Inspection on 09/10/07 for Havering Court Nursing Home

This inspection was carried out on 9th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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 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 Sarah Buckle Unannounced Inspection 9th October 2007 10:30 Havering Court Nursing Home DS0000015593.V351119.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.V351119.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.V351119.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 buckmed@bupa.com www.bupa.com BUPA Care Homes (BNH) Ltd 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) 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.V351119.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 20th March 2007 Brief Description of the Service: Havering Court is a purpose built residential care home with nursing, which is operated by BUPA, a large private company that runs similar homes across the UK. The home is registered for 36 younger adults (18 to 65) who have a range of physical disabilities, and 16 older people (over age 65). It is situated in Havering - atte - Bower, a semi-rural area, which is an approximately 15 minute bus journey from the nearest rail link in Romford Town Centre. The home is set in spacious ground and woodlands, which provide pleasant views from bedroom windows. The accommodation is spread over a ground and a lower ground floor, with access via a lift and stairs. The lower ground floor has 14 bedrooms of varying sizes, bathrooms and showers and, a large lounge with French windows onto a pleasant patio and garden. The main kitchen, laundry, and staff rooms are also on this floor. The remaining bedrooms are on the ground floor, along with a large lounge/dining area, staff office, bathrooms, and communal sitting areas. Many of the service users have very high dependency needs due to the level of physical disability, and in addition some have learning disabilities. Nursing and personal care are provided on a 24-hour basis. The current scale of charges is £529.24 - £946.79 for older people and £660.99 - £1508.90 for young people with a physical disability. Additional costs for items such as hairdressing, chiropody and in some cases physiotherapy are charged separately. Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection at Havering Court was a routine unannounced key inspection. The inspection included a site visit to this service on 9th October 2007, which lasted seven hours. The manager was present at the site visit. Havering Court provides care to older people and to younger physically disabled people. As the majority of the residents are younger physically disabled adults, the National Minimum Standards applicable to a care home for younger adults have mainly been used during his inspection. However, some consideration has also been given to the National Minimum Standards for Older People. During the course of this inspection surveys were sent to residents within the home, to their relatives and to visiting health care professionals. Although twelve surveys were sent to residents, only three were completed and returned and the same is true for relatives. None of the healthcare surveys have been completed and returned to the Commission. The manager at the home completed and returned the Annual Quality Assurance Assessment. This was due to be received on 27/08/07, and was received on 19/10/07. During the visit to this service a number of residents and staff members were spoken with, staff and resident interaction was observed and a tour of the premises was undertaken. Relevant documents and records were examined and the manager spoken with at length. Information obtained from the various sources of evidence will be reflected in the body of this report. What the service does well: The initial assessment process within the home ensures that the needs of the prospective resident are identified prior to admittance. There is appropriate information for prospective residents to make a choice regarding the home prior to moving in; there is also the opportunity for prospective residents and their family/ representative to visit the home. Links with family members and with the community at large are encouraged and developed within the home. Recruitment practice is robust within the home and safeguarding of vulnerable adults is given a high priority. Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The care planning documents within Havering Court and not consistently completed to a good standard. Risk assessments are brief and relate mainly to keeping people safe. Daily care notes are completed, but are task based and not centred on the holistic needs of the person concerned. Care plans are not used as a working tool by care staff within the home. They are written in only by RGN’s and kept locked in the nurse’s station. Without access to care plans, care workers will have limited information regarding the Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 7 identified care and support needs of the individuals they are working with. They will also have inadequate access to information regarding areas of risk for the resident, and information regarding moving and handling. Staffing levels on the lower floor of the home are questionable, as the lounge was left frequently unsupervised with high dependency residents in it, for sustained periods of time up to fifteen minutes. Residents and relatives expressed some concern regarding the night staff not understanding their needs and not being as good as the day staff, and regarding the staffing levels within the home on evenings and weekends. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are not made to Havering Court unless a full needs assessment has been undertaken, which includes input from the prospective resident and their family or representative, where appropriate. Prospective individuals are given adequate opportunity to spend time in the home prior to admission. EVIDENCE: Havering Court has a comprehensive pre-admission assessment process in place. The home uses the QUEST system for assessing and devising care plans. The manager stated that all residents are assessed prior to being admitted to the home and that this is usually undertaken in the hospital where Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 10 the prospective resident is to be admitted from. A further assessment is completed in the home on the day of their admission and care plans are developed from this. One care plan was sampled in depth in relation to initial assessment. The resident was not newly admitted and it was positive to note that a reassessment had been carried out two years after their admission date. The assessment was thorough and included a photograph of the resident, their personal details, date of birth, next of kin, input from professionals and a medication list. The assessment looked at areas such as communication, lifestyle, maintaining a safe environment, cognition, breathing, eating and drinking, eliminating, personal cleansing and dressing, controlling body temperature, sleeping, pain management, medication and end of life arrangements. Where an area of need is identified, care plans and risk assessments are put in place. The manager stated that most people are admitted from hospital, however, sometimes relatives telephone to make enquiries and an appointment is made for them to visit the home. An assessment is then undertaken. There is a trial period in place for up to eight weeks, but the manager stated that residents are free to decide to move out if they wish to at any time. Two of three residents surveys completed and returned to the Commission stated that they received enough information about the home before they moved in. One person stated, “This was a preferred home due to the wide range of residents. I did not want to be in a home where all the residents were very old…” a second person said “(I) was shown around and told everything I wanted to know”. A third resident stated that Havering Court was the only home that would accept them with their particular condition. Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans at Havering Court are variable in terms of the information they contain and with regards to the regularity of their reviews. The care plans within the home are not adequately used as a working document and care workers do not have appropriate access to them. Risk assessments are contained within the care plans, however; these are basic and mainly focus on keeping people safe. EVIDENCE: Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 12 Two care plans were sampled during the course of the inspection and these were examined in some depth. The home uses the QUEST system for care planning. Both of the residents whose care plans were examined had complex needs. The first care plan contained information regarding the residents support needs, including their choices regarding lifestyle, their needs and abilities in relation to verbal and non-verbal communication, support required in relation to unpredictable behaviour, however, there were a number of plans in the file regarding unpredictable behaviour and these were variable in terms of the detail. The first was unclear and did not outline clear strategies for the management of possible unpredictable behaviour, whereas a second plan further on the file was clear and person centred i.e. ‘ Explain to (the resident) that you will leave the room and have no wish to upset (the resident), go back after 15 – 30 minutes and try again. Try to allocate preferred carer where possible. Don’t try to force (the resident) to have care, empower (the resident) and give (them) the choice. Ask (the resident) to call when (they) are ready to receive care’. There was also a third plan in relation to this support need, with differing information form the previous two. This conflicting information could present difficulties for the staff members offering support to the resident. The BUPA manual handling assessment was completed and included a monthly weight record and pressure sore risk rating. The ‘safe system of work’ was also completed and identified that the resident required two carers for all handling tasks, using the Oxford hoist and glide sheet, full body sling and sliding board, and shower chair. A care plan was in place regarding sensitive skin and being at risk of pressure sores. This stated that pressure areas should be monitored, cream applied and changes reported. The Waterlow assessment for pressure sores showed that the residents risk rating had increased, from 16 to 21; however there was no further information regarding how this increased risk should be managed. A care plan regarding reduced mobility does state that a pressure mattress is in use. A number of risk assessments had been completed and these related to seizures, using an electric wheelchair, smoking and bedrails. These were completed with varying degrees of efficiency. The seizure assessment was clear and detailed and referred the reader to the care plan. The wheelchair assessment stated there was a risk of the resident falling and that they should be checked half hourly, as they refuse to wear a lap belt. One staff member spoken with said that the resident was not checked in this way, and that the resident tended to call out if they needed anything. The bed rails assessment was not completed clearly i.e. the assessment asked, is the resident at risk of falling if bed rails are used, and the assessment is ticked as yes. The Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 13 assessment then states that bed rails should not be used, but the assessment is continued. The assessment asks whether the resident uses a pressure mattress and the no tick box is marked, which is contrary to the information in the care plan regarding reduced mobility. The assessment states that the use of bed rails has been discussed with the resident’s next of kin and recorded. There was no evidence of this, and neither the next of kin nor the manager/head of care had signed the restraint form. It was positive to note that the care plan regarding seizures was clear in relation to the early signs to look out for. There was a catheter change record, which not completed to reflect the changes that had taken place. Further information was contained in the review of the care plan. The use of two documents in this instance means that a clear record is not maintained in one place and could lead to confusion. The care plan was reviewed monthly until July 2007 and had not been reviewed since then. The second care plan examined was a much better organised document and all of the care plans seen were clear, detailed and instructive. For example the care plan regarding pressure area care stated ‘Maintain privacy and dignity for (the resident) at all times. Explain the procedure to (the resident), administer analgesic prior to dressing if prescribed, clean wound with warm water, use cavilon as barrier, dressing should be changed every third day, observe for signs of infection’ etc. Alongside this care plan there were regular photographs taken of the wound, a tissue viability review completed regularly and a weekly wound assessment chart. The care plan was reviewed monthly. During discussion with a staff member it became apparent that care plans for all residents are kept locked in the nurses station and only completed by registered nurses. The care workers within the home do not have on-going access to the care plans as a working document and consequently may not have up to date information regarding the changing needs of residents or even clear information about the type and level of support required by each resident. Three resident surveys were completed and returned to the Commission and two of these stated that they always make decisions about what they do each day and one stated that they usually do. One comment received stated, “I join in when I feel like it. I am not made to do things that I do not wish to”. All three surveys said that they are able to do what they want to during the day, evening and at the weekend. One person stated, “I like my life in the home”. Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 14 Three relative surveys were also completed and returned to the Commission. One of these stated that the care home usually meets the needs of their friend/relative. They commented, “The care that (my relative) has received in the nursing home has been fantastic. All (their) needs have been addressed, both physical and mental. (They) have received a warm and friendly welcome since (they) arrived in the home – everyone has put a lot of time and care into (their) welfare to make (them) a part of the family”. Two further surveys stated that the home usually meets the need of their relative. One resident spoken with stated that they would like a comfortable armchair to sit in, rather than sitting in a wheelchair all day. They also stated that they have to go to bed much earlier than they would like. Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 16 Havering Court is committed to enabling people who use the service to develop their skills and the residents are given the opportunity to take part in a variety of opportunities both within the home and in the community, there is however, room for further improvement in this area. People who use the service at Havering Court are encouraged to develop and maintain important personal and family relationships. The meals are balanced and nutritious and the care staff are sensitive to the needs of residents who require assistance with feeding. EVIDENCE: There are two activity coordinators employed within the home for a total of 72 hours each week. The manager stated that a lot of work has been done on activities since the last key inspection. He said that there are now activities up and down stairs and that the garden is also used when the weather is good. New garden furniture had been brought to accommodate this, and a sensory garden has been developed, which has a central water feature. The manager stated that some residents are involved in maintaining the sensory garden. It was noted on a tour of the premises that a lower floor door was open to allow residents to access the garden. The sensory room is now in use for some residents and is due to have a cinema installed, with a projector and a big screen. The manager stated that he wants to recreate the cinema experience for residents. The home has a well put together reminiscence area, with games that can be enjoyed by residents if they wish to use them. One resident within the home has been supported to access a local college to study IT. During the site visit to the home it was noted that the lower level lounge did not have specific activities happening. A number of residents were dozing or watching TV during the course of the morning and after lunch a DVD was put on for them to watch. The activities coordinator did come into the lounge and asked if anyone wanted to join in singing. Two residents went to the upstairs lounge to take part in the Karaoke session. The Karaoke session went on throughout the afternoon and it sounded as though many residents enjoyed this immensely. One staff member spoken with was asked about two residents with complex needs and how their quality of life was enhanced. The staff member explained that one resident is involved in activities and that (they) like Karaoke, being Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 17 out on the patio to get fresh air, TV and music. The resident has an extensive CD collection and likes to listen to these. A second resident tries to join in with singing and loves buses and ‘On the Buses’ DVD’s, which are watched in (their) room. They also like books and a cuddly toy. The staff member also stated that some residents are taken into the sensory room, where story tapes are played and lights are used. Residents are also taken out on trips to Southend. The week prior to the inspection was a designated ‘community week’ within the home, where groups within the community were encouraged to come into Havering Court. The manager stated that the Association of Old Aged Pensioners was involved, as was The British Legion and other community groups. The week ended with a celebration and an entertainer. The manager stated that a resident’s forum has been established to give a voice to the people who live at Havering Court. This forum is chaired by a resident and has the intention of enabling choice, consultation and collaboration. One resident went shopping with support during the afternoon of the site visit. There is a church service once each month within the home. There was good evidence that relatives were encouraged to visit service users at Havering Court. Two of the relative surveys completed and returned to the Commission stated that the care home always helps their relatives to keep in touch. One comment stated, “…it is difficult for (my relative) to keep in touch with me, but I keep in close contact with Havering Court and I am given all information about (their) health and every-day matters”. A third relative commented that this question does not apply, as their relative is not aware. All three surveys stated that they are always kept up to date with important issues that affect their relative. During the inspection one mealtime was observed. This was in the lower lounge. It was positive to note that tables were laid with clothes and napkins in the same way that the upstairs dining area is laid. One resident sat at the table to eat their meal and was most complimentary about it. All of the residents who required support with feeding were observed to be sensitively enabled to eat. There was a lively and friendly atmosphere in the lounge during the mealtime with banter and conversation between the staff and residents. Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents within Havering Court have appropriate access to healthcare services. Personal support is in the main part responsive to the individual needs of the residents; however, access to care plans for all care staff would improve this. The home has an efficient medication policy and medication is in the main part suitably managed, however, there are some areas for improvement. EVIDENCE: Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 19 In the care plans sampled there was evidence of GP, optician, dentist and chiropodist intervention. There was also evidence of physiotherapy and speech therapy input and a tissue viability nurse. Wound management is proactive within the home, and one staff member stated that there were two residents with pressure sores on the lower floor of the home. The file for one of these residents was examined and the information regarding pressure area care was clear and detailed. Two of the resident surveys returned to the Commission stated that the carers at Havering Court usually listen to and act on what they say. One person commented “I prefer it when there are regular staff on duty. I do not like so many changes. Staff seem to leave the home so much, and new people seem not to understand my needs”. A third resident stated that carers sometimes listen to and act on what they say, they commented, “It depends who is on duty”. Care plans within the home are not used as a working document by all of the staff team, and consequently not all of the staff team will necessarily have information regarding the individual needs of the residents within the home or of their preferences and requirements. The home uses the Lloyds chemist monitored dosage system for the administration of medication. The medication trolley and medication administration records for the lower floor of the home were examined during the inspection. It was positive to note that both the medication fridge and the medication storage room temperature are taken and recorded daily. The fridge did show some high readings, and when the door was opened for examination purposes went up to 9 degrees. It was also recorded as being 9 degrees on 2nd October 2007. It is important that the fridge remains within the 2 to 8 degrees range to ensure that the medication stored therein remains effective. The manager at Havering Court stated that once each week the head of care completes the medication round to ensure that all is in place and to check the medication has been given as prescribed. He also said that the medication supply is received on a Friday to start the following Monday, however, as some medication is sometimes missing this is now being changed to a Thursday, to allow more time to check the medication in and to request any missing medication. The manager stated that a new training course in medication is being introduced and the documentation relating to this was seen during the inspection. This is a course devised by Lloyd’s pharmacy in conjunction with Keele University. There are three units to be covered and the pharmacist at Lloyds assesses each unit once completed. The manager stated that all RGN’s within the home would be completing this training. Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 20 Only RGN’s and the head of care administer medication within the home. There were no omissions noted within the MAR file and the medication in the blister packs tallied with that recorded as being taken on the MAR sheet. However, there were a number areas for improvement to reduce the risk of error in administering medication. One resident had not taken their paracetamol on a number of occasions and this was recorded on the MAR as ‘O’ or ‘other’, however, this was not defined and the reason for this was not recorded on the back of the MAR sheet. Handwritten medication profiles had been completed, however these were not counter signed to reduce the possibility of error. In some instances a second MAR sheet had been printed to reduce the use of handwritten medication profiles, however, where this duplicate information had not been crossed out, there was the risk of error and double administration of the same medication. It was also noted that there were no protocols in place regarding when ‘as and when’ or PRN medication should be offered or administered. The controlled drugs were examined. These were stored separately in a locked metal cupboard, however, it was not certain that this was secured to a solid wall. The drugs register was appropriately documented and the amount of drugs tallied with the amount recorded in the register. Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Havering Court has a sufficiently open culture and encourages residents to express their views and concerns. Some residents are appropriately aware of how to make a complaint, however, others are not. The home maintains a suitable record of complaints including details of any investigation and the outcome. The policies and procedures for Safeguarding Adults are available and give clear guidance to those people using them. EVIDENCE: The manager at Havering Court is a trainer in safeguarding vulnerable adults, he is also on a steering committee for Adult Protection at Havering nursing and residential home forum. The manager had copies of the new safeguarding policy from Havering Council, which he was distributing amongst the staff team. He stated that safeguarding training is part of the induction process for all staff and that they Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 22 watch a DVD and complete a questionnaire to ensure they understand the information they are given. Manual handling training is also part of the induction programme for new staff and the manager stated that no one goes onto the floor of the home without completing this. There was no evidence available to demonstrate which staff members had completed manual handling or safeguarding training. A training matrix was requested and a period of ten days given for it to be sent to the Commission, however, at the time of writing the report this information has not been received. In July 2007 a resident alleged that a staff member had been verbally abusive towards them. The manager provided the documentation to demonstrate how this allegation had been progressed. An alert was raised with Havering Council and the staff member was suspended pending an investigation. Havering Council placed the responsibility for the investigation onto the home and this was carried out. It was clear form the documentation seen during the inspection that the manager acted appropriately. The complaints and compliments log was examined. There had been two complaints since the beginning of 2007. One of these was formal and one informal. There were also a number of compliments seen and ‘personal best’ forms completed. One letter of compliment stated, “This is a lovely, warm, friendly and caring atmosphere for all the residents………I have really been impressed with the amount of time the staff here found to help settle (the resident) into (their) new home. They listen to (their) stories, needs and worries. Your staff show a clear level of dedication to their job which adds to a very high professional standard”. All of the resident’s surveys stated that they knew who to speak to if they were not happy; one resident said they would speak to the manager and another said to a relative. Two of the surveys said they do know how to make a complaint, and one said that they did not. All three of the relative surveys stated that they knew how to make a complaint about the care provided by the home, and one person said that the home always responds appropriately to any concerns raised and two stated that it usually does. Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there and is in the main part well maintained. People who use the service are encouraged to personalise their bedrooms. The home is well lit, clean and tidy. There were no apparent odours in the home on the day of the site visit. EVIDENCE: Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 24 A tour of the premise was undertaken with the manager of the home. Overall the home was well presented and maintained to a good standard. Refurbishment has been completed since the last inspection and some adaptations have also been put in place. One resident has had their doorframe widened to accommodate their electric wheelchair and to promote independence. A second resident has had a shower put in place rather than a bath in their en suite. There are four corridors within the home and each of these are painted a different colour. There are artworks and pictures on the walls, which brighten them up and add to the feeling of homeliness. All of the resident’s bedrooms seen were personalised according to their taste and some people had pictures and photographs on the walls, others had teddy bears etc. On the lower floor one bathroom was still being used to store equipment, rendering it un-useable by residents. The other bathroom was a wet room, and therefore only had shower facilities. This is limiting in terms of choice for the residents within the home. The option of bath or shower should be available. The items stored in the bathroom need to be removed as soon as possible. There is one full time maintenance person employed by the home. During the inspection a bedroom in the process of being refurbished was seen. The manager stated that new carpets had been laid in the communal corridors. The home was clean and odour free on the day of the inspection. One resident survey stated that the home is always fresh and clean; one stated that it usually is and one that it sometimes is. This resident commented, “My bathroom is cleaned daily. My carpet is hovered les than daily often due to staff shortages. I have been in my own same room (for a number of years). It has never been redecorated and is very shabby. This was raised with the previous manager and a note was made – nothing happened. Although my room is cleaned this is always superficial. I have never known the furniture to be pulled out for a ‘spring clean’ and would like the home to have regular provision for this”. Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are in the main part, adequate numbers of staff at Havering Court to meet the health and welfare of the people using the service, however, some areas within the home are unsupervised for long periods. Staff recruitment is robust. The service recognises the importance of staff training. EVIDENCE: Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 26 Staffing levels were discussed with the manager and these were stated to be two RGN and one head of care with eight carers on the upper floor during the morning period and one RGN and three carers on the lower floor during the morning. In the afternoon this level decreased on the upper floor to two RGN’s and five carers. At night the home has one RGN on each floor, with four carers upstairs and one carer downstairs. During the course of the site visit to this service, long periods of time were spent observing the lower floor lounge and there were a number of periods of up to 15 minutes whereby the lounge was left unsupervised. At the time there were six residents in the lounge, one of these had recently returned from hospital and two were highly dependent. None of the residents within the lounge during this time low dependency. One staff member spoken with stated that thirteen of the residents on the lower floor require the hoist for moving and transfers. They also said that most of the residents the lower floor are high dependency and need help with feeding and bathing. According to the Annual Quality Assurance Assessment received from the home eight staff members have achieved NVQ level 2 or above and eight are working towards an NVQ. This translates into 24 of the total care staff team of which there are forty-one. One resident survey received stated that the staff members at Havering Court always treat them well, and two stated that the staff usually do. One comment received stated, “It depends which staff are on duty. My present key worker is excellent but the night care varies greatly in that some staff are fine but others do not understand my needs and do not treat me respectfully”, a second comment stated, “Pay staff better. Some night staff not as good”. Two relatives’ surveys stated that the care service provided always supports people to live the life they choose. One comment received said, “(There) is a very strong ethos in Havering Court Nursing Home that no resident be forced to do anything against their will or restrict them in any form…There is a relaxed/caring and loving atmosphere in Havering”. A third relative said, ‘(My relative) is unaware but if (they) were aware (they) wouldn’t choose to live (their) life like this and neither would I want (them) to’. One relative also stated under the ‘How do you think the care home or agency can improve?’ section of the survey, that, “Maybe more care staff but I know this can’t always be possible (money). To try and persuade staff to stay. There always seems to be different staff and it takes them time to get to know the residents they are assigned to – their habits, likes and dislikes and their routine”. A second relative reiterated this by saying, “Pay carers a more realistic salary to try and stem the constant turnover of staff”. Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 27 During the site visit the manager did state that the home has engaged in a recruitment drive to ensure that agency staff are no longer needed within the home. He said that the staff team has now stabilised and no agency staff are used. Staff members were observed interacting with residents in a positive and supportive manner. The atmosphere within the home is relaxed and friendly. One staff member spoken with had clear knowledge regarding the individual needs of people who live at the home. One resident came into the managers’ office during the inspection to express a concern for another resident who was coughing. There was clear evidence that the home has an open and inclusive ethos. Staff recruitment files were examined and contained all of the required information, including employment history, proof of ID, start date, references and POVAFirst checks. One file examined had made an application for a CRB check, and had allowed the employee to start work in a supervised manner with a POVAFirst check while awaiting the CRB to be completed. Induction is undertaken with all new staff. There is a two day induction period, where training is completed including Safeguarding training and manual handling training. The inductee then works with a mentor for a period of one month and completes a learning portfolio, which is signed off by their mentor as completed and which is based on the Skills for Care Induction Standards. The manager stated that there is a three-month probation period before the offer of employment is formally offered. A training matrix was requested as part of the inspection. On the day of the site visit the manager stated that this document was not currently up to date. A copy was requested within ten days from the date of the inspection; however, the Commission has not yet received this. Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 29 The manager at Havering Court is experienced, competent to run the home and works to make improvements to the service provided. EVIDENCE: The manager at Havering Court has been in post since March of this year. In the period since the last key inspection there has been a lot of work done to make improvements to the home and it was clear during the course of the inspection that good systems and structures are being put in place. The manager at Havering Court has completed an MBA and his application for registration with the Commission is currently in process. It was clear the manager is positive and proactive and willing to work towards meeting requirements made at the last key inspection, although there is still some work to be done in order to fully realise this. One resident spoken with stated that the manager was very good and that he worked all hours. Information received on the AQAA states that the manager ‘walks the floor’ of the home at least once each day. Quality assurance is completed within the home and a copy of the most recent report was seen during the inspection. A financial audit was also examined, which demonstrated that the home is meeting its targets effectively. The accidents and incidents book was looked at and this had clear information contained within it, which was well recorded. It was positive to note that quarterly incident statistics are collected and sent to BUPA for analysis/information. A number of health and safety certificates were viewed including the gas safety certificate and fire alarms systems and these were in date. Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 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 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT Standard No Score 37 3 38 X 39 3 40 X 41 X 42 3 43 X 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 X X Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 31 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 14 &15 Requirement The registered persons must ensure that service user plans; reflect all their care needs, are reviewed monthly and, used as a working tool by staff. This refers to inconsistency in the level to which care plans are completed and reviewed and to the fact that care plans are locked in the nurses station and inaccessible to care workers. Areas one and two above have been previously stated with a timescale of 31/07/06 and 30/06/07. Some improvement has been seen; this must now be consistently implemented. 13(4)(c) & The registered persons must (15) ensure that individual risk assessments are completed to a sufficient level and outline the means to manage any risk to the person. Risk assessments regarding the use of restraint must be completed in consultation with residents or their representatives and their consent obtained. DS0000015593.V351119.R01.S.doc Timescale for action 31/12/07 2. YA7 30/11/07 Havering Court Nursing Home Version 5.2 Page 32 3. YA19 13(2) This refers to risk assessments completed containing only basics detail, and to restraint risk assessments not being signed by the resident or their representative. The registered person must ensure that arrangements are in place for the safe storage, recording and administration of medication. This refers to the medication fridge having a slightly high temperature recorded, to the controlled drugs cupboard being attached to a stud rather than a solid wall, to handwritten medication profiles not being countersigned, to duplicate MAR sheets being contained within the MAR file, to staff members not defining reasons for medication not being administered and to protocols not being in place for ‘as and when required’ medication. The registered persons must keep the staffing levels under review. This refers to the lower floor, where the lounge is unsupervised for frequent periods during the day and to comments received by residents who expressed concerned about night and weekend staffing levels. 31/12/07 4. YA32 18 31/12/07 Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 33 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 YA27 Good Practice Recommendations The registered person should ensure that the bathroom on the lower floor is not used to store equipment rendering it unusable, as this denies the residents a choice of having either a bath or a shower, and means that there is only one shower available for use on the lower floor for 14 residents. The registered persons should continue to provide training to ensure that at least 50 of care staff to achieve NVQ Level 2 or above. The registered persons should ensure that the manager is registered with the Commission. 2. 3. YA35 YA37 Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Havering Court Nursing Home DS0000015593.V351119.R01.S.doc Version 5.2 Page 35 - 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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