Care Homes for Older People Page 15 of 34 Evidence: medicines at the dose and frequency that their doctor prescribed for them so as to maintain their health and welfare. Three of the people whose medicines we looked at were prescribed medicines to be given only when needed. None of these people had care plans describing to staff when these medicines are to be given. This means that these people may not be being given their medicines when they need them or they may be being given medicines that they do not need. People have their medicines given to them by the care staff. There was evidence that one carer had completed a training course in the safe handling of medicines. A further five carers had completed the first unit of a training course but had not yet started the second unit. Further training on medication handling for staff was booked for 19 August 2009. Staff had access to written procedures on the safe handling of medicines. One person kept a supply of their own medicine in their room. The risks to this individual had been identified. However it did not consider the risks to other people who live in the home nor did it describe how any risks that had been identified were to be minimised. This could put people at an unnecessary risk of harm. All medicines were stored securely for the protection of people who use the service. Medicines needing cool storage were not all being kept in a fridge. This means that the medicine that was wrongly being stored in the drug trolley at room temperature may not be fit for use. Medicines that can be misused, known as Controlled Drugs, were not stored correctly, as the home does not have a Controlled Drugs cupboard that meets the requirements of The Misuse of Drugs (Safe Custody) Regulations 1973. Southampton Social Services had already identified to the service that there were issues with the safe handling of medication. However on the day of the inspection there remanied a number of concerns regarding the handling of peoples medicines safely, indicating that the service had failed to act quickly to address concerns, and people were left at risk. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a range of activities for service users, which meets their expectations and the religious and recreational interests of service users at the home are provided for. Service users are able to maintain contact with family and friends and visitors are welcome at any time. Service users are supported to exercise choice and control over their lives and are provided with a balanced diet at a time convenient to them. However the hot water boiler in the kitchen presents a risk to service users and staff. Evidence: The home provides a range of activities for residents and these are displayed on a notice board in the dining room, activities include; games, bingo, visiting entertainer (once per fortnight) singalongs and TV and videos. Each service user has an activities section in their care plan and this gives information on service users likes and dislikes. A number of service users have stated that they do not wish to be involved in activities as they prefer their own company and wish to stay in their rooms. The home does not have a dedicated activities co-ordinator and activities are organised by staff and those staff spoken to said that they enjoyed organising activities for residents. Those residents spoken to were happy with the activities provided, some stated that they preferred watching TV whilst others were happy to be involved with whatever Care Homes for Older People Page 17 of 34 Evidence: was going on. Some of the service users at the home go out independently and are free to come and go as they wish. One service user likes to go to the local church on a Wednesday and helps out and another likes to take part in church services that are held at the home on a regular basis. The home has a visiting policy and there are no restrictions on visitors. We looked at the visitors book which was in the hallway of the home and this showed that there are regular visitors to the home. It was noted that in one service users care plan there was information that they had a relative who lived in another residential home and the home was arranging for the service user to go and visit. Residents spoken to said that their visitors were always made welcome by the staff and that their visitors could call whenever they wanted. Residents spoken to confirmed that they are able to make informed choices and were able to control their own lives as much as possible. some of the residents at the home are able to access the local community independently and there are no restrictions. We observed staff and residents interacting and it was clear that they get on well together and this was confirmed by both residents and staff. We observed residents being consulted throughout the day from the choice of what was on TV to what they wanted to do. Staff spoken to told us that they always ask residents what they want and would always respect their wishes and views. Staff were observed speaking to residents appropriately using their preferred form of address, also knocking on residents doors before entering. Residents are encouraged to bring some of their own possessions into the home and those rooms seen had been personalised. The home operates a planned menu, which is changed regularly and residents likes and dislikes are taken into consideration. A record of food eaten by residents is kept and on the day of the inspection the lunch time meal was steak and kidney pie, mashed potato and vegetables. Staff at the home prepare meals and breakfast is available for whenever residents get up, lunch is normally 1200 and supper at 1700. We were told that the menu is flexible to take into account residents choices and service users told us that the food was plentiful and good. The home employs a cook who comes in the afternoon and he provides Caribbean dishes for one resident. Staff consult residents and tell them what the main meal is and will provide an alternative if the main choice is not to their liking. Meals are served in the dining room at the home, although residents can eat elsewhere if they wish. We observed lunch at the home and this was a social occasion when everyone came down from their rooms and was very relaxed. Care Homes for Older People Page 18 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure in place, which includes all required information. The home has policies and procedures help to protect residents from any form of abuse, however the manager does not have safeguarding training to ensure that people are protected. Evidence: The AQAA returned by the provider prior to the inspection indicated that there had been no complaints made to the home since they new organisation took over the home. We saw that the home had a clear complaints procedure and the manager was aware of the need to keep a log of any complaints with information on the action taken to investigate the complaint and also the outcome of the complaint recorded. Residents spoken to were not fully aware that the home had a complaints procedure but stated that they would address any complaint they may have to a staff member and were confident that this would be quickly resolved. Staff members spoken to were aware of the complaints procedure and said that they would support any resident to make a complaint if they wished to do so. Staff at the home receive training on adult protection and staff members spoken to said that they would report any concerns to the manger. The home has a whistle blowing policy and also a copy of the Hampshire Adult Protection procedure. There has been one adult protection issue at the home and this was investigated by the relevant authority and has been resolved satisfactorily and there were records regarding this Care Homes for Older People Page 19 of 34 Evidence: issue held at the home. As part of the managers registration process it was recommended that she attended adult protection training for managers, however this has not yet taken place and the manager informed us that she intends to undertake this training in the near future. Care Homes for Older People Page 20 of 34 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. Residents live in a safe and well-maintained environment and have access to reasonably comfortable indoor and outdoor facilities, however there is a not a shared area where service users can meet people in private. Residents have the specialist equipment they require to maximise their independence and the home was generally clean, pleasant and hygienic, however the laundry area of the home is in need of refurbishment to fully protect service users and staff from any cross infection. Evidence: The home is over 3 floors and there are 8 single and 4 double rooms providing accommodation for up to 16 service users. The home has 2 bathrooms with WCs and there are also additional WCs on the ground and 2nd floor of the building. There is a large lounge area with TV and video and also a music system. There is a conservatory, which backs onto the lounge area and this is used as a smoking room for residents. All furniture and fixtures were in a reasonable state of repair and the home was clean and tidy. The dining room is in the center of the ground floor and this also houses the working office which is a table in the dining room. Although residents do not see this as a problem, there is a risk that this compromises confidentiality as residents are free to use the dining room and this presents a confidentiality issue when staff are speaking on the phone and visiting health care professionals who completed surveys Care Homes for Older People Page 21 of 34 Evidence: also told us that at times this can be a problem as there are no facilities to speak to residents in private other that their own rooms which service users are at times reluctant to use. The manager is aware of this issue and told us that she is working with the provider and looking for a solution to the problem. This is a situation that is historical in the home and has not changed since the new organisation took over the running of the home. Service users who we spoke with were happy with the accommodation provided and told us that they had no problems or concerns with the office being in the dining room. Comments included - I am very happy here, it suits me just fine, I am very comfortable and everything is fine. The home had alcohol gel dispensers situated around the home to prevent the spread of infection, but service users we spoke with told us that they do not bother to use these. There was suitable hand washing soap dispensers and paper hand towels in bathrooms and WCs. We checked water temperatures around the home and these were all thermostatically controlled and these kept hot water temperatures at a suitable level and this protects service users. The bathroom on the second floor has had its bath hoist removed and the paneling on the bath is broken and needs to be repaired, the manager informed us that a new hoist is due to be fitted next week and the bathroom panels will be replaced when this is complete. We looked at the laundry area and this was situated at the back of the residents lounge, the door to the laundry is kept locked and this contained a new domestic washing matching with an industrial tumble drier. The manger told us that the intention is to rent an industrial washing machine. Care staff carry out laundry duties and there was suitable protective clothing, however the laundry also housed the boiler and this has recently been replaced and pipe work was not covered so the laundry walls were not easily cleanable. The laundry was in need of refurbishment to ensure that all surfaces were readily cleanable to help prevent the spread of any infection, also there were no hand washing facilities in the laundry area and no signs directing people to the nearest hand washing area. The home did not have a clear procedure for washing any soiled items and the lack of a clear policy and procedure together with the lack of readily cleanable surfaces and lack of hand washing facilities presents a risk to service users and staff from any cross infection. Care Homes for Older People Page 22 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has sufficient staff on duty to ensure service users receive the support they require. Staff were found to be well motivated and service users are protected by the homes recruitment procedures. Staff have been provided with some training but have not been povided with specific training to meet peoples needs. Evidence: On the day of the visit we looked at the staffing levels for the day of the visit and this showed that between 0800 and 1400 there are 4 care staff on duty, between 1400 and 2000 there are 3 care staff on duty and between 2000 and 0800 there are 2 care staff on duty, one of which is able to sleep between 2200 and 0600 if not required, the other staff member is awake throughout the night. These numbers are complemented by cook/ handyman and an administrative assistant and also the homes manager who works flexibly at the home 40 hours per week. Staffing numbers were discussed with the manager and she stated that she felt that staffing levels were sufficient with the current number of residents but that staffing numbers would be kept under review. Service users spoken to said that they felt that staffing levels were adequate and comments received included - I get all the help I need, there is always someone around and the staff help me when I need it. Staff members spoken to told us that they felt that there were enough staff on duty to meet the needs of the service users at the home. Care Homes for Older People Page 23 of 34 Evidence: The home employs a total of 12 care staff and 3 members of staff have a minimum of NVQ2, with 1 staff member currently studying for NVQ2. The manager stated that the home would support staff to obtain National Vocational Qualifications. Recruitment records were seen for 2 members of staff, one of whom was the most recent employee and recruitment records contained all of the required information including; application form, 2 x references, photograph, birth certificate, Criminal Record Beuarau and Protection of Vulnerable Adults checks. The homes completed AQAA told us that recruitment practices were thorough and this was confirmed by the documents we saw on the day of the visit and we found that the recruitment practices were robust and this helps to protect service users. Staff training records were looked at and staff files contained training certificates and there was also a training log which showed what training had been completed and also provided dates when refresher training was required. Records showed that staff have received training in first aid, food hygiene, moving and handling, fire, infection control, adult protection, medication, health and safety, diabetes and the mental capacity act. On the day of the visit training was due to take place for staff in dementia awareness. We discussed training with the manager and found that as yet staff had not received any training with regard to mental health or challenging behaviour. but the manager told us that she is in the process of arranging this training for staff. As the majority of residents have mental health needs the manager must ensure that suitable training is provide for staff particularly mental health training so that they can meet the assessed needs of the service users who live at the home and to give staff the skills and knowledge to provide the correct support to service users. Care Homes for Older People Page 24 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by a person fit to be in charge, however the overall management of the service currently fails to fully ensure that peoples needs are fully met and responded to in a manner, which protects their safety and promotes their well-being. The home has a quality assurance system in place but Peoples views are not fully considered as part of a process of quality assurance to ensure that the home is run in the best interests of people living at the service. The homes systems for handling of monies does not fully safeguard the people living at the service. The health, safety and welfare of service users and staff are generally promoted and protected Evidence: The home has a manager who has demonstrated her fitness to manage the service and was registered with the Care Quality Commission in January 2009. She informed Care Homes for Older People Page 25 of 34 Evidence: us that she continues to update her skills and knowledge, however however she has not yet undertaken safeguarding training as recommended as part of the registration process. Service users and staff who we spoke with had no concerns about the management of the home and told us that the manager was very approachable. However we found that she has not ensured that the care practices inncluding recording in care plans and risk assessments fully supports the delivery of care to protect people. The home has a Quality assurance system and there are regular residents meetings. There are regular staff meetings and staff receive regular supervision. We discussed quality assurance with the manager and she told us that she had not yet sent out any surveys out to service users, relatives, staff and visitors. There was information in residents monthly reviews that service users were asked how the home was meeting their needs but the quality assurance system at the home is not yet fully embedded and this needs to be followed up at the next visit to the service to see that the views of service users and other interested parties are taken into consideration. The home manages the finances of 2 residents and at present their benefits are paid into the Haven Rose account. The manager told us that she was not happy with this arrangement and had asked the bank if they could open a sub account for each resident but this had not been possible. Both of these service users also have large amounts of petty cash in their personal spending money and the manager told us that both of these service users have not had any of their personal spending money taken out of the Haven Rose account for approximately six months and this is not in the best interests of the service users concerned. We discussed this issue with the registered manager and she intends to contact each service users care manager to try and resolve this issue. All of the other service users at the home have relatives who manage their finances and the home keeps some personal spending money for service users. This money is kept in separate petty cash tins in the homes safe and there were records of any monies spent with receipts available. We checked the balances for 2 service users and these were found to be correct. The home has a fire risk assessment for the building and the fire log book was inspected and all required recording and testing had been carried out. Certificates were seen for annual tests of equipment and these were all in date. Fire equipment was last tested in December 2008, Private electrical equipment in November 2008, Stair lift in June 2009 and the gas safety certificate was issued in March 2009. Staff told us that the handyman is available to fix and small problems and if there are any other issues they would report them to the manager who gets them repaired quickly. Service users told us that they were happy with their home and that they felt safe and Care Homes for Older People Page 26 of 34 Evidence: secure. Generally homes policies and procedures help protect service users and staff, however the laundry area and also the hot water boiler in the kitchen present a risk to service users and staff. Care Homes for Older People Page 27 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must 20/10/2009 ensure that all service users have a clear plan of care that sets out in detail the action which needs to be taken by care staff to ensure that all aspects of the health and personal and social care needs of service users are met. And care plans must be kept under review This will ensure that staff have the information they need to provide the care and support that service users need and in the way they prefer. Good recording in daily reports and monthly reviews will also ensure that there is good evidence that service users care needs are and continue to be met. Care Homes for Older People Page 29 of 34 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 2 7 13 The registered person must ensure that as far as is reasonably practicable service users are protected from avoidable risks clear risk assessments, which give staff information on the identified risk and that give staff clear information on how to minimise any risk will help protect service users 20/10/2009 3 9 13 The manager must review 07/09/2009 the medication practices. Particular attention must be paid to: - ensuring that all medicines are given at the dose and frequency the doctor has prescribed - keeping complete and accurate records of all medicines given to people - ensuring detailed risk assessments are in place for people who look after any of their own medicines - ensuring that detailed care plans are in place to describe to staff when to give people medicines that are prescribed to be given when needed - ensuring that medicines are given to people by staff Care Homes for Older People Page 30 of 34 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 who are trained and competent to do so This will ensure that people in the home receive the medication that has been prescribed for them 4 9 13 All Controlled Drugs, including Temazepam, must be stored in a cabinet that meets the requirements of The Misuse of Drugs (Safe Custody) Regulations 1973 In order to comply with the law 5 15 13 The registered person must 31/08/2009 ensure that any unnecessary risks to the health and safety of service users are identified and so far as possible eliminated Securely fixing the hot water boiler in the kitchen will help protect staff and service users from potential harm 6 26 13 The registered person must make arrangements to prevent the spread of infection in the home Readily cleanable surfaces in the laundry area together with a clear procedure for staff with regard to washing any soiled items and the 10/11/2009 04/11/2009 Care Homes for Older People Page 31 of 34 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 availability of suitable hand washing facilities will help protect staff and service users from any cross infection 7 30 18 The registered person must ensure that all staff receive training appropriate to the work they are to perform. Staff must receive training so that they have the skills and knowledge to provide the care and support service users need, particularly with regard to medication administration, mental health and Safeguarding training. 8 35 20 The registered person must ensure that any money held on behalf of service users is not held in an account used by the registered person in connection with the carrying on or management of the care home. This will ensure that both the home and service users are protected. 06/11/2009 12/10/2009 Care Homes for Older People Page 32 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 34 of 34 - 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!