Inspection on 20/03/07 for Havering Court Nursing Home

This inspection was carried out on 20th March 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Havering Court Nursing Home 09/10/07

Havering Court Nursing Home 31/05/06

Havering Court Nursing Home 05/01/06

Havering Court Nursing Home 30/07/05

Havering Court Nursing Home 24/03/05

Havering Court Nursing Home 17/08/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Havering Court Nursing Home Havering Road Havering-atte-Bower Romford Essex RM1 4YW Lead Inspector Stanley Phipps Key Unannounced Inspection 20th March 2007 11:00 Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 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 Havering Court Nursing Home DS0000015593.V333729.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 and Care Homes for Adults 18 – 65*. 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. Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Havering Court Nursing Home Address Havering Road Havering-atte-Bower Romford Essex RM1 4YW 01708 737 788 01708 740 783 waltonki@bupa.com www.bupa.com BUPA Care Homes (BNH) Limited Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (16), Physical disability (36) of places Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 16 BEDS FOR ELDERLY FRAIL 36 BEDS FOR PHYSICALLY DISABLED MINIMUM STAFFING NOTICE Date of last inspection 31st May 2006 Brief Description of the Service: Havering Court is a purpose built residential care home with nursing, which is operated by BUPA, a large private company that runs similar homes across the UK. The home is registered for 36 younger adults (18 to 65) who have a range of physical disabilities, and 16 older people (over age 65). It is situated in Havering - atte - Bower, a semi-rural area, which is an approximately 15 minute bus journey from the nearest rail link in Romford Town Centre. The home is set in spacious ground and woodlands, which provide pleasant views from bedroom windows. The accommodation is spread over a ground and a lower ground floor, with access via a lift and stairs. The lower ground floor has 14 bedrooms of varying sizes, bathrooms and showers and, a large lounge with French windows onto a pleasant patio and garden. The main kitchen, laundry, and staff rooms are also on this floor. The remaining bedrooms are on the ground floor, along with a large lounge/dining area, staff office, bathrooms, and communal sitting areas. Many of the service users have very high dependency needs due to the level of physical disability, and in addition some have learning disabilities. Nursing and personal care are provided on a 24-hour basis. The current scale of charges is £529.24 - £946.79 for older people and £660.99 - £1508.90 for young people with a physical disability. Additional costs for items such as hairdressing, chiropody and in some cases physiotherapy are charged separately. Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over seven hours and was the second of its kind, carried out as part of the annual inspection programme for this home. The manager was present at the inspection and it was noted that the previously registered manager had resigned from her post towards the end of 2006. Two inspectors carried out the inspection and this enabled more time to be spent on each floor examining with some detail - the operations of the home. The home provides care to frail older people and also to younger physically disabled people. As the majority of the residents are younger physically disabled adults, the National Minimum Standards applicable to care home for younger adults have been used for this inspection, but due consideration has been given to the corresponding National Minimum Standards applicable to care homes for older people. In principle both groups of service users work well together, without affecting each other. Given the fact that there has been another change in manager and a high number of improvements that were required of the registered persons, the stability and progress made had been in some ways, affected. In speaking with the new manager, this was acknowledged. The inspectors provided the new manager with information on medication, clinical triggers for nutrition, falls, continence and pressure area care together with the Commission’s publications - Highlight of the day, Safe and Sound and Better Safe than Sorry. Equality and diversity issues were discussed in great detail with the manager, as it was evident that the needs of some of the service users are not being met. Currently this is with regard to spiritual needs and some cultural needs. The inspectors were also able to have a discussion with the manager around the need for staff to be trained in identifying and meeting the different needs of service users, and this included areas such as sexuality. It is important that everyone’s rights are promoted in a sensitive way, and that the organisation raises awareness amongst the staff team, encourages discussion and to remind them that sexual orientation/gender identity is about more than sex. Evidence was gathered from speaking with; staff and service users working on both floors, and visiting health professionals, viewing records, observing care practice and touring the home. Fifteen comment cards that were returned by service users were also considered in compiling this report. The inspectors found that service users were generally receiving an adequate level of service at Havering Court. This could improve once the registered persons continue to focus on meeting the requirements set out in this report. In speaking to the manager there was a verbal commitment to making the relevant improvements to drive up standards in the home, and so, produce better quality outcomes for service users living there. Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Ensure that the specialist services for prospective and current service users are clearly detailed in the statement of purpose. Service user plans and risk assessments need to accurately reflect the needs of individuals – including how they are to be safely provided. Needs to also reflect choices made. Provide activities in consultation with service users- that best meet their needs. Promote greater equality and diversity in relation to religion and sexuality. Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 7 Improve on enabling access to physiotherapy services as well as ensuring that clinical records are appropriately maintained. The safe handling of medication is paramount to good health promotion and all service users are entitled to this, whilst living at Havering Court. A stable and competent staff team is needed, one that is permanent and able to provide consistently high standards of care. It must be reflective of the dependency needs of service users. Review the induction programme to ensure that staff have information in relation to safeguarding adults at early stage. The maintenance programme needs reviewing to ensure that the damage to walls and doorways, are more frequently decorated. Arrange for more appropriate storage of equipment for a safer home. Provide regular supervision for all levels of staff. Improve on the quality assurance strategy, involving service users views as part of developing the service. 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. Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2(Adults 18-65). 1&3 (Older People) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Prospective service users have the benefit of updated information in relation to the home, although this needs to improve for the younger adults. Service users’ needs are generally assessed prior to admission to Havering Court, and this provides a sound basis for meeting them. EVIDENCE: An updated statement of purpose and service user guide was in place and from discussions with service users and their relatives – they were aware of it. From feedback received over ninety percent felt that they had enough information about the home prior to deciding to live there. One individual indicated that he was brought there and left, but was quite pleased with the service. Another wrote that; ’the information was very good’. Although, the information regarding the services were available, a number of younger service users Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 10 expressed concerns around the lack of activities regarding their needs and the desire to go out more. In discussions with the manager, it was evident that the statement of purpose and service user guide needed reviewing so that the information given to prospective service users is clear as to the real opportunities available to people who choose to move into Havering Court. This is particularly true for the younger physically disabled, most of who found themselves being engaged in the generic operations of the service. Havering Court is set up with the aim of providing a specialist service to this group (YPD) along with services for the elderly and, as such the documents needed to be clearer around this. A number of case files representing the two groups between both floors were examined. Comprehensive assessments were found in place and this included, those for the most recently admitted service users. There was evidence that the pre- admission assessments were, carried out by qualified staff and service users and/or their relatives are involved in the process. There was also evidence that a summary of the service users needs is obtained as part of information gathering prior to admission. In most cases prior visits are encouraged as part of this process. The home generally admits service users during the core hours of 9a.m. and 5p.m. to ensure that missing and pertinent information could be followed up fairly promptly. Admissions on a particular day are, usually carried out by the nurse in charge. The process takes into consideration the individual needs, which are matched against the home’s ability to meet them. This includes having staff with the skills and expertise to deliver the care and support identified from the initial assessment. The process also takes into consideration the type of equipment required to meet specialist needs. Service users are therefore generally assured that the service is capable of meeting their needs and goals. Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,and 9 (Adults 18-65) 7, 14 and 33 (Older People). People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Despite some improvements in service user planning, this did go far enough to ensure good consistent care. Service users were generally pleased with how their rights were promoted, but there was evidence that some did not have the benefit of this experience. Risk management systems were in place to promote service users’ independence, however more effort is required to ensure their safety. EVIDENCE: Service user plans were in place for all the individuals that were case-tracked across both floors. They were developed from a comprehensive assessment, including preadmission information. They also contained detailed information regarding the specific care needs and individual preferences of service users. It Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 12 was noticeable that some were more detailed and comprehensive than others. More effort was placed on ensuring that personal preferences/life choices were recorded and, this is positive. Good care planning was particularly noticeable in catheter care, wound management, moving and handling and personal care. The organisation introduced a ‘QUEST’ model of care planning, which could include areas for pain management, family input and end of life. These areas had not been covered in the files inspected. There was evidence that some of the service user plans are being reviewed, but not always on a monthly basis. This problem was noted at the last inspection. Whilst there were daily progress notes, they were not always linked to the individual plans. There was also evidence that some staff including agency staff were not referring to service users’ plan when delivering care. One service user reported: ”I am not happy with the agency carers because they come into my room and do not know my needs, and they handle me wrongly”. One care plan made reference to staff being aware and reading the Royal Marsden handbook of clinical procedures, but this document was not available on the lower ground floor and the nurse-in-charge of this unit was not sure where she would find a copy. It is essential that all staff providing care to service users are made aware of the needs and their individual plan before delivering care. Similarly, documents that are pertinent to delivery of care must be available to ensure that the care is provided in line with any specialist guidelines. This would improve the opportunities for good and consistent care provision at Havering Court. There was evidence that risk assessments were carried in a number of cases and for a various reasons – mostly in promoting service user’s safety and, their independence. For many service users the use of bedrails was common and the use of lap restraints in wheelchairs, to a lesser degree. From assessing the relevant case files, there was limited evidence to support the fact that appropriate risk assessments had been undertaken as a matter of course. It is essential that the need for bed-rails, lap restraints or, indeed, any other form of restraint be discussed with the service user and/or family/advocate and, that appropriate risk assessments are in place together with regular reviews. One of the service users interviewed stated; ‘I do not know why this strap is on me’. This individual was sat in his room after lunch in front of his TV on a wheelchair. What was interesting was that during the interview he fiddled about with the lap restraint and was amazed and relieved that he could undo it. It must be clear why these devices are used and as stated earlier, consultation with service users and their advocates/significant others must take place regarding the use of such restrictions. Service users spoken to confirmed that they had choices within the routines of the home, and that they could get up and go to bed when they wanted, although one individual stated that he could not do what he wished during the Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 13 evenings. It was clear that other choices were not always enabled or responded to. For example one individual said; “I need help with reading my daily newspaper, but this does not always happen”. Another service user said; “it is like a prison because the doors are often locked and I can’t go out into the garden when I want to”. During a tour of the ground floor the inspectors found doors leading to the garden locked, with devices that were ‘out of reach’ for service users. These issues were discussed with the manager at the end of the inspection, and he has agreed to address them. There was no evidence of independent advocacy input at the time of the inspection, although the manager advised that should this be required, arrangements would be made for access to such services. It was however noted that in many cases, service users relatives were involved in promoting the rights and interests of their loved ones. This is positive. Some of the service users spoken to confirmed that they manage their own finances and where support and assistance is required, then this is usually available. The management does not act as appointee for any of the service users. Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 15 12, 13, 15, 16, and 17 (Adults 18-65) and 10,12,13 and 15 (Older People). People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users are involved in various activities, which need to be enhanced. They are part of their community, although more needs to be done in relation to promoting equality and diversity across the home. Service users maintain good links with their friends and families and have their rights promoted at Havering Court. Their nutritional needs are well provided for, which is enhanced through choice and variety. EVIDENCE: Service users spoken to and those providing written feedback informed that activities do take place in the home. Some were pleased with it while others were not. Since the last inspection, one of the activities’ staff had moved on and so this has left a void. Plans were in place to address this as it had an impact on the range and frequency of activities that were currently provided. It is important however for staff to participate and engage in activities recognising the importance and benefits to service users. This may involve just sitting and talking to service users, reading a newspaper, book or magazine to them. It would also help if activity resources are left available in the communal areas so that service users can dip in and dip out as they wish. The reminiscence corner on the ground floor is a good example of this. Generally service users are able to take part in age and peer appropriate activities. On the day of the inspection several of the service users, who were either frail elderly or younger physically disabled adults, were taking part in a quiz on the upper floor. This quiz was obviously being enjoyed by all parties and was a regular occurrence at the home. There were no activities taking place for those individuals accommodated on the lower ground floor. Whilst it is accepted that service users from the lower ground floor can participate in activities taking place on the upper floor, some many not wish to move out of their lounge. It is essential that activities are made available to all service users, irrespective of room location. In discussion with one of the younger service users, he indicated that the activities were more skewed towards older people and while he did not mind at times – he would prefer activities that were more challenging and stimulating. Another older, but mentally able service user said that “I really find bingo boring and sometimes there is no choice, so I just sit in my room”. In discussing activities with one other individual, he informed that the activities could be more person centred, and he described that he is able to use his computer with internet-access (which he pays for) to keep him stimulated. This is positive and could be encouraged more in the home. Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 16 It was obvious from posters around the home and from discussions with service users there was entertainment for them, and they all recently took part in a fun day for Comic Relief. Elvis at Havering Court was scheduled for the 5/4/07 and some of the service users were looking forward to this. However, the posters and decorations were all on the ground floor, but none on the lower ground floor. There is an activities programme, which showed that bingo was on in the afternoon. A sensory room in place, but this is rarely used, which for such a valuable resource is, unfortunate. There was no reference to this room in service user plans. The registered persons need to review its activities to ensure that they are widely available and more suited to all service users. There was good evidence to support the fact that service users are given opportunities to access the community. For most this is done using dial-a-ride and/or mini buses. Arrangements are also made for service users to register for the London taxi-card scheme and this is positive. They use the community for shopping and leisure and the local pub remains a good resource for some service users choosing that option. There was also evidence that information on community resources are available to service users and this is positive. Service users commented: “that the manager arranges for us to go out when we request to do so”. It was noted that more work needs to be done around equality and diversity in the home, as some areas such as spirituality and sexuality were not adequately addressed. One individual felt that he did not have the opportunity to either visit a mosque or meet with an Imam at the home. It was evident that Christian festivals are being celebrated at the home and these are inclusive of all of the individuals who wish to participate. There were others of different religious persuasions that did not share a similar experience. In a multi-cultural home it is important that individuals are able to share different views and experiences. The same is true with regard to sexuality as it was not clear that staff were able to identify and meet the specific needs of service users. This was discussed with the manager and is more than likely a training issue. It is important that everyone’s rights, young or old, are promoted in a sensitive way, and that the organisation raises awareness amongst the staff team, encourages discussion and, to remind them that sexual orientation/gender identity is about more than sex. It is about culture and community and many other aspects. This is an area for improvement. There was good evidence that relatives were encouraged to visit service users at Havering Court and this includes taking them out in the community as and when required. Service users spoken to confirmed that there is an open visiting policy and felt that their relatives were welcomed into the home. Feedback received from relatives confirmed this and on the day of the inspection one relative was seen to be using the servery on the ground floor to make drinks. A sample of service users spoken to confirmed that could have Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 17 friends visit them if they wished to. There are also good arrangements in place to meet relatives, should privacy be required. A good level of interaction was seen between staff and service users, and the latter confirmed that staff were good with regard to privacy and always knocked on doors and were generally polite. However, several individuals did say that; “some of the night staff were not always very kind”. In discussion with the manager, he provided evidence of doing night monitoring visits to improve the experiences of service users. It is positive that he has started acting on feedback received from service users, which should provide better outcomes for them. Service users spoken to also confirmed that they had choice regarding getting up and going to bed and this was observed on the day of the inspection. This was observed during the course of the inspection. Over ninety five percent of the feedback received confirmed that the routines of the home were flexible and all service users preferred it that way. It was noted that the quality of the food had improved significantly since the last inspection. Most of the service users were happier with the meals provided and, relatives spoken to shared similar views. Meals were reportedly more varied and reflective of the choices made by service users. It was noted that a small sample of service users felt that the meals could improve further and the head chef have been working on meeting as many of them to ensure that maximum satisfaction is achieved. He has demonstrated that he is willing to meet individual preferences, where service users were unhappy with what is provided on the day and this is positive. Fresh fruit and vegetables were available, although fruit was mainly seen on the upper floor. One service user stated; “when I want a fruit I just go up and take one”. This must be looked at as not every service user would take this approach and so, may lose out on enjoying fruits when they choose to. In general there was a good supply of food, which included fresh and frozen food. From observation it was conclusive that the specialist nutritional requirements of the service user groups were adequately provided for. It was also observed that food was appropriately stored to ensure that they maintain their nutritional values. Meals were observed on both floors during the course of the inspection and the experiences were indeed different for those on the lower ground floor. Whilst the upper floor was immaculately prepared, service users on the ground floor did not have a similar opportunity to eat at a dining table that was set. There was a lack of napkins and tray cloths for those individuals on the lower ground floor and the experience of dining should pleasant and special for all individuals. Staff were observed to assist and support residents appropriately with feeding, and the meal times are staggered so that all service users, whether in their bedrooms or in the lounge receive the required assistance. Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 18 From the service user plans viewed it was evident that nutritional screening is undertaken and that the weight of each individual is monitored on a regular basis. Given the length of time between breakfast from one day to the other, a night bite system is in place to ensure that service users are not left for over twelve hours without food or drink. To enable this, the chef prepares a platter of sandwiches for the evening, which is left in the fridge in the serving area on the ground floor, as are other items such as bread for toasting, tins of beans and soup. There is no such storage on the lower ground floor and the inspectors were unconvinced that service users on this floor had the full benefit of the night bite system. This was confirmed with some service users on the lower ground floor, who had no knowledge of the service, neither did they have the benefit of having an advertisement of the service on that floor. This was discussed with both the manager and the head chef, who have agreed to ensure that service users accommodated on the lower ground floor have the same choices and service as those on the ground floor. Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. (Adults 18 –65) and 8,9 and 10 (Older People). People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users do not always receive the personal care and support they require. Their physical and emotional health needs are generally met but staffing and, at times the inadequate recording of clinical activity can affect this. While improvements have been made in the handling of medication, it did not go far enough to ensure the health, safety and overall wellbeing of service users. EVIDENCE: Feedback received from service users and relatives was mixed with regards to how they experience personal care and support in meeting their needs. In fact, it was similar to the views expressed at the last inspection. One service user said; “the majority of us on this floor are totally dependent when in bed, and in the mornings there is not always sufficient staff on duty and often I have to Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 20 wait a long time for assistance”. Another said; “it does depend who is on, and often there are lots of agency staff who do not know what to do”. In discussion with one of the younger service users, he described his experience of having to wait for up to four hours in a soiled pad as: “unsatisfactory”. He indicated that he was told that the home could not get agency cover due to the short notice given by permanent staff. The general impression is that the quality of care is affected by the level of agency staff and/or numbers of staff on duty. This is an area that has been identified last year and continues to be an area of concern. Specialist equipment is available and a physiotherapist visits the home. In an interview with the physiotherapist she felt that the staff understood the needs of service users and liaised professionally at all times with her. However, one service user spoken to said that; “If I had physiotherapy on my foot it would help to give me confidence so that perhaps I could be more independent and be able to stand, or even walk”. Another service user informed that before he came into Havering Court he was on the verge of making his first step, now he is dependent on using a wheelchair. He reportedly received physiotherapy four times per week prior to coming into the home, and this has been reduced to twice. He is not sure why and is unhappy. Obviously some service users require the services of a physiotherapist but are not currently getting them. It was noted from the feedback that a greater percentage of service users felt that they were listened to when compared to the last inspection, and this is an improvement. The key worker system is used in the home and service users spoken to were generally happy with the arrangements. Service users were observed to have specialist equipment with which to communicate and to promote their independence and this is also positive. However, attention must be given to the staffing arrangements and the arrangements for physiotherapy to ensure that the outcomes for service users with regard to personal support are improved. From inspecting the files and talking to service users and staff it was apparent that individuals are registered with a GP, see an optician and, dentist on a regular basis or as needed. Other healthcare professionals are involved where required. Records seen on wound management gave a reasonable account of the wounds and their progress. Photographs are taken periodically and there is a system of monitoring pressure sores and checking that the correct dressings and equipment are in place. However, some monitoring charts were not up to date, for example one such chart for pressure care monitoring had no entry beyond the 17th March 2007. In discussions with the service user later, she did confirm that the appropriate care was given and that the cream is applied. Monitoring charts are clinical records and must be treated as such. Overall, wound management has improved in the home, as the organisation now taps into the specialist advice provided by the tissue viability nurse from the PCT. The registered persons also made arrangements for their tissue viability nurse to provide training to two link nurses and to care staff. There Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 21 was a greater awareness of the importance of wound management and protecting skin integrity. Additional training in skin care is also planned and this should go a long way to improving standards in the home. In this respect the outcomes for service users were positive, with reduced concerns around wound care. The medication systems were examined and some improvement has been noted since the last inspection. The medication records that were inspected on the lower ground floor were generally found to be in good order. However, when creams or gels are applied the person actually applying such creams or gels should be signing to confirm that these have been applied according to the prescription. Although there was evidence of safe and good practices in relation to medication on the ground floor, some were concerns identified. In one particular case, a service user’s drug was not ordered for over five days, the drug eventually came in on the 19/3/07, had not been checked in, and as such had not been administered until lunch time on the 20/3/07. This is poor practice and must improve. It was noted that the last medication audit was carried out in January 2007 although a system was in place to have this done monthly. In discussion with the manager he proposed to carry out weekly audits, sharing this responsibility with the head of care. This should improve the handling of medication in the home. Drugs used in the home were appropriately stored in most cases and it was noted that controlled drugs were not in use at the time of the visit. The lighting in the clinical room on the ground floor needed improving and plans were in place to have this rectified. Qualified nurses administer medication and service users should receive a safe service. Staff would benefit from having an updated copy of the BNF, which is a good reference in relation to medication. Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 22 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 (Adults 18-65) and 16, 18 and 35. (Older People). People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. There are systems are in place to ensure that service users complaints are acted upon. Service users are generally safeguarded from the risk of abuse, but this could be enhanced, by reviewing the induction programme for staff. EVIDENCE: Service users spoken to on both the lower and ground floors were clear about whom they would raise any concerns with. All felt confident and able to complain and several said: “the new manager is really nice and approachable, and he comes round every morning”. One individual stated; “the manager listens and gets back to you when issues are raised”. Feedback received from relatives indicated that they were both: aware of the complaints procedure and confident in approaching the new manager. Staff interviewed demonstrated a good understanding of supporting service users to voice their concerns if they are unhappy. The complaints log was inspected and this showed that complaints are dealt with promptly. However, it is not just formal complaints that should be recorded, but concerns must also be logged. In this way the manager will have a clearer view of the areas for improvement. It should be noted that the Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 23 registered persons monitor complaints as part of their monthly visits to the home. A number of letters complimenting the service was also on record. From viewing the training records it was evident that many of the staff have undertaken training in the protection of vulnerable adults. However, the induction programme must be reviewed to ensure that prior to commencing actual working in the home, all staff will have undertaken training in safeguarding and protecting vulnerable adults. This would ensure a consistent approach from the start and hence reduce risks to service users. There have been issues regarding safeguarding adults and they were handled much more efficiently and speedily, including the timely referrals to the local authority. In this respect service users were less at risk of abuse, which is positive. The home’s bursar deals with all the finances of the home including the monies held for service users. There are good accounting systems in place with service users having individual accounts, and receipts being kept for items purchased on their behalf. Records show that service users sign for their money where able, or if staff are involved then two signatures are obtained. Manual balances are maintained until these can be transferred to the computerised system. A senior administrator comes in to audit the systems and check accounts. The manager then signs this off, which confirms the outcome/s. This is a good safeguard for service users. Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 29,and 30 (Adults 18-65) and 19 and 26 (Older People). People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home is generally maintained to a satisfactory standard but some areas still require work. Service users have the specialist equipment they need to maximise their independence and comfort, although appropriate arrangements need to be made for storing them. The home is generally clean and hygienic, which ensures the safety and comfort of service users. EVIDENCE: The inspectors undertook a detailed tour of the environment and there was a homely feel to it. The décor was generally satisfactory and an ongoing Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 25 programme of redecoration was in place. The registered persons reported that the estates surveyor visited the home and reviewed the maintenance schedules and that BUPA’s health and safety department carried out an audit, following the last inspection. Service users spoken to confirmed that they are consulted in deciding various developments in the home, and this is positive. The furnishings and fixtures were of a good standard and, in a good state of repair. This included the bedrooms viewed during the course of the visit. The maintenance person also has a rolling programme for the redecoration of bedrooms as they become vacant, or in need of redecoration. Because of the walls being of “soft” material, according to the maintenance person, there is always a lot to do around filling and repairing holes in walls where chairs, beds or wheelchairs have pushed into them. This would need reviewing to ensure that damage to walls and doorways, which gave an unsightly look in some cases – are dealt with more frequently. Service users were generally pleased with the heating, lighting and ventilation throughout the home. Many were observed mobilising with various aids including wheelchairs round the home. It was clear that the environment was designed and maintained to promote service user independence. A good example of this is where the door entry system has been lowered so service users can use it. Although service users on the lower ground floor have a lovely view of the garden, the locking systems in place made it impossible for individuals, wishing to independently access it. The registered persons may also want to look at this. Specialist equipment was seen around the home including chairs, wheelchairs and shower trolleys for service users who cannot sit up. Lifting hoists were also seen on each floor. However, there was an issue with storage, as equipment was seen stored in communal areas such as bathrooms and corridors. This must be reviewed to ensure the safety of both service users and staff working in the home. The maintenance records for hoists and slings were checked and found to be in order. The laundry area was clean and tidy with appropriate equipment such as gloves and goggles being used as necessary. A new tumble dryer and roller iron was due for delivery following the inspection. The laundry staff were familiar with infection control measures and this is positive in promoting safety throughout the home. Attention need to be paid to ensuring that service users’ socks are not destroyed and that they return in ‘like’ pairs. Many of the male service users raised this as experience that they were unhappy with. The kitchen was maintained to a good standard and the home was devoid of offensive odours. Service users were, generally more satisfied with the environment. Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 (Adults 18 –65) and 27, 28, 29 and 30 (Older People). People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users continue to receive care and support by a mixture of permanent and agency staff, which affects standards in the home. They are protected by the homes recruitment policies and procedures. Improvements in relation to training now means that service users are receiving a better service. However, this could be enhanced by regular supervision for staff. EVIDENCE: Staffing levels were discussed with the manager and it was felt that they were generally improved and now, more closely linked to the dependency levels of service users. Concerns were however raised in relation to the night staffing levels and the mix of staff used on weekends and at times, bank holidays. Feedback from staff also indicated that some parts of the home were higher Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 27 e.g. in the green corridor, and felt that this needed to be taken into account. Service users were not satisfied with what seems to be the frequent use of agency staff, which affects the balance and consistency of care delivered to them. At the time of the visit the manager reported that there were no vacancies at the ‘trained staff’ level, but that he needed to recruit up to six carers. There is also a small bank pool of up to two staff, which increases the need for using agency staff. In addition to this it was clear that a number of care staff were without a basic NVQ level 2 in Care and this is an area that needs addressing. Only seven had achieved the qualification and another seven had started, with four identified to go on the training. This would ensure that the basic competency levels of staff are achieved and hence service users stand to benefit, from this. The new manager is working on this. It should be noted that with the mixing and matching of staff, using agency staff that the competency levels cannot be guaranteed and so there is a risk to the standard of service delivery. It is important that the staffing levels particularly at nights and weekends are kept under review, along with the use of agency staff in the home. The files of four new members of staff were inspected and the required checks and documentation were in evidence. Interview records are also maintained and the current recruitment processes are robust. Two members of the administrative staff have undertaken training in document identification. This ensures that applicants produce the correct documents for their eligibility to work in the UK. Service users are therefore protected by home’s recruitment practices and this is positive. There is a training matrix in place and the manager is ensuring that all staff have received the mandatory training and that this is updated on a regular basis. Some of the recent training included first aid, fire safety, moving and handling, food hygiene, POVA and training around such things as brain injuries and Huntington’s disease. A staff induction book is given to all new members of staff and they must complete this, and also a starter pack containing key policies. Interviews held with newly recruited staff confirmed that they had a thorough induction, which they found effective. It was clear that the organisation worked positively towards ensuring that training is provided for the benefit of staff and service users alike. From speaking with staff and viewing records it was clear that some staff are receiving supervision on a regular basis. It is essential that all staff receive regular supervision both on a one to one basis and, clinical and care supervision. One of the support staff receives guidance from senior staff on a daily basis, which is positive. Staff across the board, need to have a similar experience, which includes both formal and informal supervision. Staff meetings are being held on a regular basis and minutes are maintained of these meetings. This is useful in ensuring that information is frequently passed on and issues discussed in the interest of the service. Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 (Adults 18 –65) and 31,33,35 and 38 (Older People). People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. There are systems in place to ensure that the home is well run, which is affected by changes in managers. While there are some quality assurance systems in place, more is required to ensure that standards of improvements are achieved and maintained. Service users benefit from the administration of good health and safety practices in the home. Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 29 EVIDENCE: Many of the service users providing feedback were concerned with the various changes of managers at Havering Court. They expressed the view that, just as the improvements were starting to come – the previous manager left. They now had a new manager in post that is experienced and came from a similar type of establishment. It was also disclosed that he was previously registered with the Commission. In discussion with him, he was suitably qualified and demonstrated a commitment and vision to improving standards in the home, as well as outcomes for service users. At the time of the visit he was going through his probation and felt that he was having good support from his line manager. Some of the service users comments included: “he seems to have his head screwed on properly”; “he seems really nice and approachable” and “I like him and hope he stays longer than the others have”. Staffing comments were also quite positive and included: “he is making a difference, and that he is very approachable and seems to get things done”. It was clear that service users and staff alike were homing in on their experiences with the new manager. This is a clear indicator as to the importance of the having a manager committed to the home. Service users seemed to need assurances that they would be safe and well looked after. It is therefore incumbent on the registered persons to progress with the Commission for the manager to be registered, without undue delay. Since the last inspection there was evidence that quality audits were carried out by the registered providers. It was also clear that service users were consulted more, about various aspects of the home, which is positive. The manager very early on, held a meeting with relatives and service users and, has been on night monitoring visits to the home. In fact he has been monitoring the punctuality and sickness levels of staff as this was having an adverse impact on the care service users were receiving. However, there was no evidence of a service users’ survey and, an annual development plan for the home was not available. While the registered persons carry out frequent monthly provider visits to the home – it is important to seek widely, the views of service users, linking the outcomes to a development plan. A comprehensive health and safety policy is in place for the benefit of staff and service users. Maintenance records for fire safety, fire alarm testing, lift maintenance, gas, electric, water testing, grounds maintenance, pest control for kitchen, equipment such as hoists and slings were inspected and found to be in good order and up to date. Accident records were also inspected and seen to be of a good standard with evidence of follow up by the management team. Generally there has been a low level of accidents in the home. Safe working practice risk assessments have also been completed. Interviews with staff confirmed their awareness of health and safety in the home and this is positive. Service users’ safety is promoted and assured at Havering Court. Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 3 35 3 36 2 CONDUCT AND MANAGEMENT Standard No Score 37 2 38 x 39 2 40 x 41 x 42 3 43 x 2 2 X 2 x LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Havering Court Nursing Home Score 2 2 2 x DS0000015593.V333729.R01.S.doc Version 5.2 Page 31 YES Are there any outstanding requirements from the last inspection? 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 YA1 Regulation 6(a) Requirement Timescale for action 30/06/07 2. YA6 3. YA7 4. YA9 5. YA12 The registered persons are required to review the statement of purpose and service user guide to make clearer the specialist services provided for younger adults. 14 &15 The registered persons must 30/06/07 ensure that service user plans; reflect all their care needs, are reviewed monthly and, used as a working tool by staff. Areas one and two above have been previously stated with a timescale of 31/07/06. 13(4)(c) & The registered persons must 30/06/07 (15) ensure that individual risk assessments are carried out including when using restraint devices. They must be developed and reviewed in consultation with service users and their advocates. 14 & 15 The registered persons must 15/07/07 ensure that service users’ choices are duly recorded in their individual plans and, acted upon in promoting their welfare. 16(2)(o) The registered persons must 15/07/07 review its activities to ensure DS0000015593.V333729.R01.S.doc Version 5.2 Page 32 Havering Court Nursing Home 6. YA13 12(4)(b) 7. YA18 12,13 8. YA18 18 9. YA19 12,13 10. YA20 OP9 13 (2) 11. YA23 13 12. YA24 23 that they are widely available and more suited to all service users living in the home. The registered persons must review its equality and diversity strategy in relation to religion and sexuality to meet the specific needs of service users. The registered persons must ensure that additional support such as physiotherapy is made available in line with service users needs. The registered persons must provide a stable staff team to ensure that residents are supported and cared for by a competent team. This is previously made requirement with a timescale of 31/08/06. The registered person must ensure that clinical monitoring charts are appropriately completed for all service users. The registered person must ensure that arrangements are in place for the safe handling and administration of medication with specific reference to: ordering medication and checking in of medication, audit trails, and, safe administration. The latter three of identified areas have been part of a previously stated requirement with a timescale of 31/07/06. The registered persons must review their induction programme to ensure that all staff receive training with regard to safeguarding adults, prior to commencing work in the home. The registered persons must review it maintenance programme to ensure that all parts of the home are DS0000015593.V333729.R01.S.doc 31/07/07 31/07/07 31/07/07 31/07/07 30/06/07 15/07/07 31/07/07 Havering Court Nursing Home Version 5.2 Page 33 13. YA29 23(2)(l) 14. YA32 18 15. YA36 18 16. YA39 24 consistently in good repair with reference to paintwork in corridors and on woodwork/doorways. This is part of a previously made requirement with a timescale of 31/08/06. The registered persons must ensure that appropriate arrangements are made for the storage of equipment, particularly in relation to hoists. The registered persons must keep under review the staffing levels particularly at nights and weekends to ensure it meets the dependency needs of service users. Positive action must also be taken to recruit a permanent staff team that meets needs of service users. The registered persons must ensure that all levels of staff are in receipt of regular supervision that is in line with the NMS (YA36) and (OP36). The registered persons must carry out an annual service user survey and have an annual development plan in place in promoting quality assurance in the home. 31/07/07 31/07/07 31/07/07 15/08/07 Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 34 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. 2. 3. 4. 5. 6. Refer to Standard YA6 YA17 YA22 YA18 YA35 YA37 Good Practice Recommendations The registered persons should ensure that documents required for guidance in the provision of care are available to staff at all times. The registered persons should make suitable arrangements for service users on the ground floor to have appropriate access to a dining table, fruits and the night bite system. The registered persons should record concerns raised, including the action/s taken. The registered persons should have a system to ensure that service users socks are; returned to them in matching pairs, and without damage. The registered persons should continue to provide training in order that at least 50 of care staff to achieve NVQ Level 2 or above. The registered persons should ensure that the manager is registered with the Commission. Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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. Extracts may not be used or reproduced without the express permission of CSCI. Havering Court Nursing Home DS0000015593.V333729.R01.S.doc Version 5.2 Page 36 - 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!