Inspection on 31/05/06 for Havering Court Nursing Home

This inspection was carried out on 31st May 2006.

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 no outstanding requirements from the previous inspection report, but made 20 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 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 Diane Roberts Key Unannounced Inspection 09:00 31st May 2006 and 16th June 2006 Havering Court Nursing Home DS0000015593.V297915.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.V297915.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.V297915.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 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) BUPA Care Homes (BNH) Limited Ms Christine Ann Walton 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.V297915.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 5th January 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 disability, and some have additional 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 occasionally physiotherapy are charged separately. Havering Court Nursing Home DS0000015593.V297915.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 eight hours and was carried out as part of the annual inspection programme for this home. The registered manager was present at the inspection. Following the return of comment cards from residents a further visit was undertaken on the 16.6.2006, which lasted two and a half hours. The home is primarily for Adults aged 18 – 65 and this is where the inspecting officer focused the inspection. The home is also registered for Older People and these standards were also taken into account although may not be specifically referred to in this report unless significant shortfalls were noted. At the current time both resident groups work well together without one or other affecting any individuals quality of life. This home has spent a significant period of time without a manager. The new manager, who has been in post just over six months, is steadily bringing the home back on line and making positive changes and developments. However, there is still some significant work to do and this is reflected in this report. The Inspection focused upon all of the key standards and the homes response to the last agenda for action. A partial tour of the premises was undertaken. Evidence was also taken from the Pre Inspection Questionnaire completed by the home and submitted to the CSCI. Five residents and five staff were spoken to during the inspection. Ten comment cards were received from residents and one from the visiting GP. Six comment cards were received from staff working at the home. At the time of writing this report the home is undergoing an Adult Protection Investigation. What the service does well: Both groups of residents who commented are very happy with the range and availability of activities provided at the home. The Manager has the right approach to the development of the home and has an open approach when working with the CSCI. The home has sound recruitment practices and checks staff fully before employment. Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 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 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.V297915.R01.S.doc Version 5.2 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 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 (Adults 18-65). 3 (Older People )Standard 6is not applicable to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are generally properly assessed prior to admission to the home, which ensures the home can meet their current needs. EVIDENCE: Assessment documentation was inspected from both resident groups and recent admissions. The home has a comprehensive assessment tool in place. One assessment was satisfactory containing detailed, individualised information and was current for the admission in the past few days. The second assessment was also satisfactory apart from a two-month lapse between assessment and admission. This was discussed with the manager who Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 9 was not in post at the time and assures the CSCI that assessments are now kept up to date to ensure that the home can meet the needs of new residents. The manager tends to primarily undertake the pre admission assessments, with the head of care backing her up. Visits prior to admission are always encouraged. From discussion with the manager, no special arrangements are made for the admission of a resident on the day although pre planning for equipment etc. would have taken place. The nurse in charge admits the resident and the manager makes sure that she meets him or her early on. The home only accepts admissions during the hours of 9 a.m to 5 p.m to ensure that they can obtain all the required information during office hours should there be shortfalls. Residents who were able to comment felt that they had enough information upon admission and were able to visit the home, should they wish, before they made a decision. Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 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 the following standard(s): 6,7,and 9 (Adults 18-65) 7, 14 and 33 (Older People). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have individual plans of care in place but shortfalls are evident that need to be addressed. Whilst it is clear that some residents make decisions about their lives, evidence in some cases is limited. Where possible, residents are supported to take risks, although evidence of this limited in some cases. EVIDENCE: Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 11 Each resident has a care plan in place. The care plan is developed from a comprehensive assessment, including pre admission information. The care plans contained detailed information regarding specific care needs and they also showed some individual preferences. It was noted that in many cases, work had not been done to complete personal preference sheets/daily living choices and this could affect the resident’s rights to express choice and take risks. This needs to be addressed. Residents have life maps in place and these should be supported by the personal preferences/daily living choice sheets. It is the homes policy to update and review care plans and associated assessments monthly. Some of the care plans were seen to be out of date and had not been reviewed for a couple of months. Many of the residents have specific care needs openly displayed on notices in their own bedrooms, giving guidance to staff. Some of these needs were not identified in the individuals care plan and also can compromise a resident’s dignity and privacy. No evidence was seen that either residents or their representatives had been involved in the development of their care plan and this needs to be reviewed. There was evidence in some care plans that formal reviews with placing social workers had taken place. Each resident has a key worker and this was evident with the care plan. The daily progress notes were well linked to the care plans in place, but not all identified care needs had a care plan. Residents were seen to have appropriate risk assessments in place. Some of these require review, as in some cases where risks have been identified, it is unclear as to what action has been taken by the home to remove or reduce the risk. This was discussed with the manager. The manager plans to launch a resident of the day scheme whereby the resident’s care plan would be thoroughly reviewed, with the resident and their family, medication would be reviewed and their room deep cleaned and given a maintenance check. The home aim to start this on the 1.6.06 and a plan was seen to be in place, developed by the Head of Care. Residents spoken to confirmed that they had choice about how they spent their day and that they had choices within the routines of the home. The home has information available to residents on the availability of local advocacy services. Some residents who commented felt that staff made decisions for them without consultation because it was quicker and easier for staff to do this, even when they felt quite capable themselves. Some felt this type of approach had changed for the better since the new manager was in post. Residents spoken to confirm that they manage their own finances where possible. They were happy with the support they received from the home with regard to this. The home does not act as appointee for any residents. Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 12 Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, and 17. (Adults 18-65) and 10,12,13 and 15 (Older People). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to take part in appropriate and varied activities. Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 14 Residents have good links with the local community. Residents are able to maintain links with family and friends. Staff at the home respects residents’ rights. The quality of the meals service at the home is variable. EVIDENCE: Residents spoken to and who commented were very happy with the activities programme at the home. This is also reflected in the homes quality audit carried out in Autumn 2005. Two activity officers are employed by the home and they are currently changing format of recording to individual notes, which will be held in each care plan. Records show that residents take part in a wide range of activities appropriate for their needs and preferences, where recorded. Residents spoken to outlined a good range of activities attended both in and out of the home. They confirmed that both the care staff and management team come out with them, in their own time. There is a programme of activities for each floor and they are planned and appropriate for the resident group on that floor, but residents can attend what they want. The activity officers ensure that residents know what is going on throughout the home. From discussion, it is clear that the Activities staff know the residents and their preferences well. They are keen to encourage residents to develop the range of activities they undertake. It is also clear that they are knowledgeable regarding appropriate activities and the resources available to them in the local community. The home uses both Dial a Ride and minibuses to take people out and can manage to take six residents and six carers out at one time. Where possible they get families involved. From discussion, the manager is planning to visit a BUPA home in Birmingham with a similar resident group to look at their systems of working and specifically meals and activities. Residents spoken to confirmed an open visiting policy and felt that their relatives were welcomed into the home. Residents access the local community for shopping and leisure, with the local pub being a good resource for a group of residents in the home. The home is holding a fete on the 24th June 2006 and this was prominently advertised in the local community. Whilst the home has routines, residents spoken to felt that they had choice within these and often there was compromise on both sides to achieve the end Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 15 objective. Residents spoken to confirmed that they had choice regarding getting up and going to bed and this was observed on the day of the inspection. A good level of interaction was seen between staff and residents and residents said they had a choice about how they wanted to spend their time. Residents who commented confirmed that staff were good with regard to privacy and always knocked on doors and were polite. Incomplete records in the care planning system do not evidence that all residents have been given choice and that their preferences are clear for all staff. Residents who commented had mixed feelings about the quality and variety of the food and felt that this was linked to who was on duty in the kitchen. They confirmed that they had a choice from the menu offered. Several of the residents who commented said that the food was bland and those who could, looked forward to visits away from the home where they could eat out. On discussion the manager is already aware of these issues and has consulted with residents on the catering and is planning changes to both the menu and mealtime arrangements. Lunch was seen to be a relaxed affair in the dining room but residents in their rooms, who need to be helped, felt that the deployment of staff at mealtimes could be better. A nutritional assessment is undertaken and records show that residents’ weights are being monitored. Good detail was seen in residents’ care plans and staff meeting minutes show that the management team are trying to ensure a consistent approach to the prescription and use of supplement drinks. Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 18, 19 and 20. (Adults 18 –65) and 8,9 and 10 (Older People). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents do not always receive the personal care and support they require. Residents’ physical and emotional health needs are generally met but staffing at the home can affect this. Some of the medication systems at the home require improving. EVIDENCE: Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 17 Residents who commented had mixed feelings about whether the care and support provide by staff met their needs. Comments, reflected in many cases, that it depended who was on duty that day as to the level of care provided. Some residents felt that they were not always listened to, with staff making the decision for them. This is also reflected in the home’s own quality audit of Autumn 2005. Some residents felt that mealtimes and bedtimes were rushed whilst others were quite happy with the arrangements. Some residents who commented felt that they had to wait a significant time for staff to answer a call bell whilst others were quite happy with the response times from staff. The overriding impression that residents give is that the level of agency staff on duty affects the quality of care. The home tries to ensure that people of their choice care for residents and this was observed in the care records and from discussion with staff. Residents were observed to have specialist equipment with which to communicate and to promote their independence. From discussion the staff team are constantly looking at ways to improve this aspect of life for residents. A physiotherapist visits the home two to three times a week. Some residents pay privately for this service and others are referred via the PCT. Some residents confirmed that they saw the physiotherapist and felt that the service was good. Nursing staff undertake the care of wound management at the home and records relating to this were inspected. Currently eight residents have pressure sores, from records many of them are minor and dressings in place as a protection. The majority of records seen give a reasonable account of the wound and its progress. Some of the wound evaluations need to give more detail other than ‘dressing changed’. Occasionally photos are taken. The team has a system of monitoring pressure sores and checking that the correct equipment is in place. From discussion with the manager, the team do need to be looking as to why the sores are developing in the first place and focusing on prevention as well as wound management. Records show that the team have used a tissue viability nurse locally for input and BUPA now have a new tissue viability nurse who will be having input into the home. The GP who visits the home commented positively regarding communication from the staff team at the home about residents’ healthcare needs. He also felt that the staff were knowledgeable regarding residents’ care needs and that overall the care provided at the home was acceptable. Residents spoken to felt that the GP service was good and that they were seen quickly when needed. Records evidence timely interventions from GP services. Chiropody records need review to ensure they are evidencing the service that is in place. Records show that residents have access to opticians and dental practitioners when required. Records also show that residents are under the care of specialist healthcare staff as appropriate. Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 18 The medication systems at the home were inspected. The home uses a bottle to mouth and dosset box system, supplied by a local pharmacist. The records were generally in good order. Handwritten prescriptions added on during the month were occasionally unsatisfactory. Some were seen to be unclear – especially if tablets have been prescribed and the liquid form of the medication has been obtained for the resident to manage. The PRN recording on the MAR sheets needs to be clear and consistent in the home. Staff are trying to record on the wrong part of the sheet and records are becoming unintelligible. Whilst the checking in system has improved, there are still some shortfalls, mainly with additional items added later in the month. The night staff check in all the regular medication and sign for checking in and this was seen to be good. Additional medications, possibly received by the day staff are not so consistently recorded. This needs to be addressed. Dates of opening are needed on the liquid medications and staff should ensure that the correct date is recorded; as one bottle of antibiotics had the wrong date recorded and cause a query as to how much had been administered. No controlled drugs were being stored at the time of the key inspection. BUPA has a contract in place for the disposal of medications in a chemical jel, Whilst this has made the home look at their ordering and become more efficient, so there is less to dispose of, they are not using the system as per the contract put in place. BUPA are reviewing this contract and in the meantime the home should use the system correctly. At the second visit a qualified nurse was observed dispensing medication from the trolley. The nurse went to administer medication in another room, leaving the trolley unlocked in a corridor with other unidentified, dispensed medication on the top of the trolley, with the keys. The nurse was also away from the trolley for a significant period of time. This shortfall was highlighted to the manager and head of care. This needs to be addressed. Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 (Adults 18-65) and 16, 18 and 35. (Older People). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has systems in place, which ensures that residents’ views are listened to. The home has systems in place, which help to ensure that residents are protected from abuse. EVIDENCE: Residents who commented were clear about whom they would raise any concerns with. They commented that both the manager and head of care were regularly in contact with them and available should they have any concerns. The home has a system for logging and monitoring concerns and complaints. Records were inspected. Complaints were seen to be dealt with promptly. Records and discussion show an objective approach by the manager. Good records and analysis were seen. Since January 2006, the home has had 5 Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 20 complaints relating to minor care issues, staff attitude, facilities, falls and conflict between two residents. The home has an adult protection policy in place and discussion with the manager and staff shows a good understanding of this subject. Training records show that the majority of staff at the home, including ancillary staff, have received training with only a small percentage still requiring attendance. At the time of the inspection the home was undergoing a POVA investigation. The speed at which the home reports incidents to the Adult Protection Team does require review. Home has a bursar who deals with all the finances of the home including residents’ monies. Good systems are in place and residents have individual accounts with one building society account and they work out interest monthly and produce statement. Transparent accounting was seen. Statements are sent to residents / families as much as they want. Records show that clients sign for their money where possible. Balances were seen on computer records. A senior administrator comes in to audit the systems and check accounts. The manager then signs this off. Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 21 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 the following standard(s): 24 29,and 30 (Adults 18-65) and 19 and 26 (Older People). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally maintained to a satisfactory standard but some areas still require work. Residents have the specialist equipment they need to maximise their independence and comfort. The home is generally clean but attention to detail is needed in some areas. Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 22 EVIDENCE: A partial tour of the home was undertaken. From discussion, the manager has the right approach to developing the environment for residents and involving them in this aspect of the home. The home has plans in place to replace flooring in the main reception area and dining room. Residents have been involved in choosing a wood floor. A modern storage area is being built in the dining area and there are plans to put a work surface in, so that residents can help themselves to items at breakfast and other meals, if they are able. The manager is getting more input from residents in choosing items for the home, such as cutlery, crockery and table linen and this is proving popular. The corridors were seen to be very clinical and not homely with minimal pictures in place. Those bedrooms seen were satisfactory apart from some paintwork repairs needed to doorways etc. The home has a lot of wheelchair users and this is reflected in the state of the door frames and lower corridors etc. Overall many areas still have paintwork issues but some work has been done on doorways and wall protectors have been put in place in some areas. The home has addressed many of the premises items on the previous agenda but seems unable to keep up with the maintenance of the corridors and paintwork at the home. The maintenance programme sent to the CSCI following the last inspection has not been fully adhered to. This was discussed with the manager and the regional manager. The reality is that the paintwork is an ongoing job in this home. There will always be areas that need work because of the client group and the equipment moved about. The regional manager plans to update the programme and resubmit it to the CSCI along with supporting information after discussing the issues with the estates manager for BUPA. Residents’ needs are being taken into account and things such as the door entry system has been lowered so residents can use it. A sensory garden is being built but still requires significant work. Residents from the home have chosen the water feature. Thought is being given to access and the height of flowerbeds. Further thought could be given to the siting of notice boards etc around the home in relation to residents abilities. Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 23 Storage in parts of the home is an issue. Bathrooms and residents’ ensuite toilets are primarily used for storing old/unused specialist chairs and pads etc. This makes these rooms look messy and access can be an issue, with items on the floor. This needs to be addressed. The home now has a room for smokers to use and extraction has been fitted. This room is unpleasant and un-stimulating, with poor décor. It was seen to be dirty on the day of the inspection. Specialist equipment was seen around the home including chairs, wheelchairs and shower trolleys for residents who cannot sit up. Lifting hoists were also seen on each floor. On the day of the inspection the community wheelchair team were visiting the home. Overall, the home was seen to be clean with attention to detail needed in some areas. Residents who commented did not always feel that the home was fresh and clean with one commenting that ‘for some reason it always looks dirty. No odours were noted on the day of the key inspection but one resident commented that some of the carpets smell. The homes quality audit of Autumn 2005 reflects that residents are generally happy with the environment. Bathroom floors were noted to need a deep clean/scrub and residents’ lifting hoists also need cleaning. The outside bin storage area was very messy and overrun with squirrels that even eat through the hard plastic lids of the bins. The home is trying to come up with ideas to address this problem, including building a new bin store. Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. 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). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are cared for and supported by a mixture of permanent and agency staff, which affects standards in the home. Residents are protected by the homes recruitment policies and procedures There are significant gaps in the staff training, which affects the competency of the staff at the home. EVIDENCE: Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 25 Staffing levels at the home were discussed with the manager. Levels are not linked to the current dependency level of the residents in the home and are those that have been in place historically. Some residents spoken to feel that in some parts of the home the staffing level is too low and exacerbated by the use of agency staff. The manager needs to review the staffing levels in line with current dependency. Recent staff rotas were reviewed and show that a significant amount of agency staff is being used to support the rota, particularly at weekends. The homes quality audit of Autumn 2005 reflects residents’ dissatisfaction with the staffing arrangements at the home. The manager has been actively trying to recruit quality staff to the home but is finding this difficult at times. Extra staff are provided for escorts out of the home to hospital appointments etc. Residents spoken to find the use of agency staff frustrating and worrying at times. The management team needs to ensure that it recruits some more permanent staff to the home. Two staff were files checked at random. The home has a checklist system in place. The required checks and documentation were seen to be in place including registration checks for nursing staff. Interview records are also maintained. A staff induction book is completed and new starter pack containing key policies is given to new staff. The home also ensures that new staff are up to date with statutory training. In addition the manager is sending staff on TOPPs induction course that run over a 6-month period. The manager needs to check that the induction is linked to Skills for Care. The manager has a training matrix/plan in place and is working hard to catch up and ensure that all staff have the mandatory training in place. Work has been done to try ensure that all staff have manual handling and fire safety training but records show that there are still some staff that need to attend. Plans are in place to provide training in health and safety and food hygiene next. Training records show that significant gaps remain in relation to staff training and this includes knowledge for staff on the specialist resident group they care for. Records show that only 5 out of 34 care staff have an NVQ level 2 or above. The manager is trying to promote NVQ training within the home. The home needs to ensure that all nursing staff are up to date with current thinking/practices with wound management. Minutes of the staff team meetings also show consultation with staff regarding training being planned for the future. Whilst residents feel that the staffing levels are an issue as is agency use, they did comment that they felt the competence of the staff working at the home was acceptable. Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 26 Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 27 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 at least once during a 12 month period. 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). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents will eventually benefit from a well run home. Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 28 The quality systems, including consultation with residents, need to be developed further. The health and safety of residents is promoted and protected. EVIDENCE: Residents who commented felt that the home had improved since the new manager had been in post. They felt that she is accessible and that they saw her around the home a great deal if they needed to speak to her. The manager is very experienced in the management of care/nursing homes and realises the extent of the work that is needed to address the shortfalls at Havering Court. BUPA has comprehensive internal quality auditing systems in place but these have yet to be completed at Havering Court. The last resident satisfaction questionnaire was completed in the Autumn of 2005. Overall the residents felt that the quality of the service had gone down from 57 to 41 and less residents responded. This was around the time the new manager started in post. Copies are made available to residents and relatives etc. No action plan is linked to this survey. The manager has also completed a residents’ questionnaire on catering, as she was aware that people were unhappy with the service. Action is being taken following this. The manager is consulting more with residents on the running of the home but this could still be extended further. Records show that the manager has held relatives’ meetings and is consulting with them on a wide range of subjects. BUPA have a comprehensive health and safety policy in place. Accident records were inspected and seen to be of a good standard with evidence of follow up by the management team. Records also show efforts to address any issue noted to ensure the risk of a repeat accident is limited. Safe working practice risk assessments have been completed and the manager has started reviewing these but has work to do as they have not been reviewed since 2003. From information submitted by the home and a random sample, records show that maintenance and safety certification for equipment/fixtures and fittings in the home are up to date. Havering Court Nursing Home DS0000015593.V297915.R01.S.doc Version 5.2 Page 29 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 X 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 3 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X 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 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Havering Court Nursing Home Score 2 2 2 X DS0000015593.V297915.R01.S.doc Version 5.2 Page 30 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 YA6 Regulation 14 and 15. Requirement The registered person must ensure that they consult with the resident or their representative about their care plan, keep the care plan under review and ensure that all care needs have a care plan. The registered person must ensure that residents care plan contains information on their individual choices and preferences. The registered person must ensure that the privacy and dignity of residents is upheld with regard to notices in resident’s rooms. The registered person should ensure that risk assessments are completed fully, outlining any action taken to reduce identified risks. The registered person must ensure that residents, care plan outline residents choices in relation to risk taking and staff intervention. DS0000015593.V297915.R01.S.doc Timescale for action 31/07/06 2. YA6 12 31/07/06 3 YA6 12 14/07/06 4. YA7 15 31/07/06 5. YA9 12 31/07/06 Havering Court Nursing Home Version 5.2 Page 31 6. YA17 16 7. YA18 18 8. YA19 18 9. YA19 OP8 12 10. YA19 OP8 12 11 YA20 OP9 13 (2) 11. YA23 13 12. YA24 23 The registered person must ensure that the meal service at the home is acceptable to the resident group, with regard to both the food and the flexibility of the service. The registered person must provide a stable staff team to ensure that residents are supported and cared for by a competent team. The registered person must provide a stable staff team to ensure that both the physical and emotional health needs of resident are met. The registered person must ensure that the prevention of pressure sores is addressed at the home and that wound management is of an acceptable standard. The registered person must ensue that residents are receiving a satisfactory chiropody service. The registered person must ensure that arrangements are in place for the safe handling and administration of medication with specific reference to: handwritten prescriptions, checking in of medication, PRN recording, audit trails, disposal of medication and safe administration. The registered person must ensure that all staff are trained with regard to Adult Protection and that the home review its policy with regard to notifying incidents. The registered person must keep all parts of the home in good repair with reference to paintwork in corridors and on woodwork/doorways and the DS0000015593.V297915.R01.S.doc 31/07/06 31/08/06 31/08/06 31/07/06 31/07/06 31/07/06 14/07/06 31/08/06 Havering Court Nursing Home Version 5.2 Page 32 13. YA30 23 14. YA32 18 15. YA35 18 16 YA39 24 smokers’ lounge. Repeat requirement. The registered person must ensure that all parts of the home are kept clean, with particular reference to the smokers’ lounge, bathroom floors and residents’ lifting hoists. The registered person must review the staffing levels provided in line with the current dependency of residents at the home. The registered person must ensure that all staff have the required statutory training and any further specialist training relating the registration of the home which will enable them to care for residents competently. The registered person must ensure that they develop the quality assurance systems in the home. 31/07/06 14/07/06 30/09/06 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard YA24 YA24 YA35 YA37 YA42 Good Practice Recommendations The registered person should review the storage facilities in the home. The registered person should review the external bin store in an effort to make it vermin proof. The Registered Person should continue to provide training in order that at least 50 of care staff to achieve NVQ Level 2 or above. The registered person should ensure that the manager has the support to enable her to bring the home back on line. The registered person should review the safe working practice risk assessments. DS0000015593.V297915.R01.S.doc Version 5.2 Page 33 Havering Court Nursing Home Commission for Social Care Inspection Ilford Area Office 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. 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