CARE HOMES FOR OLDER PEOPLE
Haverholme House Care Home Broughton Road Appleby Scunthorpe North Lincolnshire DN15 0AD Lead Inspector
Ms Matun Wawryk Unannounced Inspection 13th March 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 Haverholme House Care Home DS0000002789.V282721.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. Haverholme House Care Home DS0000002789.V282721.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Haverholme House Care Home Address Broughton Road Appleby Scunthorpe North Lincolnshire DN15 0AD 01724 862722 01724 870887 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) Ancyra Health Limited Mrs Rosemarie Ann Wright Care Home 52 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (52), of places Physical disability (45), Physical disability over 65 years of age (45) Haverholme House Care Home DS0000002789.V282721.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registration category DE(E) 1 male refers solely to the service user identified in the application V29651. 20th October 2005 Date of last inspection Brief Description of the Service: Haveholme House Care Home is set on the outskirts of the village of Appleby near Scunthorpe. It is an older style mansion house, retaining many original features, with a modern extension to the side. The home is registered to care for 52 people. The home has been divided into two facilities: service users with nursing needs are located in the main building, which is called Pine Tree Court and based on two floors, access is via a lift. The service users with residential care needs are accommodated in the newer purpose built extension, which is called Grove Court and is on the ground floor of the purpose built building. These units although joined are managed separately. The majority of the rooms offer lovely views of the surrounding countryside. The grounds are extensive and always well cared for; there are a variety of sitting areas, all accessible for wheelchair users. There is a large car park at the front of the building. Haverholme House Care Home DS0000002789.V282721.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on the 13th and 14th of March 2006. To find out how the home was run and if the service users who lived there were pleased with the care they received the inspector spoke to individually to five service users and left a number of comments cards for service users and/or their relatives to complete and return to the inspector. The inspector also spoke to the manager; a nurse, two senior care workers and two care workers who were working in the home at the time of the inspection. In addition the inspector looked at a range of paperwork in relation to staff recruitment, induction, supervision, training, rotas, menus, fire records, care plans, activity records, complaints and the servicing of equipment. What the service does well:
The home was very clean and tidy and had a friendly atmosphere with lots of space in the rooms where people sit, relax and eat. There was a core group of staff that had worked at the home for several years. The inspector found the staff to be very friendly and they knew about the care the service users who lived in the home needed. The service users who the inspector spoke to, and those who completed a questionnaire said the staff were helpful, and did anything they could for them and made their family and visitors feel very welcome. Service users said the staff always knocked on their doors before going into their rooms or the toilets and if they needed help staff made sure their privacy and dignity was respected. Staff reported that relatives are made to feel welcome when visiting the home; records and discussions with service users confirmed this, thereby helping service users to maintain family contacts. Relatives who completed a questionnaire stated they were very happy with the care and support provided to their relatives. Safety checks were in place to ensure that the environment the people live in and for staff to work in is safe. Haverholme House Care Home DS0000002789.V282721.R01.S.doc Version 5.1 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. Haverholme House Care Home DS0000002789.V282721.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 Haverholme House Care Home DS0000002789.V282721.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): Key standards 3 and 6 were assessed and met at the last inspection and were therefore not reassessed on this occasion. EVIDENCE: Haverholme House Care Home DS0000002789.V282721.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 10 Not all care plans included all the information staff needed to meet the assessed needs of service users. This could potentially put residents at risk. Personal support is provided in a way, which respects the service users’ right to privacy and dignity. EVIDENCE: The inspector examined four care programmes for service users with a range of needs. In the main the documentation system was found to be detailed and well maintained although a number of inconsistencies and gaps were identified through case tracking. The care plan for one service user was comprehensive with needs covered and guidance in place for all of the care staff were providing. One service user who had been in the home for three weeks did not have any completed risk assessments and care plans. Daily records indicated the service user exhibited challenging behaviours and required assistance with some personal care. Failure to provide risk assessments and care plans could result in the service user not receiving the correct care or staff not dealing with the service user in the right way. The registered person must ensure all service
Haverholme House Care Home DS0000002789.V282721.R01.S.doc Version 5.1 Page 10 users have a care plan and where required care plans must be supported by completed risk assessments. This is needed to ensure staff know that care and support should be provided and to ensure staff provide care in the right way. Evidence from records and discussion with staff showed the identified needs of one service user were not being met in significant areas. It was evident from discussions with staff that they were trying their best to meet the needs of this individual but lacked knowledge and skills in some essential areas. The service user was displaying challenging behaviour and a significant area of risk had been identified, however this had not resulted in the formulation of a risk assessment and management plan. The service user had significant communication problems, requiring specialist equipment but this had not been installed, although staff were trying to arrange this. The inspector advised that a reassessment of the individual’s needs is undertaken. This is needed to ensure the home is equipped to fully meet the needs of the service user. All the service users were registered with a GP. Individual plans and discussions with staff and service users showed that the health care needs of the service users were generally being met and that service users had access to health care services as required. A record of health screening and visits to and from health care professionals was kept for each service user. The home had a range of risk assessment tools for example, manual handling, water low and nutritional screening. Generally these were comprehensive and well maintained although some deficiencies were noted. For example: Examination of one service user’s care records revealed the service user had a pressure sore and was receiving district-nursing support. A specific care plan for pressure area care was not in place. The inspector advises that for those service users at risk of developing pressure areas, individual care plans are developed. These must contain sufficient information to guide staff practice for example, they should set out in detail tasks staff are expected to carry out for that individual e.g. where ‘regular’ positional changes are advised care plans must be more specific in terms frequency, manoeuvres and monitoring arrangements etc. Haverholme House Care Home DS0000002789.V282721.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 14 The home provides flexible daily routines and some activities are provided to meet the capabilities and preferences of service users. EVIDENCE: Service users spoken to said daily routines were flexible. Service users confirmed that they were able to choose how to spend their day, what clothes to wear and which visitors to receive. There were no set times for rising or retiring. Service users are consulted on a range of matters, which affect their daily lives through service user meetings, quality assurance questionnaires and one to one meetings. The home employs an activity co-ordinator, although at the time of the inspection this post was vacant. Service users and staff commented that generally there was a good range of activities provided in the home. However in the absence of the activity co-ordinator care staff are organising activities for service users. Whilst it was evident that care staff were trying their best to ensure a full programme of activities, they were clearly not able to devote enough time to this because of their caring duties. The in-house programme included quizzes, singalongs, film shows and trips out. In interview the manager reported that action had been taken to recruit a new co-ordinator.
Haverholme House Care Home DS0000002789.V282721.R01.S.doc Version 5.1 Page 12 Although the home is situated in a rural position, the service is well established; the manager and staff reported that local schools visited the home, communion services are held monthly and fundraising events such as fayres are well attended. Staff reported that the open home operates an open door visiting policy and this was confirmed in discussions with all the service users the inspector spoke to. Service users commented that staff offered their visitors drinks. Staff reported that they helped service users to maintain family contacts by sending cards at significant occasions such as birthdays and Christmas and supported service users on outings. This was confirmed in discussion with residents. Relatives who returned a questionnaire reported they were very happy with the care and support provided to their relative. The home has a mini bus, which is used to transport service users on outings and to provide transport for visitors to the home, thereby helping service users to maintain family contacts. Haverholme House Care Home DS0000002789.V282721.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards 16 and 18 were assessed and met at the last inspection and were therefore not reassessed on this occasion. EVIDENCE: Haverholme House Care Home DS0000002789.V282721.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Key standard 19 and 26 were assessed and met at the last inspection and were therefore not reassessed on this occasion. EVIDENCE: Haverholme House Care Home DS0000002789.V282721.R01.S.doc Version 5.1 Page 15 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): 29 & 30 The arrangements for vetting staff before they start working in the home do not ensure the safety and protection of service users. Staff training is generally satisfactory although improvement is needed in the provision of mandatory training. EVIDENCE: The inspector examined the personnel records for one worker employed since the last inspection. The majority of records required by regulation 19 of the Care Homes Regulations were in place. A POVA first check had been sought and a satisfactory Criminal Records Bureau check had been obtained, however only one written reference had been obtained. Failure to follow sound recruitment practice potentially places service users at risk and this practice must cease. The registered person must ensure two written references are obtained before staff commence working in the home. The manager maintained individual staff training records and the inspector examined a sample of these. Records showed staff had been provided with a range of training although some gaps were noted. Records and discussions with staff identified most staff had not had any recent moving and handling training. Some staff had seen a moving and handling video. This does not equip staff with the required skills to move and handle people safely and formal moving and handling training must be provided, this
Haverholme House Care Home DS0000002789.V282721.R01.S.doc Version 5.1 Page 16 must include hoist training. This is needed to meet health and safety requirements. Some staff were undertaking specialist tasks for example peg feeding. It was reported that nurses working in the home had provided this training for this. Whilst this is acceptable practice, evidence of effective teaching must be provided and training must include assessment of competence. A written record of any specialist training provided must be made. Training records did not evidence that some care staff had received service specific training and development in areas such as continence, pressure area care, dementia, strokes and other conditions common to older people. This is needed to ensure staff have the necessary skills, knowledge and competencies to meet the needs of service users as set out in the home’s statement of purpose. The home’s training plans and priorities must now taken account of this Haverholme House Care Home DS0000002789.V282721.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): 33 The home has a quality assurance programme in place. EVIDENCE: The home has achieved the local authority’s Quality Development Award. In addition the home operates an internal quality assurance programme. The quality assurance system consisted of weekly and monthly audits and quarterly surveys service users, their carers, staff and key stakeholders. Feedback is reported to the companies Head Office; this ensures ensured the area manager is kept informed. Questionnaires seek feedback on a number of key areas for example meals, laundry, personal care etc. Once the information is returned the results are collated and placed on the notice board in the home. Action plans are developed to meet shortfalls highlighted by questionnaires. Haverholme House Care Home DS0000002789.V282721.R01.S.doc Version 5.1 Page 18 The registered person should ensure copies of the home’s quality assurance plan or a summary of this is made available in the service user guide and for inspection purposes. Haverholme House Care Home DS0000002789.V282721.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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x X 3 X X X X X Haverholme House Care Home DS0000002789.V282721.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 OP7 Regulation 15.1. Requirement The registered person must continue to develop the care programmes documentation to ensure all problems are clearly identified with associated care interventions. (Previous time scale of 07/03/05 not met). The registered person must complete a care plan for service user A. Where required care plans must be supported by completed risk assessments. The registered person must arrange to have service user B needs reassessed. If the outcome of the assessment determines the home cannot meet all the service users care and support needs the service user must be moved to a more suitable placement The registered person must ensure service users are not admitted to the home where required care and support is not available to the service user and
DS0000002789.V282721.R01.S.doc Timescale for action 27/01/06 2. OP7 15 & 13 17/03/06 3. OP7 13 17/03/06 4. OP3OP7 13 13/03/06 Haverholme House Care Home Version 5.1 Page 21 5 OP38 18(1)(c ) 12(4)(b 6 OP38 18 staff The registered person must ensure staff are provided with manual handling training including hoist training. Training must be facilitated by a competently trained person The registered person must ensure where care staff undertake specialist tasks, evidence of effective teaching must be provided and training must include assessment of competence. A written record of any specialist training provided must be made. The registered person must ensure no worker commences working in the home until to satisfactory references have been obtained. The registered person must obtain the missing reference for staff member A 30/04/05 30/04/06 7 OP29 19 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Haverholme House Care Home DS0000002789.V282721.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Haverholme House Care Home DS0000002789.V282721.R01.S.doc Version 5.1 Page 23 Haverholme House Care Home DS0000002789.V282721.R01.S.doc Version 5.1 Page 24 Haverholme House Care Home DS0000002789.V282721.R01.S.doc Version 5.1 Page 25 - 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!
