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Inspection on 02/02/07 for Havencroft Nursing Home

Also see our care home review for Havencroft Nursing Home for more information

This inspection was carried out on 2nd February 2007.

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

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

What the care home does well

The home provides a comfortable homely environment. Many of the bedrooms have been personalised by the resident, and this helps to reflect the individual`s personality. All areas of the home were observed to be clean and tidy, the management of odours was commended. The home employs a good maintenance operative who ensures that all the appropriate health and safety checks are completed. He also undertakes redecoration to areas of the home.

What has improved since the last inspection?

Some improvement was evident in meeting the requirements from the last inspection. Improvements were evident with staff recruitment, staff training, medication administration, staffing levels and staff training. The first floor shower room had been upgraded since the last inspection and this has enhanced the appearance of this room. Staff training had improved since the last inspection.

What the care home could do better:

Even though improvement was evident with the care planning documentation, it was still inconsistent and in some cases failed to meet the standard. Some minor issues were still evident with the administration of medication management. Specialist training for the nurses and carers in clinical areas, Parkinson`s, Diabetes, epilepsy, should be provided to assist all staff in meeting the care needs of the residents.

CARE HOMES FOR OLDER PEOPLE Havencroft Nursing Home Lea End Lane Hopwood Birmingham West Midlands B48 7AS Lead Inspector Chris Potter Unannounced Inspection 09:30a 2 February 2007 nd 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 Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 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. Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Havencroft Nursing Home Address Lea End Lane Hopwood Birmingham West Midlands B48 7AS 0121 445 2154 0121 445 2159 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) Regal Care Limited Lesley Ann Owen Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32), Physical disability (4), Physical disability of places over 65 years of age (32) Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th September 2006 Brief Description of the Service: Havencroft is a large, Victorian, 3 storey residence which is located in the village of Hopwood, close to the boundary of the City of Birmingham. The home is registered to provide nursing care for up to 32 frail elderly people, who may have a physical disability, and for up to 4 service users, between the ages of 55 and 64 years, who have a physical disability. The maximum number of people who can be accommodated is 32. The registered providers are Regal Care Limited, and the Registered Manager for the home is Lesley Owen, who is a first level registered nurse with many years experience working in both the National Health Service and the private sector. Havencroft’s fees range from between £440.00 for a shared room and £460.00 for a single room. The home charges additional fees for hairdressing, chiropody and daily newspapers. Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the homes second unannounced key inspection for 2006/07, which took place on the 2nd of February 2007 by 2 regulation inspectors from the CSCI. The inspection totalled 11 hours of inspection time. The last full key inspection was in September 2006. Following the September inspection the home was issued with an immediate requirement notice to address the serious concerns. These included concerns about their administration of medication practise; poor care documentation, staff recruitment policy not being followed, staff training not being up to date. Staffing levels, and failing to notify the CSCI of significant events in the home. During this inspection the views of several residents, 2 relatives and 3 staff members were sought to establish their opinion about the home and its facilities. Comments received included “the staff make you feel very welcome.” “The staff are pleasant” “the staff are very polite they are like your friends.” Building work is imminent to provide an extension to the building and upgrade the existing home. The manager informed the inspectors that the work looks to commence in March 2007. Given the plans to change the home, the environmental standards were not fully assessed at this inspection. What the service does well: The home provides a comfortable homely environment. Many of the bedrooms have been personalised by the resident, and this helps to reflect the individual’s personality. All areas of the home were observed to be clean and tidy, the management of odours was commended. The home employs a good maintenance operative who ensures that all the appropriate health and safety checks are completed. He also undertakes redecoration to areas of the home. Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. The summary of this inspection report can be made available in other formats on request. Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 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 Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All residents are appropriately assessed prior to being admitted to the home. All residents are provided with the appropriate information to assist them in making their choice. EVIDENCE: Since the last inspection the home has reviewed and updated their Statement of Purpose and Service User’s Guide. Some additional information is still required to fully comply with the standard. Residents spoken to during the inspection confirmed that they had been provided with the appropriate information to assist them in choosing the home. Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 Page 9 5 care files were reviewed at the time at the inspection, these contained a copy of the pre-admission assessment, which had been undertaken prior to their admission to the home. 3 of the residents were spoken to and confirmed that a pre- admission assessment had been completed and appropriate information had been provided to assist them with their choice. The 3 new residents confirmed that they were pleased with their bedrooms and that they had been able to take some of their own furniture into the home to assist them to settle in. Comments from residents included “I was made to feel welcome, the staff are pleasant” A resident recently admitted to the home commented that they had settled in quite well, but was missing “home”. Visitors spoken to confirmed that they were pleased with the home and found the staff to be helpful. It is recommended that the home provide some chairs for the visitors to use during their visits. Visitors were observed sitting uncomfortably during the inspection. Since the last inspection the home has provided some dementia training for the staff, and some diabetic training for the nurses. Further clinical training for all staff is required. A fully qualified first aider should be rostered on all shifts for the 24-hour period. Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The inconsistencies with care documentation fails to provide clear directives for staff to meet the assessed needs of the residents. The medication system is safe although some minor recording work would further ensure the safety of the system. EVIDENCE: Since the last inspection the nurse’s have attended care plan training as required from the last inspection. 7 residents care files were reviewed at the time of the inspection. These evidenced that an effort has been made by the manager and some of the nurses to provide a care record reflective of the residents care needs. It was noticeable that the handwritten care records were more clinically effective than the pre- printed care plans. These basically Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 Page 11 consisted of a tick list that had not been personalised to the individual resident(s). The manager has completed a review of all the diabetic residents and improved the care records to provide more specific directives for all staff. The care records for residents with dementia and Parkinson’s need to be updated to reflect current clinical good practise. Care plans were being reviewed frequently, however not all the changes were being incorporated into the care plan. For example one resident with a significant weight loss had not had their care plan updated appropriately. Care plans had not been formally agreed with and counter-signed by the resident and/or their next of kin. Appropriate risk assessments had been undertaken for the residents, and these showed evidence of being reviewed and updated monthly. Accident details had not been included in the resident’s care file in all cases. The nurse should ensure that a record is also included in the residents care file, and if an injury was sustained complete an appropriate care plan so the staff can review and monitor the injury. Medication management had improved since the last inspection, and the nurse have received some diabetic training. Some gaps were still present on the resident’s medication administration record (MAR). All nurses must ensure that they sign to confirm that medication has been administered at the time the medication was given or a code to state that for one reason the medication was not given. To ensure that all medication can be accounted for in the home, the nurses must ensure that they record the amount of medication returned or destroyed. Residents stated that staff treat them with dignity and respect. Residents able to comment felt that their privacy is respected. Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Social and recreational activities are limited and are not suitable for all residents. The home provides a varied well balanced choice of food for the residents. EVIDENCE: Since the last inspection the home has recently employed an activities organiser to work 8 hours in the home. In addition the care staff arrange some activities, planned social entertainment twice per month, and outings for some residents about twice per month. On the day of the inspection the residents had a singer in the afternoon, which they appeared to enjoy. The home should review the activities and assess them on the individuals needs and abilities and a review of this included in the residents care documentation. Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 Page 13 Visitors confirmed that they are able to visit at any reasonable time, and can either sit in the lounges or the resident’s bedrooms. Residents who were able to comment and staff spoken with confirmed that residents wishes about what time they get up and what time they go to bed are accommodated. Residents who were in their bedrooms at the time of the inspection, confirmed that was their choice. Comments received from residents and staff about the food was most complimentary, and stated that it was really nice. The residents confirmed that they are always offered a choice of meals. Comments included “The food is really nice for the residents and there is always a choice.” “The food is very good including fresh salmon, a very good choice”. A daily record is maintained by the staff of what food the residents have eaten each day. Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a clear complaints policy in place, which is being adhered to. Staff are aware of their protection of vulnerable policy and many have received training. EVIDENCE: Since the last inspection the home has received two complaints records reviewed indicate that the home addressed the complaints in accordance with their complaints policy. 17 staff have attended protection of vulnerable adult training since the last inspection. Staff spoken to confirmed that they were aware of the policy, and would raise any concerns with the manager if they were worried. Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some areas of the home have benefited from investment making them hospitable, however many areas within the home are in need of decorative improvement to match the positive standards achieved within those areas that have been redecorated. EVIDENCE: The home currently has capacity to accommodate 32 residents in seven double and 18 single bedrooms. Plans to extend and upgrade the existing home are planned to commence in March. Since the last inspection the home has provided an electrical sluicing disinfector, the need to ensure all nursing floors Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 Page 16 are fitted with a sluicing disinfector was discussed given the building changes are imminent. The bathroom has been upgraded on the first floor since the last inspection this has enhanced the appearance of this room. The ground floor toilet/shower room is still awaiting upgrade by external contractors the manager confirmed that quotes had been received for the work. All areas of the home were observed to be clean and tidy, no odours were evident in any part of the home. Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are minimal for the number of residents in the home at the time of the inspection. The recruitment procedure was being adhered to which assists in further protection of residents. Additional training is required to ensure that staff are competent to meet the needs of the residents. EVIDENCE: On the day of the inspection the home was delivering care to 25 service users, some assessed as being high dependency. The Staffing rota’s were reviewed which showed that the home provides minimal staffing numbers to meet the care needs of the residents for the 24 hour period and was particularly noticeably on the late shift. The duty rota should still clearly demonstrate the senior staff and the nominated first aider for each shift. The manager demonstrated a good knowledge and understanding of the residents care needs and communicated easily with them. Staff spoken with felt that the Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 Page 18 staffing levels were manageable, but it was difficult when staff were off sick at short notice. The staff turnover appears to have settled down and the home is not using agency staff at the moment. Residents who were spoken to stated, “That the staff were helpful. “ A resident who had expressed some issues at the last inspection felt that things had improved in the home. All residents were very complimentary about the manager. Staff training records were reviewed these showed that since the last inspection the home had arranged various training courses for the staff. Moving and handling all staff were up to date, only 2 staff have not completed food hygiene training, 20 staff have completed dementia training, health and safety, 5 not up to date. 6 staff have completed bereavement training, 17 staff have completed protection of vulnerable adults. The trained staff have completed care planning and diabetic update. 7 staff have completed NVQ level 2 training. The home must ensure that a nominated first aider is rostered on duty for the 24-hour period that has completed the full first aid course. It was recommended that the home arrange some clinical training for the nurse and care staff to assist them in meeting the resident’s needs and providing clear care records. 3 new staff files were reviewed at the time of the inspection, and these evidenced that the home were adhering to their recruitment policy. Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is appropriately qualified to manage the nursing home. The health, safety and welfare of the residents and staff are safeguarded. EVIDENCE: The manager is a first level nurse who has completed the registered managers award. Both residents and staff were most complimentary about the manager and confirmed how approachable she was. The manager stated that she was being provided with support from the owners. Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 Page 20 The home has recently started its quality-monitoring audit and were waiting for the responses to be returned. Only 2 comments have presently been returned from relatives. Due to the number of residents with communication difficulties regular resident meetings are not held. Relatives meetings have not been held recently due to the poor attendance by relatives. All records inspected that regular health and safety checks are being carried out. The home has completed a new fire risk assessment since the last inspection. Since the last inspection the home has introduced a new system and include any issues identified with the staff members one to one supervision. Records were available and up to date relating to their supervision program. Staff spoken with advised how useful this was. Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 Page 21 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 2 X 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 3 X 3 Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 Page 22 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 OP9 Regulation 13 Requirement The registered nurse must ensure all medication administered is signed for. When medication is not given, an appropriate code must be entered onto the MAR chart. Remains outstanding from previous inspection. Timescale for action 02/02/07 2. OP1 4 (1) The Statement of Purpose must be updated to fully comply with the National Minimal Standard Not fully met from last inspection. 31/03/07 3. OP1 5 (1) The Service User’s Guide must be updated to fully comply with the National Minimal Standard. Not fully met from last inspection 31/03/07 4. OP4 12 (1) The home must be able to demonstrate that it can meet the assessed needs of the residents fully. Partially met from last inspection. 31/03/07 5. OP7 15 (1) The registered nurses must generate a care plan for the residents to fully reflect their care needs and how care staff are to deliver that care. 31/03/07 Not fully implemented from last inspection. 6. OP7 15 (1) The care plan must evidence that 30/05/07 the resident or their representative has input into the DS0000004115.V329105.R01.S.doc Version 5.2 Page 23 Havencroft Nursing Home care plan. Remains outstanding from last inspection. 7. OP8 12 (1) The home must ensure that accident / incident records are included within the residents care records. 02/02/07 8. OP9 13 The home must be able to audit 02/02/07 all medication in the home and the need to record the amount of medication returned to pharmacy is required. The home must review the activities provided. More suitable activities must be available for the more highly dependent residents. Remains outstanding from the last inspection. 9. OP12 15 (1) 30/05/07 10. OP30 18 The home must ensure that all staff has the appropriate skills through training in specialist areas to ensure the care needs of the residents are met and the evidence is recorded in the care documentation. Remains outstanding from the last inspection. 30/05/07 11. OP27 13 (4) c The home must ensure that the off duty identifies the nurses and senior care staff on duty and also the nominated first aider for each duty. Protective glazing film must be applied to all areas of low-level glazing. Remains outstanding from the last inspection. 28/02/07 12. OP24 13 (4) 31/03/07 13. OP26 13(3) A mechanical sluicing disinfector must be provided on floors accommodating nursing residents. The results of the quality DS0000004115.V329105.R01.S.doc 31/05/07 14. OP33 12 30/06/07 Version 5.2 Page 24 Havencroft Nursing Home assurance audit should be available for the CSCI and the residents. 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 OP13 Good Practice Recommendations It is recommended that the home make provision for seating when they are visiting the home. Havencroft Nursing Home DS0000004115.V329105.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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