Inspection on 15/01/07 for Haverholme House Care Home

This inspection was carried out on 15th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

Other inspections for this house

Haverholme House Care Home 23/11/09

Haverholme House Care Home 08/01/09

Haverholme House Care Home 09/01/08

Haverholme House Care Home 13/03/06

Haverholme House Care Home 20/10/05

Haverholme House Care Home 02/02/05

Haverholme House Care Home 07/07/04

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Haverholme House Care Home Broughton Road Appleby Scunthorpe North Lincolnshire DN15 0AD Lead Inspector Ms Matun Wawryk Unannounced Inspection 15th January 2007 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.V308592.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. Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Haverholme House Care Home Address Broughton Road Appleby Scunthorpe North Lincolnshire DN15 0AD 01724 862722 01724 282378 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 Position Vacant 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.V308592.R01.S.doc Version 5.2 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. 13th March 2006 Date of last inspection Brief Description of the Service: Haveholme House Care Home is situated 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 service users with residential care needs are accommodated in the newer purpose built extension, which is called Grove Court. All bedrooms are single occupancy and most offer lovely views of the surrounding countryside. The grounds are extensive and 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. As at 24th August 2006 the weekly fees ranged from £327 to £365 per week. Residents will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these can be obtained from the manager. Information on the service is made available to prospective and current residents via the homes statement of purpose, service user guide and inspection report. Copies of these documents can be obtained from the home. Haverholme House Care Home DS0000002789.V308592.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 first key inspection of 2006/07. The inspection visit took place over 1 day in January 2006. Mrs Matun Wawryk and Mrs Janet Lamb Regulation Inspectors carried out the site visit Prior to visiting to the home the inspector sent survey questionnaires to fortynine staff of which thirteen (27 ) were returned; twenty-seven residents of which fourteen (52 ) were returned and two professional staff. Comments received were analysed on their return and any issues identified were checked out during the inspection visit. Following the visit questionnaires were also sent to twenty relatives of, which nine (45 ) were returned. Some of the comments received by people have been included in this report. Information received by the Commission since the last inspection was also considered in forming a judgement about the overall standards of care provided by the home. Forty-nine residents were living in the home on the day of the inspection visit. The inspectors had discussions with eight residents, the operations director, the homes administrator, two nurses, one senior care worker, three care workers, a domestic and three relatives to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. The inspectors checked to see that residents privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured residents were safe and protected in their environments. Documentation in relation to the assessments people had prior to admission to the home and support plans produced to meet assessed needs were examined. In addition the inspector also looked at a number of records in relation to the recruitment of staff, medication practices, complaints management, staffing levels, staff training, induction and supervision. The inspectors also looked at how the home monitored the quality of the service it provided and how the home was managed overall. Since the last visit in March 2006, the Commission has received two complaints about the home. One complaint was passed to the owners of the home for them to investigate and the Commission looked into the second. Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The manager and staff team had tried to make sure some of the things the inspector asked them to do at the last inspection visit had been completed. However there were still a few things outstanding. The home had improved the quality of resident care plans. Plans seen contained a lot of information about the needs of the resident. This meant staff had access to all necessary guidance to tell what help the person needed, when they needed it. More staff had been provided with essential training in safe working practices for example; moving and handling people. Thereby helping staff to carryout their work more effectively and safely. Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 7 What they could do better: The home makes information about the home available to prospective residents and their representatives through a statement of purpose and service user guide. Both these documents needed to be updated to show changes of staff and fees charged. This was needed to ensure that the rights and best interests of the people living in the home are promoted and to ensure prospective residents and or their representatives have all the information they need to help them make informed choices about which home they want to reside in. Although some social activities were arranged discussions with residents and staff showed residents need to have access to a wider range of activities both within and outside of the home that offers them a choice of stimulating and interesting things to do. Following a check on a sample of employment records for new staff it was the identified that the home was not always following good practice when recruiting and selecting staff and action must now be taken to address this. The home must now ensure all required checks on prospective employees are carried out before they start working in the home. Failure to do so could result in resident’s being put at risk of harm. Not all staff had completed training in the protection of vulnerable adults from abuse. This was important, as all staff need know what to do and who to tell if they suspect abuse has occurred. Also not all staff had up to date certificates in other important training for example moving and handling, fire safety, health and safety and first aid. This training must now be provided to all staff because its important that staff know how to move and handle residents safely, to ensure they know what to do in the event of a fire and to ensure residents receive appropriate help should they have an accident. The manager and senior staff were supervising staff on a 1-1 basis, but these supervisory meetings were not up to date for all staff. The manager must now ensure staff get more regular 1-1 supervision. This is important because staff need to be provided with necessary guidance; leadership and support to ensure residents living in the home are safe and well cared for. Information received from residents, staff and relatives indicated that a review of staffing levels is needed, based on assessment of the needs of the residents, this would enable more informed judgement to be made about the homes staffing needs. The inspectors would like to thank everyone who completed a questionnaire and/or took the time to talk to then during the inspection visits. Their comments and input have been a valuable source of information, which has helped inform this report. Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 8 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. Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 9 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.V308592.R01.S.doc Version 5.2 Page 10 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, 2 and 3 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. All residents undergo a full needs assessment before admission. Residents need to be given better information about fees and charges to enable them to make informed decision about whether the home can meet their needs. EVIDENCE: The home had a statement of purpose and service user guide, which give lots of information about the home. These documents required updating to show staff changes and to give more information about fees and charges including Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 11 information about whether charges or arrangements differ for people whose care is funded partly or wholly funded by a third party. It is important that general fee information is widely available at an early stage to enable people to make informed choices. Three staff spoken to were to give detailed information about the admissions procedure for the home. Staff said the manager or one of the nurses would where needed visit prospective residents before making a decision about whether the home could meet the person’s needs. Staff said residents were provided with a copy of the service user guide either before or on admission to the home. Fourteen residents returned a questionnaire; twelve said they had been provided with written information about the home before they moved in. Of these ten confirmed they had also received a contract/statement of terms and conditions from the home. One individual could not recall whether they had received one, another individual said social services had issued the contract. Examination of a sample of files showed resident agreements were in place for some residents, however in most cases these were over two years old and some had not been signed by the resident or their representative. It is important that each resident knows what he or she is paying for and any terms of residency. The manager is advised to ensure everyone who is coming to live in the home is given a personalised statement specifically relating to the care, accommodation etc that they will receive for the fee being paid. This should be supplied, at the latest, at the point at which someone takes up residence in the home. Full details about can be found in the revised Care Homes Regulations. Each resident had their own individual care file and a sample of four care files were looked at. This evidenced that admissions are not made to the home until a full needs assessment has been undertaken. All the files contained a needs assessment, completed by the responsible funding authority. In addition the home had also completed its own assessment before a placement had been offered or on admission. There was nothing to show that residents were formally advised that the home could meet their needs, this should now happen. Individual care plans had been developed identifying the persons needs and abilities using the information in the assessments and other information obtained from discussions with the resident and/or their families. Residents at the home who received nursing care had had an assessment by a NHS registered nurse from the local Primary Care Trust, to determine the level of nursing input required by each individual and to determine the amount of financial support they would receive. Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 12 Staff members spoken to were knowledgeable about the needs of each resident and had a good understanding of their specific problems/abilities and the care needed on a daily basis. Currently the home employs a small number of male carers this means as far as practicable residents can have some choice about the gender of staff who deliver their care. Information from the Pre-Inspection, survey questionnaires and discussion with residents established that all the residents were white/British. The operations manager said the home is able to support individuals with specific cultural or diverse needs following a needs assessment being completed. And where necessary additional training and guidance would to provided to staff to enable them to be responsive to the resident’s individual needs. Comments from the face-to-face discussions with three relatives and eight residents showed that overall they were pleased with the care being given. Two residents and the relative of another were questioned about what information was provided to them about the home and fees charged. All those spoken to were able to show a clear understanding of what they were required to pay and were satisfied that they had been given enough verbal information from the manager/staff before deciding to come into the home. One service user said ‘ I am quite satisfied that the home can meet my needs’. Nine relatives returned a questionnaire. In response to the question ‘are you satisfied with the overall care provided? eight said yes, one said no. Comments received included ‘ in my opinion the home is faultless and I think of the nurses and carers as my friend’ another wrote ‘ I feel the standard of care has gone down in the last six months’. The home does not accept intermediate care placements so standard six is not applicable to the home. Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 13 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 good. This judgement has been made using available evidence including a visit to this service. The care and support each resident needed and received was documented and care provided was based on assessment of individual needs and choices. Personal support is offered in such a way as to promote and protect the service users privacy and dignity. Arrangements for meeting the health care needs of service users are satisfactory. EVIDENCE: Staff reported that individual care plans were in place for all residents. Four residents care plans were examined, these set out in the health, personal and social care needs identified for each person. The plans looked at had been evaluated on a monthly basis and any changes to the care being given was documented and implemented by the staff. Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 14 Risk assessments were in place to cover a wide range of areas including, skin problems (pressure sores), nutrition, moving/handling and activities of daily living. Information about the resident’s social interests, likes and dislikes, spiritual needs were also included within the individuals care plan. Records evidenced that the responsible funding authorities of some residents had carried out regular reviews, although this was not the case for all. The manager needs to ensure regular in-house reviews of care plans involving the resident and/or their representative are carried out as a minimum annually. Some residents had signed agreement to their care plan, but this was not happening in the majority of cases. This is an area the care plans could be further improved by ensuring all residents or their relatives (as appropriate) sign care plans to indicate they have had input to their plans and agreed the contents. All the residents spoken to said that they had good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. Responses to the resident survey showed that residents were satisfied with the level of medical support given to them, although one resident wrote in their questionnaire ‘ I feel I could do to see a doctor more often than I do’. Evidence from discussion with staff and residents showed residents’ personal aids were well maintained and the home provided the necessary aids and equipment to support both staff and residents in daily living. Entries in care plans specified where individuals had specific dietary needs, including Percutaneous Endoscopic Gastrostomy Feeding (PEG), food supplements and soft diets. Records evidenced staff were monitoring the weights of residents on a regular basis and evidence in the plans showed dieticians were contacted if the home had particular concerns about an individual. Records showed nurses and some care workers had received training in PEG feeding. It is important that before care workers carryout this task an assessment of their competency specific to the resident is made by a competent person and the outcome of the assessment is recorded. One area where health care could be improved includes, Ensuring fluid balance charts are kept for residents with PEG tubes. The keeping of detailed records of all feeds (including batch numbers) and flushes administered via the PEG tube is standard nursing practice. The home had a range of written guidance (policies and procedures) for medication. The medication policy for the home says that people can selfmedicate if they want to after a risk assessment has been completed and Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 15 agreed. All of the residents spoken to said they preferred the staff to administer their medication. A signature list of staff authorised to administer medication was present. Qualified nurses administered medication to residents with nursing needs and senior care workers administered medication to nonnursing residents. Records showed these staff had completed medication training. Checks on the medication records showed that overall these were well maintained and kept up to date, however there were a few areas where they needed to be improved. These included; Staff were sometimes handwriting medication onto the medication sheets (transcribing), but were not always following good practice. Staff need to include the amounts of medication received or brought forward, and two staff need to sign the entry to indicate they have both witnessed that the information on the sheet is correct. Balances of medication were not always being recorded on the medication sheet, to show running totals. This should now happen One resident was having medication administered via a PEG. Feedback from one nurse indicated that more than one dosage of medication was given at the same time. Records did not give any information about a need to flush the PEG tube between the administration of each medication. Failure to do this may result in blockages occurring. Such an outcome would be detrimental to the health and wellbeing of the resident. Checks on the controlled drugs and register showed that these are up to date, accurate and well managed. Residents and relative comments obtained through face-to-face discussions and surveys showed that overall they were very satisfied with the care and support offered by the staff. All the residents spoken to said they were happy with the way in which personal care was given, and they felt that the staff respected their wishes, choices, privacy and dignity. As indicated in other sections of this report resident’s had some choice regarding the gender of staff delivering their care as the home employed both male and female staff. One individual said ‘ the care staff are very good’ another said ‘the staff are very good at attending to my needs’. Another wrote in their questionnaire ‘the care staff are very busy and don’t have much time to sit and talk’, one relative wrote in a questionnaire ‘I find the staff very helpful and friendly’. Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 16 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. Residents were offered a limited range of activities. Residents were encouraged and supported to maintain family contacts with visitors being made welcome at any time. The meals provided to residents are of a good quality and offer some choice, although residents feel a greater variety of food could be provided. EVIDENCE: Staff said the routines of the home were planned around the resident’s needs and wishes. All of the residents spoken to said they were able to make choices about things that mattered to them. Residents confirmed there were no set times for rising or retiring. In discussion staff displayed good knowledge of individual residents needs, likes/ dislikes and family support and records contained information on people religious observances. Staff said residents would be supported to access local churches or to attend services held in the community where this was needed and this was confirmed in discussions with residents. Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 17 The home employs a part-time activities co-ordinator who organises and runs activities in and out of the home, although only limited information about events and activities was on display in the home. Of the fourteen residents questionnaires that were returned, two residents did not give a response to the question about activities, one person said they preferred not to join in activities whereas five stated that there were sufficient activities ‘always, three people said there were sufficient activities sometimes’ and one answered never. Four residents spoken to said they were satisfied with the level of activities available to them but commented that it was always the same people who joined in these. Residents also commented that activities did not appear to meet the needs of more dependant residents. This assertion was supported by most of the staff spoken to. Little information was documented in the care plans about individual wishes and needs regarding social and emotional care. Examination of a sample of files established social profiles had been completed, however in some cases these were not detailed. This together with the information from questionnaires and discussions with residents and staff showed staff need to look in more detail at peoples social stimulation needs in order to better tailor daily activities to the individual wishes, needs and capabilities of some residents. The operations manager was aware of the need to improve this area of practice. Discussion with the residents indicates that they have good contact with their families and friends. All the residents said they were able to see visitors in the lounge or in the privacy of their own room and they could go out of the home with family or staff. Three relatives spoken to confirmed they were made welcome when visiting. Comments from residents spoken to showed they were generally satisfied with the meals provided by the home. Examination of the menu showed a variety of food was made available including fresh vegetables and fruit. Residents confirmed they were offered a choice of meals on a daily basis. Fourteen residents returned a questionnaire. In response to question ‘Do you like the meals at the home’ three residents said always, five said usually, five said sometimes and one did not give a response to this question. Comments received included; ‘I feel more green vegetables could be included in our diet, another commented ‘food not as good as it used to be’. One relative spoken to said ‘food adequate but lacks interest’. One relative wrote in a questionnaire ‘mid-day meal usually very good, teatime not very good or suitable’, and another wrote ‘I am happy with the care, meals could be improved’. These comments show that a review of menu should be considered. This matter was fully discussed with the operations manager who gave an assurance that she was planning to review the menus in consultation with residents and cooks. Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. The home had a satisfactory complaints system and staff and residents can be assured complaints and concerns will be listened to and acted upon. Adult protection systems need to be supported by a more consistent staff-training programme and more robust staff recruitment practice. EVIDENCE: The home had a complaints policy and procedure and information about how to complain was included in the homes statement of purpose and service user guide. Staff spoken to said that they had no specific complaints about the home and felt confident to raise issues of concern if they arose and that the manager or nurse in charge was always available for them to talk to if needed. Checks on the complaint records in the home showed the manager had dealt with two internal issues since the last visit in March 2006. These concerned a care issue and staffing levels and have now been resolved. Residents and relatives spoken to during the visits were aware of who to complain to should the need arise. Fourteen residents returned a Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 19 questionnaire, responses showed residents had been made aware of the complaint procedure and knew who to refer concerns to. Information from the Pre-Inspection Questionnaire and discussion with the operations manager indicated the home had policies and procedures to cover adult protection and prevention of abuse, whistle blowing, management of challenging behaviours and management of residents money and financial affairs. In discussion with staff about abuse, what it was and what they would do if they suspected or saw any abuse staff stated that they would report any concerns to the nurse in charge or manager. Not all staff spoken to were aware of the multi-agency adult protection procedures concerning referral and investigation of allegations of suspected abuse. Training records evidenced that whilst a number of staff had had adult protection training, a number of staff still needed to receive this training. Action must now be taken to address this. Since the last visit one adult protection referral had been made. The Commission carried out an unannounced inspection visit in response to a complaint about the way the home had handled this incident. The findings of the visit showed the home had not beached any regulations and that they had followed the multi-agency adult protection referral process. Examination of a sample of staff files showed the home was not always following good practice when appointing new staff. This is not acceptable practice as it potentially puts residents at risk of harm. The operations manager assured the inspectors that from now on new staff would not start work until the checks are obtained. This will be followed up at any future visit. Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 20 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, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided a clean and safe environment for people who live and work there and residents were able to personalise their bedrooms. EVIDENCE: The home was clean, tidy and odour free. Since the last inspection the home had had some problems with damp in two bedrooms and work was being carried out to rectify the problem. This had resulted in damage and staining of some hallway carpets. An assurance was given that once remedial work was completed, the hallway would be redecorated and the carpets would be replaced. This matter will be followed up at the next inspection visit. Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 21 All the residents spoken to were happy with their rooms and said they had everything they needed. All bedrooms looked at were clean and tidy and were furnished and decorated in a homely style. Many people had furnished their bedrooms with a range of personal items, some bringing in items of furniture to reflect their own individual choice and taste. Fourteen residents returned a questionnaire. In response to the question ‘is the home clean and fresh’ all respondents said always or usually. One relative wrote in their questionnaire ‘the home does not always smell nice’. All the bedrooms are single this means personal care and treatments can carried out in private thereby ensuring the privacy and dignity of the resident. Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 22 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): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home did not operate safe recruitment and selection practice. This potentially puts residents at risk of harm. This was compounded by inconsistent induction training and staff supervision. EVIDENCE: The roles and responsibilities of staff were clearly defined and discussion with staff demonstrated their understanding of the management and reporting structures for the home. Information given in the pre-inspection questionnaire did not include the number of staffing hours provided, or the dependency levels of residents. Comments in the questionnaire from the manager indicated she had concerns about staffing levels in the home. Inspection of the duty rota and discussion with the operations manager indicated staffing levels at the home remain the same as at the last inspection. Staff spoken said staffing levels were generally satisfactory, although two commented that they had little or no time to spend talking residents. Six Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 23 nurses/care workers returned a questionnaire. In response to the question do you feel there enough staff on duty to meet residents needs on all shifts? One said yes, four said no and one wrote ‘depends on dependency levels’. Seven support staff returned a questionnaire all wrote ‘don’t know’ or not applicable’ to the question about staffing. Most of the fourteen residents who returned a questionnaire said they always or usually received the care they needed. One resident wrote ‘I feel there are not enough staff on duty sometimes’ a relative wrote in one questionnaire ‘ it would be nice if the staff had time to give my mother a drink mid morning and afternoon’ Feedback from discussions with residents indicated they generally felt staffing levels were satisfactory to enable their needs to be met. One resident wrote in their questionnaire ‘felt staff are sometimes were rushed of their feet and said more staffing was needed’. One resident said they were sometimes prevented from having more frequent baths because staffing did not always allow this to happen. Nine relatives returned a questionnaire, in response to the question ‘in your opinion are there always sufficient numbers of staff on duty, four said yes and five said no. Because records did not give clear information on dependency levels for specific residents it was not possible to check whether existing staffing levels are appropriate. A review of staffing needs to be carried out based on assessment of the dependency levels of residents, using a recognised dependency tool, this is will enable more accurate judgements to be made about the homes staffing needs. All the residents spoken to said the staff were nice, friendly, had a good approach and they got on well with most of them. The inspectors observed good interaction between several staff members and residents during the visit. The home had an equal opportunities policy and procedure. Information from the staff personnel records, training records and discussion with staff, showed the procedure was promoted when employing new staff and throughout working practices in the home including staffs access to training. The home had a recruitment policy and procedure, which described the process to be followed when recruiting new staff. There was nothing to show that the home had considered involving residents in the appointment process. Employment records for a sample group of six staff appointed since the last inspection were examined. This showed two workers had started working in the home without a Protection of Vulnerable Adult register checks (POVA 1st) or Criminal Records Bureau check (CRB - police check). A second reference had not been obtained for one worker, before they started working in the home. A second reference for another worker was obtained after they started working in the home. This was not acceptable practice because it potentially puts Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 24 residents at risk of harm. The operations manager gave an assurance that in future no staff would start working or carry out any shadowing shifts until all checks were obtained. The operations manager stated that all new staff had a formal induction and a pro-forma for recording induction training was in place. The induction programme included opportunities for new staff to work alongside more experienced staff (shadowing). One staff member spoken to described her induction as ‘very good’. A request to look at the induction records for four workers showed an absence of written records confirming what induction training had been provided for two workers, records for the other two established only a very basic induction had been completed. This training did not meet not meet Skills for Care Common Induction Standards. This is not acceptable practice. It is important that new staff undergo a thorough induction to ensure they are equipped with the necessary skills to do the job and action must now be taken to address this matter. Information in the pre-inspection questionnaire states as at the 23rd of August 2006 seven care worker out of total of twenty-five had obtained a National Vocational Qualifications (NVQ). The manager had devised a basic training plan to incorporate mandatory training and updates. However records indicated that some staff were not up to date with all required training for example moving and handling, fire safety, first aid. This training must now be provided. This is needed to ensure staff know how to move and handle residents safely, to ensure they know what to do in the event of a fire and to ensure residents receive appropriate help should they have an accident. An annual appraisal system was in place in the home and records showed some staff had had an annual appraisal, however these were well over due for others. It is importance that annual reviews are kept up to date, this is needed to ensure the homes training plans and priorities accurately reflect the needs of the staff team. Evidence from records and staff surveys showed that some staff had had some training in conditions affecting older people. However there is a need for more specialised training to be offered to all staff that reflects the different care needs of older people for example; diabetes and strokes. This is needed to ensure staff have the required skills and competencies to meet the changing needs of residents Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 25 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): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there were deficiencies in the way the home was managed that may put service users at risk, information gathered showed the operations manager was aware of the issues and was actively looking at ways addressing identified shortfalls. Residents were satisfied with they service received. This similarly applies to staff, who were also satisfied with the support they received. EVIDENCE: The registered manager left the home in December 2006. A deputy area manager was managing the home on a day-to-day basis but was off sick at the Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 26 time of this visit. There is a need to employ a permanent manager for the home, who must then submit an application to register with the Commission. Staff spoken to said they had not noticed any significant changes since the previous manager had left. Staff said they believed the home was being managed well and said they found the nurses to be approachable and supportive. Some records were not readily available to the inspectors and some of the homes staff; the operations manager gave reasons for this. An assurance was given that an action plan was being put in place to address this problem. The inspectors saw evidence that the operations manager was committed to addressing breaches in regulation. For example, on drawing the manager’s attention to poor recruitment practice, she immediately arranged for an audit of all staff file to be completed and gave an assurance that any missing records would be obtained as a matter of priority. The operations manager stated that North Lincolnshire Council had awarded the home its Gold Standard for Quality Assurance. In addition the home had a range of other mechanisms in place to monitor the quality of services provided this included regular audits, regulation 26 visits and regular three monthly surveys with residents and their families. The inspectors were told that on return, comments received were analysed and action plans put in place to address any identified issues. At the inspection visit carried out in March 2006, the then manager had not fully completed any surveys for the previous three months, at this visit, staff were again unable to produce any summary reports for the home which showed the outcomes of quality monitoring arrangements. It is important that regular reports are produced this is needed to show how residents, relatives and other key people are consulted about services provided by the home and to ensure continuous improvements are made. Information from the pre-inspection questionnaire indicated that the majority of resident’s families look after their relative’s financial affairs. The home handled small amounts of money for some residents. From a sample of records examined it was established that residents were able to access their money on request, and receipts were kept for all transactions. All monies were kept safe and secure within the home and only the administrator or manager has access to the funds. A staff supervision programme was in place and each staff member had an allocated supervisor. Examination of a sample of supervision records showed some staff were in receipt of regular supervision. However this was not the case for others, with records showing infrequent supervision meetings. Discussion with the operations manager indicated that they were aware of this problem and an assurance was provided that the supervision process would be up dated and carried out on a more frequent basis. This will be looked at the next visit. Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 27 General health and safety was maintained via adherence to policies and procedures, staff training and the maintenance of equipment. Information provided in the pre inspection questionnaire indicates servicing of equipment was up to date. Records of accidents were maintained and regulation 37 reports were sent on to the Commission where appropriate. As indicated in other section of this report the previous manager had devised a basic training plan to incorporate mandatory training and updates. Records showed some staff had received training in safe working practices for example, moving and handling, first aid, health and safety, fire safety and infection control. However there were a number of staff that still needed to complete elements of training listed. Failure to ensure all staff receive timely training in safe working practices potentially puts both residents and staff at risk of harm and action must now be taken to address this. The homes administrator reported that a fire risk assessment was in place, but could not locate it on the day of the visit. It is important this is document is available at all times. General risk assessments in individual resident files were seen including those for moving and handling, bed rails and daily activities of living. Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 28 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 2 3 x X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X 3 2 X 3 Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 5 (1) (b) Requirement The registered person must revise the homes service user guide to provide general fee information and each resident must be given a personalised statement specifically relating to the care, accommodation etc that they will receive for the fee being paid. This should be supplied, at the latest, at the point at which someone takes up residence in the home.. It is important that this fee information is widely available at an early stage to support people to make informed choices. Further information about this can be found in the revised Care Homes Regulations The registered person must ensure fluid balance charts are kept for residents with PEG tubes. The keeping of detailed records of all feeds (including batch numbers) and flushes administered via the PEG tube is standard nursing practice. The registered provider must DS0000002789.V308592.R01.S.doc Timescale for action 31/03/07 2 OP8 13(2) 07/02/07 3 OP12 16(m) 31/03/07 Page 30 Haverholme House Care Home Version 5.2 ensure that residents have the opportunity to exercise their choice in relation to leisure and social activities; that these choices are recorded and they are offered a range of stimulating activities both inside and out of the home. 4 OP9 13(2) The registered person must ensure that written guidance is in place covering the administration of medication via Peg tubes, guidance must give information about flushes between the administration of each medication to ensure as far as practicable blockages do not occur Guidance must be written by an appropriate health care professional. 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. Timescale of 20/09/06 not met 10/02/07 5 OP38 18 (i) 14/02/07 6 OP18 13(6) 7 OP27 18(a) The registered person must ensure all staff complete adult protection training to ensure. staff know how to recognise potential abusive practices and to ensure they know how to report allegations of suspected abuse The registered person must complete a review of the homes staffing levels based on assessment of the dependency levels of residents using a recognised dependency tool. A DS0000002789.V308592.R01.S.doc 31/03/07 31/03/07 Haverholme House Care Home Version 5.2 Page 31 8 OP29 19(d) 9 OP29 18(i) 10 OP30 18(i) 11 OP31 8(1) record of the assessment must be made. In the event that the assessment determines additional staffing is needed this must be provided. The registered person must ensure all required records as detailed in regulation 19 and schedule 2 of the Care Homes Regulations are obtained before workers start working in the home. This must included a fully completed application form, two written references. A POVA 1st check pending receipt of a CRB check. Guidance about the need to ensure staff working in the home with only a POVA first check must be supervised at all times must be followed to ensure residents are protected from potential harm The registered person must ensure new staff are provided with structured induction training, which meets Skills for Care Common Induction Standards to ensure staff are equipped with the basic skills and knowledge the job requires. All induction training must be recorded. The registered provider must ensure that there is a training programme in place that provides staff with specialist training on the elderly and diseases relating to old age for example strokes, diabetes, and sensory impairments etc. This is needed to ensure staff are aware of common diseases associated with ageing to equip them with the right skills are knowledge to support people appropriately The registered person must appoint a permanent manager for the home; Following DS0000002789.V308592.R01.S.doc 14/02/07 28/02/07 31/05/07 14/02/07 Haverholme House Care Home Version 5.2 Page 32 12 OP33 24 (1)(2) appointment this individual must make an application to register with the Commission. In the absence of a registered manager the owners of the home must confirm in writing the arrangements put in place to ensure residents and staff benefit from a home that is well managed and organised The registered person must 31/03/07 ensure that an annual development plan for the home is produced. This must show how residents, relatives and other key people are consulted about services provided by the home and any action taken to address any issues raised by these individuals. A summary report must be made available in the service user guide The registered person must ensure staff receive formal and recorded supervision as a minimum of six times a year. This is needed to ensure staff receive, necessary guidance and support to carryout their work effectively and to receive feedback on their performance The registered person must ensure all staff are provided with training in fire safety, first aid and health and safety including infection control. This is needed to ensure staff know what to do in the event of a fire, to ensure they understand the need to follow safe hygiene practice and to ensure they know what to do in the event that a resident has an accident. There must be at least one qualified first aider on duty at all times. The registered person must DS0000002789.V308592.R01.S.doc 13 OP36 18(2) 31/03/07 14 OP38 13 ( c ) (5) 31/03/07 15 OP30 18(i) 31/03/07 Page 33 Haverholme House Care Home Version 5.2 16 OP38 18(1)(c ) 12(4)(b ensure each staff member has an annual appraisal. This is needed to ensure the homes training plans and priorities meet the needs of the whole staff team The registered person must ensure staff are provided with manual handling training including hoist training. A competently trained person must facilitate training. This is needed to ensure staff know how to move and handle residents safely. Timescale of 30/04/05 not met 31/03/07 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 OP9 Good Practice Recommendations The registered person should ensure a second member of staff should witness all hand written annotations on Medication Administration Record charts. Quantities of medication received into the home should be recorded on the MAR 50 of care staff should have achieved a NVQ 2 or above in care by June 2007. The registered person should ensure residents or their relatives (as appropriate) sign care plans to indicate they have had input to their plans and agreed the contents. The registered person should to ensure a review of care plans involving the resident and/or their representative (with the residents permission) are carried out as a minimum annually. DS0000002789.V308592.R01.S.doc Version 5.2 Page 34 2 3 OP28 OP7 4 OP7 Haverholme House Care Home 5 OP15 The registered person should review the homes menus, in consultation with the residents to ensure residents are provided with the food they like to eat Haverholme House Care Home DS0000002789.V308592.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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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