Inspection on 30/07/05 for Havering Court Nursing Home

This inspection was carried out on 30th July 2005.

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 34 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 20/03/07

Havering Court Nursing Home 31/05/06

Havering Court Nursing Home 05/01/06

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 RM14 4YW Lead Inspector Edi OFarrell Unannounced Inspection 30 July 2005 10:00 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 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 G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Havering Court Nursing Home Address Havering Rod, Havering-atte-Bower, Romford, Essex RM14 4YW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01708 737 788 01708 740 783 BUPA Care Homes (BNH) Limited No 2079932 CRH Care Home 52 Category(ies) of OP Old Age 16 registration, with number PD Physical Disability 36 of places Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 16 beds for elderly frail 36 beds for physically disabled Minimum staffing notice Date of last inspection 24 March 2005 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 disabilties, 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 accomodation 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 disability, and some have additional learning disabilities. Nursing and personal care are provided on a 24 hour basis Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This, unannounced, inspection was carried out on a Saturday from mid morning to late afternoon. One of the Commission’s specialist pharmacist inspectors looked in detail at the home’s policies, procedures and practices in relation to medication. A second inspector, who has lead responsibility for the home, toured the building and grounds, spoke to service users and visitors and examined records. Staff were observed carrying out their duties, and the care provided was discussed with service users, relatives, and staff. Some service users gave their views about the service, and their experience of living in the home, but due to the level of disability others could not. Fourteen Requirements, and five Recommendations set at previous inspections were followed up. Six Requirements set as part of a Commission complaint investigation were also followed up. The findings of the inspection were discussed with the nurse in charge of the home on the day of the visit. Since the last inspection the Commission has introduced new report formats, and this includes a format for mixed category homes, such as Havering Court. This means that unlike previous inspections, where the home was judged only against the Standards for older people, at this inspection it was also judged against the Standards for younger adults. Where there are differences between the two sets of Standards the main body of the report identifies this. In the Requirement section OP refers to the Standards for older people, and YA to the standards for younger adults. Please note that the scoring section of this report relates to the Standards for younger adults, and does not allow for the scores for the Standards for older people to be added. Service users, relatives, management, and staff are thanked for their in-put to the inspection. What the service does well: Management and staff have put a considerable amount of work in over recent months in re-assessing and reviewing needs. They have produced comprehensive care plans, which include aspirations, as well as how needs should be met on a day-to-day basis. Staff have a sound knowledge of the needs of each service user, and their individual personalities, including where service user have limited or no verbal communication. The home provides an excellent catering service, which is as flexible as possible to meet the varying needs of service users, including cultural needs and wishes. Care staff encourage service users to see mealtimes as a social event, as well as assisting with feeding. Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 7 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 Standards 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 G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 8 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 suitablity 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) YA1, YA2, YA5, OP1, OP2 & OP3. Prospective service users, and their representatives have the information they need to make an informed choice about moving into the home. Service users have individual contracts. The home does not offer intermediate care so Standard OP6 does not apply to this home. EVIDENCE: The Statement of Purpose has been reviewed and amended since the last inspection, and was on display by the visitors’ signing in book. It is very detailed, and is accompanied by an up-dated Service User Guide. A separate document on the respite service has been produced. The wording of the section on the categories of service users that the home can admit needs to be changed. A copy was amended by hand during the visit and left at the home for the manager concerned to make the amendments. This is Requirement 1. Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 9 It is important that all these documents are always fully up-to-date and correct as they form a part of the information used by service users, their representatives, and placing authorities, in making decisions when choosing a home. Care files were examined and the relative of a recent admission talked about the process. Prospective service users are assessed prior to admission, and this information is then used to develop a comprehensive care plan. These set out needs, aims and how these should be met. Service users are issued with the standard BUPA contract and copies of these were seen on the files. Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) YA6, YA7, YA8, YA9, YA10, OP7, OP14, OP33 & OP37 Management and staff at the home have put a considerable amount of work in over recent months in re-assessing and reviewing needs. Care plans are comprehensive and regularly reviewed. Service users are helped to exercise choice and to make decisions about their lives, within a risk management framework. Where possible they, and their representatives are consulted on, and participate in, the life of the home. Confidential information about service users is not being stored correctly. EVIDENCE: Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 11 Ten care plans, across the two floors, were examined, and where possible discussed with the service users, and/or their relatives. The level of disability of many of the service users is extremely high, and includes severe communication difficulties. Therefore evidence was also gathered by direct and indirect observation, and discussions with care and nursing staff. All the care plans seen had been reviewed over the past few months. They were comprehensive, and included aspirations and aims, as well as how needs should be met on a day-to-day basis. The daily logs show how both care and nursing staff meet these needs, and try to maximise choice. This included times of going to bed and getting up, preference for where to eat meals, preferred form of address, style of dress etc. Each service user’s care plan is currently stored on the wall outside their bedrooms, and is therefore accessible to anyone walking down each of the corridors. There is then a separate file stored on open shelving in the office on each floor. The office on the ground floor is close to the front door, which was open for much of the visit, as was the office door, even when no one was in the office. This means that anyone could walk in and look at confidential information about service users. These methods of storing information about service users are not acceptable, and alternative arrangements must be made. This is Requirement 2. Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 12 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 experiencd 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) YA17 & OP15 The home provides an excellent catering service, which is as flexible as possible to meet the varying needs of service users, including special and cultural needs and wishes. Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 13 EVIDENCE: The menu was examined and discussed with the chef manager and service users. The lunchtime meal was seen being served to service users in both dining rooms and their own rooms. This included indirectly observing staff assisting service users to eat. The menu is very varied with three choices at lunchtime, including a vegetarian option. Special dietary needs and preferences are noted in care plans and known to the catering staff. This includes individual lifestyles, such as sleep patterns, which result in requests for different foods at different times of the day. For example during a tour of the kitchen, during mid afternoon, a request was made for a bacon sandwich for one service user, who sleeps late due to difficulties in sleeping at night. This request was complied with, with no fuss. The kitchen was well stocked with fresh fruit, salad, vegetable, meat, and poultry, and has separate fridges for each type of produce. Halal meat is purchased for one service user, and there is a Chinese, and a pie, mash, and liquor dinner once a week. The latter is very popular with the service users, as it is a traditional dish in this part of England. A recent Environmental Health report commented that the kitchen was ‘excellently run’. Comprehensive records are kept of food temperatures, during cooking and on serving. A score of 4, commendable, has been given in this report to acknowledge the work of both the catering staff and the care staff in this, important, area of care. In going to various parts of the building during lunch staff were observed assisting service users to eat. In all cases this was being done in a very careful way, and included staff engaging in dialogue with the service users. This makes mealtimes into a social, as well as a nutritional occasion. Other aspects of catering, such as equipment and decoration, are commented on in the environmental section of this report. Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) YA18, YA19, YA20, YA21, OP8, OP10, OP9 & OP11 Service users receive personal support in the way that they prefer and require, and they are treated with respect. Health, personal, and social care needs are identified in the care plans, and appear to be being met on a day-to-day basis. Some methods of recording do not give an accurate picture of the care being provided. The practices in relation to medication do not fully protect the service users. Staff need training in approaching service users and their relatives regarding dying and death. EVIDENCE: Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 15 Care plans, daily records and accident reports were examined, and health and personal care was discussed with service users, relatives and staff. Staff were observed carrying out their duties. The findings were discussed with the nurse in charge of the home. As stated earlier in this report staff have put a lot of effort into re-assessing need and writing new care plans, which are being reviewed on a monthly basis. The care plans examined cover a whole range of nursing, personal care, and psychological needs. This includes service users who have very limited cognitive ability due to brain damage or congenital disorders, such as learning disabilities. It also includes others who are very articulate, but very physically frail, or who have some degree of short-term memory loss. Practice observed during the visit, and the daily records demonstrate a commitment to meeting need in a person-centred way. The staff spoken to demonstrated a sound knowledge of the needs of each service user, and their individual personalities, even where there is limited or no verbal communication. Weight, fluid, peg feed and turning charts were in place where needed. In two of the files checked on the lower ground floor the turns for the morning had not been recorded by midday, and at the same time a fluid chart had an entry for 1.00pm. Where nursing and personal care charts are in place they must be filled in at the time of the care being provided, and must always be accurate. If staff complete such charts at an earlier or later stage in their shifts then the accuracy of the records cannot be guaranteed, and this may mean that needs are not being met. This is Requirement 3. The accuracy of service users’ records was previously raised during a recent complaint investigation, when a similar Requirement was set, this has now been incorporated to Requirement 3. One of the Commission’s specialist pharmacist inspectors carried out a detailed review of the home’s medication policy, procedure and practice. This resulted in two Immediate Requirements being set, and a separate letter, with Requirements and Recommendations will be forwarded to the home. The findings were discussed with the nurse in charge of the home during the inspection, and are encompassed by Requirement 4 set in this report. A Requirement was set at the previous inspection in relation to illness, dying, and death. This was discussed with the nurse in charge of the home following care files having been examined. She explained that many of the service users and relatives find these very emotive subjects, and are not willing to make decisions. Whilst this is very understandable, serious illness, dying, and death are events that are dealt with on a very regular basis in this home. Staff need to know the wishes of service users, and relatives, and these need to be recorded. This is Requirement 5. The Commission notes that in practice the staff do work closely with relatives and medical staff to ensure that the expressed wishes of the service users and their relatives are respected, and Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 16 that they are not automatically admitted to hospital. This aspect of care is also commented on in the staffing section of this report. A complaint investigation carried out by the Commission since the last inspection highlighted that staff are not always clear under what circumstances they should inform relatives of significant events. In response to this, and a Requirement set at the previous inspection, some information has been collected and recorded in the files. It is still not completely clear which relatives wish to be contacted under which circumstances, leaving, in particular night staff, in a difficult position. This is Requirement 6. Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 17 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 sageguarded. (OP NMS 35) The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 16, 18 and 35 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) YA 22, YA23, OP16 & OP18 The home is recording complaints in a systematic way, and responding to them promptly, seeking to resolve problems at an early stage. Not all related documents are available for inspection as they must be. The home has improved the protection of service users by providing adult protection training, and staff demonstrate an understanding of their roles and responsibilities. EVIDENCE: The complaint log held by the nursing staff was examined, this has basic information such as the date the complaint was made, who by, and in some cases whether it was upheld or not. This record showed that the current manager of the home responds promptly to complaints. The fuller details are stored in the manager’s office and were not available for inspection, as they must be. Requirement 7 is restated from the recent Commission complaint investigation, with a new timescale. Due to the full records not being able to be checked Requirement 8 has been brought forward from the Complaint investigation report, with a new timescale. Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 18 The staff training records were examined, and some staff were asked about the adult protection training that has taken place since the last inspection. The majority of staff have now been on this training, and the remainder are booked to attend. The course was facilitated by a senior manager, who has done an excellent job on raising the awareness of staff of what might constitute abuse. The staff spoken to thought that the course was extremely good, and were able to describe how it had improved their day-to-day practice. Management has acted appropriately in response to recent incidents, and have kept the Commission fully informed of their actions. Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) YA24, YA25, YA26, YA27, YA28, YA29, YA30, OP19, OP20, OP21, OP22, OP23, OP24 & OP26 The initial impression is of a homely, comfortable, clean, and safe environment, but on closer examination many of the environmental standards are not fully met. The home has already started to deal with some of the necessary work, such as the painting of bedrooms. The number and types of baths and showers in operation do not offer full choice to service users. EVIDENCE: Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 20 All parts of the building were toured, both accompanied and unaccompanied. Some of the bedrooms were visited, and several are in need of decoration. In addition paintwork on doors and skirting boards in many parts of the building are badly damaged, mainly by wheelchairs. The home’s handyman has started a programme of redecoration, and this was evident in some rooms. The Requirement set at the previous inspection has been brought forward as Requirement 9, with a new timescale, which the Commission believes to be realistic. Some specific action is needed in the flowing areas: The carpet in the bedroom where there was a recent fire must be replaced. The outer doors to the kitchen must be replaced, or redecorated, as they are very badly dented and scuffed. The kitchen must be deep cleaned; the tiled area behind the cooker is particularly in need of attention. The boiling water urn in the kitchen must be repaired or replaced. This was a Requirement set at the previous inspection, and has now been incorporated into Requirement 9 in this report. The fish fryer must be repaired and deep cleaned or replaced. The hob must be deep cleaned. The broken bath hoist in the pink corridor, and the broken shower cap in the orange corridor must be repaired. This was a Requirement set at the previous inspection and is now incorporated into Requirement 9. During a separate tour of the communal bathrooms on the ground floor it was obvious that the baths are not used, either because they are broken, or were being used for storage. The nurse in charge reported that the service users have showers, either using a specialist shower chair, or a bath trolley. These two pieces of equipment were examined, in relation to the former there were small spots of blood on the underside of the seat cover, and the latter had a small hole in the side. This is Requirement 10. The nurse in charge reported that the baths are not used, either because service users prefer showers, or, because their physical disabilities make using the baths impossible. This information was gained at the end of the visit, and was not cross referenced with the care plans or with the views of service users, and relatives. This will be followed up at the next inspection, in the meantime an assessment of the fixtures and equipment needs of all service users for bathing and showering must be carried out. This must include their preferences, and where service users do not have the capacity to make their views know, the knowledge that Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 21 their relatives have about former preferences must be taken into account. The outcomes of these assessments must then be compared to the fittings and equipment provided by the home, e.g. type of baths. Where this does not match the identified need then arrangements must be made for appropriate fittings and equipment to be provided. This is Requirement 11. The home provides a service to adult of all ages who have a wide range of disabilities, many very severe. Wheelchairs are an important part of this service, and there was evidence of the nurses referring to the specialist service so that needs are met. One service user, who sits in a wheelchair for most of the day, looked extremely uncomfortable, as due to weight gain, the chair is now too small. The nurse in charge reported, and there was written evidence to substantiate this, that referral had been made to the service. The response had been that they were understaffed, and that it could take some time to be dealt with. In other cases, where the lack of specialist wheelchairs were restricting the lifestyle of service users, the wheelchair service had written to say that it was the home’s responsibility to provide them. The Commission contacted the service following the visit to clarify the situation, and then relayed the information to the home i.e. the importance of making sure that the initial referral contained comprehensive information about the need for the chair. In particular the home needs to ensure that they include information about the impact on the lives of the service users if they do not have specialist wheelchairs. No Requirement has been set for this, but it will be checked at future inspections. Two of the home’s wheelchairs were dirty, and both had food marks on the straps. This is Requirement 12. One service user has to remain in her wheelchair all day, as a special easy chair needs to be purchased. This was discussed with her relative, and with the nurses during the visit, and then later by phone with senior management, who gave a commitment to dealing with this as a matter of urgency. It is important that where assessed needs identify the use of specialist furniture that this is provided, and that discussion on funding does not take precedence. This is Requirement 13. As stated earlier in this report in many parts of the building the paintwork is very scuffed, mainly at a low level, compatible with being scraped by wheelchairs. In addition there have been some recent accidents involving knocks to arms when wheelchairs have been taken through doorframes. Observation and discussions with staff, together with information supplied by management indicate that the doorframes may be too narrow for some of the larger wheelchairs to go through safely. Management have already informed the Commission that they are seeking advice on this so no Requirement has been set, but this will be checked on again at the next inspection. Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 22 The main door to the building is on the ground floor, and the door was not locked for most of the visit. This allows service users to freely come and go, and is used in the main by those who smoke, who then sit outside the front door. During the week there is generally an administrator in the office next to the entrance, but this is not the case at the weekend. There were times during the visit when the front door was open, and the office door with confidential files was also open, and all staff were attending to service users in other areas. This means that anyone could have entered the building. The security of the building must be reviewed. This is Requirement 14. There is a high use of wheelchairs within this home, yet the front door has to be manually opened. During the visit this was observed to be somewhat difficult for some service users. Replacement by automatic door needs to be considered. As security also needs to be taken account of a Requirement has not been set at this inspection, but this will be discussed with the management of the home at the next inspection. Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 23 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 34 and 35 (Adults 18-65) and Standards 27,29 and 30 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) YA35 & OP 30 Staff demonstrate knowledge of the needs of service users, and how these should be met. They receive training in the care of service users, but need additional training to meet some specialist needs, such as how to discuss dying and death with service users. EVIDENCE: The staff training records were examined and some staff were asked about the training they receive. Care plans and daily records were examined, and staff were observed carrying out their duties. Service users, and relatives, were asked for their views. The people living in the home have a range of complex nursing, personal care and social needs, and include people with severe communication problems. It also includes people with learning disabilities, brain damage, and progressive degenerative illnesses. All care staff have the opportunity to register for NVQs Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 24 in care, and the company also holds in-house specialist training on specific conditions, such as Huntington’s Disease. Staff can also access out-house training on this and other disorders. A Requirement was set at the previous inspection that staff receive training specific to supporting people with learning disabilities. As the timescale for this has net yet been reached this has been taken forward as Requirement 15 with the original timescale. The home provides a service to some very seriously disabled people, some of whom have deteriorating conditions. Nursing and care staff need to be equipped to deal with the very sensitive subject of dying and death, so that they can effectively support service users and their relatives. They also need to know how to deal with their own and other’s feelings in a professional manner. This was discussed with the nurse in charge during the inspection, who was advised to contact the local hospice and palliative care service for input/training. This is Requirement 16. Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 25 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 39 and 42 (Adults 18-65) and Standards 33,35 and 38 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) YA37, YA38, YA39, OP31, OP32 & OP33 The lack of a Registered Manager for over a year has affected the staff team, but input by senior managers over recent months has improved staff morale and performance. Appointments to key positions, such as the head of care should improve the situation further. Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 26 Despite not having a Registered Manager staff at the home have worked hard to make sure that the needs, and wishes, of service users remain central to the service they provide. EVIDENCE: The home has not had a Registered Manager for over a year, and the Commission has written to senior management about this on several occasions. The effect of the vacancy was discussed with some staff, and some relatives, during this visit. There was some agreement that it had had an affect, but that the input over recent months of external managers had helped to keep the staff team focused on maintaining the service. Following the inspection the Commission again spoke to the line manager of the home by phone, who confirmed that a head of care has now been appointed and that a candidate for the Registered Manager’s post would be interviewed very shortly. This is Requirement 17 brought forward from the previous inspection with a new timescale. Given the length of time that the home has been without a manager, failure to comply will result in enforcement action by the Commission. A Requirement was set at the previous inspection that there must be an annual development plan as part of quality assurance. This document was forwarded to the Commission as part of the organisation’s action plan in response to the last inspection, and therefore has been met. Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 27 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x x 3 3 Standard No 22 23 Score 2 3 Score ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 2 x x x x x x 4 Standard No 24 25 26 27 28 29 30 STAFFING 2 2 3 2 3 2 2 Score 11 12 13 14 15 16 17 Standard No 31 32 33 34 35 36 x x x x 2 x 2 2 3 x x x x Version 1.40 Page 28 CONDUCT & MANAGEMENT PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Havering Court Nursing Home Score 3 2 2 2 37 38 39 40 41 42 43 G55 S0000015593 Havering Court V240426 300705 Stage 4.doc 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, OP1 Regulation 4, 5 & 6 Requirement The Statement of Purpose and the Service User Guide must be contain the correct information about the catagories of service users that the home is registered to provide a service to. All records containing confidential information about service users must be stored securely in the home at all times. They must not be able to be accessed by unauthoried persons. All records of the care provided to meet identified needs must be accurate at all times. Previous timescale of 30/06/05 not met. Where timed recording systems are in place, such as turn charts, and fluid in-take, these must be filled in at the time that the care is delivered. All Requirements set by the specialist pharmacist inspector as part of this inspection must be actioned within the timescales set in the feedback letter. Service user death and dying wishes must be recorded in their care plans for all staff to refer to when needed. Previous timescale Timescale for action 31/10/05 2. YA10 & OP37 17 (1) (a) 31/08/05 3. YA19 & OP8 12 & 13 31/08/05 4. YA20 & OP9 13 (2) 30/7/05, 30/8/05 & 30/10/05 31/10/05 5. YA21 & OP11 12 Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 29 6. YA21 & OP11 12 7. YA22 & OP16 17 8. YA22 & OP16 22 9. YA24 &OP19 23 10. YA24 & OP19 23 of 23/07/05 not met. There must be clear instructions for staff, in relation to each service user, as to who they contact in the event of an incident or accident. This must include times of day or night that relatives wish to be contacted, and the severity of accident or incident that they wish to be informed of. Previous timescale of 30 June 2005 not met. The recording of this information must be consistent and accessible to the person in charge of the home at any given time. All required records must be available within the home for inspection by the Commission at any time. Previous timescale of 30/06/05 not met. All complaints must be thoroughly investigated and responded to. Complaint investigations must not be closed until the complainant has indicated that they are satisfied with the response, or that they wish to move onto the next stage. The home must have a regular programme of maintenance to repair or replace areas that are run down, such as flaking paintwork, equipment that does not work, and scraped woodwork. Previous timescale of 23/07/05 not met. This must result in all parts of the premises being of sound construction, and in a good state of repair and decoration at all times, including all fixtures and fittings and equipment. Equipment used for assisted baths and showers must be of G55 S0000015593 Havering Court V240426 300705 Stage 4.doc 30/09/05 30/09/05 30/09/05 30/11/05 30/09/05 Page 30 Havering Court Nursing Home Version 1.40 11. YA29 & OP22 23 12. 13. 14. YA29 & OP22 YA29 & OP22 YA24 & OP19 23 23 13 15. YA35 & OP30 18 & 19 16. 17. YA35 & OP30 YA37 & OP31 18 & 19 8&9 sound construction, and be clean and hygienic. An assessment of the fixtures and equipment needs of all service users for bathing and showering must be carried out. This must include their preferences, and where service users do not have the capacity to make their views know, the knowledge that their relatives have about former preferences must be taken into account. The outcomes of these assessments must then be compared to the fittings and equipment provided by the home, e.g. type of baths. Where this does not match the identified need then arrangements must be made for appropriate fittings and equipment to be provided. All wheelchairs must be kept clean. Where specialist equipment, including furniture, is assessed as needed, it must be provided. The security arrangements for entry to the home must be reviewed, in order to ensure that unauthorised persons cannot gain entry. Staff must be adequately trained to support people with learning difficulties. Timescale set at previous inspection not yet reached. Training and support must be provided for all staff in dealing with dying and death. The registered person must put forward a manager to be registered with the Commission. Previous timescale of 23/07/05 not met. 31/12/05 31/08/05 31/08/05 31/08/05 23/10/05 31/12/05 30/09/05 18. Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 31 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 Good Practice Recommendations Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 32 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Havering Court Nursing Home G55 S0000015593 Havering Court V240426 300705 Stage 4.doc Version 1.40 Page 33 - 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. 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