Inspection on 02/08/05 for The Haven

This inspection was carried out on 2nd August 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Haven 06/06/06

The Haven 28/12/05

The Haven 07/01/05

The Haven 12/05/04

The Haven 03/02/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE The Haven The Bungalow 19 Lincoln Road Metheringham Lincs, LN4 3EF Lead Inspector Vanessa Gent Unannounced 2 August 2005 10.00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Haven Address The Bungalow 19 Lincoln Road Metheringham Lincoln LN4 3EF 01526 322051 01526 322051 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs M Dobbs Mrs M Dobbs Care Home 29 Category(ies) of Dementia over 65 (DE(E) - 6 registration, with number Old Age (OP) - 23 of places The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 07/01/05 Brief Description of the Service: The Haven is a large, extended, chalet-type bungalow set at the end of a shared drive in the village of Metheringham. The village is on a bus route to Lincoln and has shops, a G.P. surgery and other amenities available. The home is run as a family business; the owner, who is also the manager, is actively involved on a day-to-day basis with the help of a deputy manager. The home provides personal care for up to twenty-nine people of both sexes, over the age of 65 years, some with dementia. The accommodation consists of thirteen single and eight double bedrooms. All bedrooms have hand washbasins but none is ensuite. There is a small car parking facility at the front of the property. The gardens, both in front of the home and surrounded by the bedrooms at the back, are well-tended and colourful. The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over nine hours. The main method of inspection is called “case tracking”, which involves selecting a proportion of residents, and tracking the care they receive through the checking of records, discussion with them, the care staff and observation of care practices provided. The inspector spoke with six of the twenty-five residents and two of the four care staff on duty as well as the manager and deputy manager. A tour of the home took place. What the service does well: What has improved since the last inspection? What they could do better: Requirements set at the previous inspection have not all been actioned upon, such as the covering of radiators to protect the residents from risk of scalding, providing an adequate amount and variety of activities, replacing worn carpets and providing staff with regular supervision. The home is in need of re-decoration and refurbishment throughout. Practices which were not hygienic were observed in the kitchen and laundering areas of the home and chemicals were openly stored which could put the residents at risk to their health and safety. The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 6 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 Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The home is not able to assure residents that their needs can be met or care delivered to them safely and appropriately. EVIDENCE: No pre-admission assessments were available in the care plans to ensure that the home can meet the needs of the residents it accommodates or inform staff on how to prepare the care plans or provide appropriate care for residents. This has resulted in poor documentation as found in the care plans. The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 Insufficient information for staff to understand and meet the needs of the residents and a lack of liaison with healthcare professionals means that the residents may not be cared for safely at all times. EVIDENCE: The care plans for a recently-admitted resident were not filled in at all. When asked about the care plans, the resident said he wasn’t bothered and that he still rates the home highly. Other care plans were not comprehensively completed although the home’s templates for the care plans would have given a good insight into the residents and how their needs were being met, had they been filled in. A healthcare professional stated that on her occasional visits to the home to a resident on respite care, the staff were helpful and knew why the treatment was required. Wound care is mostly managed by the provider, as she says “you can’t get a district nurse to come out to the home”. The advice of healthcare professionals is not always obtained, as confirmed by a lack of recording in the care plans. Where incidents or accidents were recorded in the accident book, these have not been cross-referenced in the care plans. The manager states that staff “would take the resident to the surgery if it was serious”. The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 15 Not enough activities are provided or sufficient lifestyle choice given to cater for the preferences and wishes of the residents or satisfy their interests and needs. Meals are not always managed in a relaxed, comfortable atmosphere. EVIDENCE: Residents said that no activities are provided and they spend all day in their chairs. Staff said they do not have the time, especially at weekends, to do activities as well as provide adequate care. One resident said “the staff spend a lot of time in the staff room”. No choice of menu is offered at lunchtime. All residents said they like the food, that it is home-cooked and plenty of fresh vegetables are given. One resident said she hadn’t eaten any lunch because staff put too much gravy on her food but have never asked what she prefers. The cook says she removes the plates from the residents herself to monitor their likes and dislikes but hadn’t spoken with that particular resident. Some residents said that a choice of food had been provided the previous summer but they would like to choose every day. Staff were not seated in a relaxed, comfortable manner to assist residents with their meal. Residents were not initially provided with cover for their clothes to prevent them being soiled during the meal. The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 11 Some meals, taken to the residents in the ‘front’ lounge/dining area, were distributed by a person under the age of 16 years and who has not had any food hygiene training. The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Residents are not always protected by staff from harm through the untoward behaviour of other residents. EVIDENCE: All staff have received training in how to protect the residents from the risk of adult abuse. Those spoken with said they would go to the manager or deputy manager if they were uncomfortable with the way residents were treated by other staff and that they know the adult protection procedure if they had serious concerns within the home. On the day of the inspection, there were insufficient staff in one of the lounges to prevent a resident upsetting or touching other residents. One resident said “Don’t leave me; I’m frightened.” The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24, 25, 26 Outstanding requirements regarding the home’s décor, fixtures and fittings and the lack of hygienic practices in the home do not provide the residents with a comfortable or safe environment. EVIDENCE: Some bedrooms are re-decorated as they are vacated, to suit the resident’s taste and wishes and are light, airy and clean. One resident said that “the bedroom is pleasant enough, with a nice view of the garden”. Many of the communal areas of the home, including the lounges, corridors, toilets and bathrooms, are in need of re-decoration and refurbishment. Carpeting, which was required to be replaced at the previous inspection, is still insitu and poses a risk to the safety of residents using that corridor. Radiators are still not covered, although this was a requirement at the previous inspection. The hot water temperatures in the residents’ hand basins differs from room to room: it is either too hot to place a hand under or not hot enough for residents to wash in comfort. There is open access to the kitchen – the kitchen door into the hall was wedged open and there is an open archway from one of the residents’ lounges The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 14 into the kitchen. The windows are not covered with netting and there is no insect repellent mechanism. Hygienic standards in the kitchen were not practiced by staff or visitors. Some staff did not wear aprons or wash their hands upon entering the kitchen. A person under 16 years was given residents’ lunch plates to carry from the kitchen to the residents. Some residents said that they have to guard the area around the kitchen to make sure other residents don’t wander into it. It was reported by staff that the sluicing of soiled articles is not practiced hygienically, being left to soak in the residents’ bath or hand wash sink in the bathroom before being laundered. The gardens are well-maintained and stocked with many colourful flowers to provide the residents with pleasant, safe and calming surroundings. The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 30 There are not sufficient staff on duty at all times to ensure that the residents’ needs are fully met. Training and study courses undertaken enable staff to provide a knowledgeable standard of care. EVIDENCE: The duty rota indicates, and staff say, that there are sufficient staff on duty on the week days but in the mornings at weekends, staff say they feel pressured to complete their work, give enough individual time to the residents or provide them with activities. The twenty-five care staff are responsible for the laundry and activities as well as their caring duties. There are five ancillary workers, including a maintenance man. The cook says she has time to prepare and cook food and wash up but not enough time for a cleaning schedule or to keep records to ensure adequate hygiene is practiced in the kitchen. Some residents said “some staff could be friendlier; some could be more respectful and polite” and “there aren’t always enough staff around when certain residents get upset.” Care staff have been encouraged to take National Vocational Qualifications courses, nine staff having already achieved qualifications and two currently undertaking level 2. Most staff are up-to-date with mandatory training, including first aid, food hygiene, moving and handling, health and safety; all have received fire awareness training. The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 16 The staff files do not indicate that specific training has been undertaken to cater for the needs of the residents with dementia. The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, 38 There are a lack of monitoring, both of the home and of staff, to ensure that consistent care is provided which means that the residents’ needs are not always met and their health, welfare and safety is not sufficiently promoted or safeguarded. EVIDENCE: The provider/manager, who was originally trained as a second level nurse, has run the home for twenty-one years. Staff say they feel they are able to share issues and concerns with her and the deputy manager although they do not always feel that the things they discuss are put into action to remedy their concerns. Staff meetings are not a regular occurrence. The provider runs and manages the home on a day-to-day basis but does not audit or monitor the service provided and did not produce an action plan for the re-decoration and refurbishment programme for the home after the last inspection. There is no questionnaire or channel for residents to ‘have their The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 18 say’ although one resident said “the manager has been a good friend; I can talk to her”. Staff do not yet receive regular supervision, as required from previous inspections. Chemicals for cleaning were left exposed on shelves in the laundry room and accessible to residents who use the adjoining corridor. This required an immediate notice to be given at the previous inspection but is still outstanding. This can put the residents and staff at risk of harm. The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 2 x x x x 3 1 2 STAFFING Standard No Score 27 2 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 3 3 2 x x 2 x 1 The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 20 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 3 Regulation 14(1) Requirement The registered person must ensure that a full pre-admission assessment is undertaken to ensure that the needs of the residents admitted to the home are met. Care plans must contain enough detail to ensure that staff know how to care for the residents and protect them from harm, and be reviewed regularly. An immediate requirement was set at this inspection, with the provider being aware of the timescale given for the completion of the first two care plans to be available for inspection. Staff must liaise with health care professionals and record accurately the care provided in relation to promoting the residents health and welfare Activities must be provided to take into account the wishes of the residents and be provided often enough to keep them occupied, as they wish. Food must be provided that accords with the choices of residents and is served in a Timescale for action 31 October 2005 2. 7 15(1, 2) 3. 8 12(1) Immediate -19 August 2005 for first two care plans and 31 December 2005 for completion of all care plans 31 October 2005 4. 12 16(2) 31 October 2005 5. 15 16(2) 30 September 2005 Page 21 The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 relaxed, comfortable atmosphere 6. 18 13(6) Residents must be protected from harm by staff who are alert to their needs and are stationed where they can monitor the behaviour of residents at all times. The home must be kept in a good state of repair and decoration to meet the needs of the residents and accord with their tastes. (Timescale of 30 March 2005 not met for the replacement of worn carpets.) Radiators must be covered or have low temperature surfaces and the hot water at the residents outlets must be of a temperature that may not cause scalds to the residents. (Timescale of 30 June 2004 and 30 July 2005 not met.) An immediate requirement was left at this inspection and the provider was aware of the timescale set. The registered person must consult with the Environmental Health Officer concerning the hygiene practices in the kitchen, laundry and all other areas in the home and these practices must comply with health and safety regulations to safeguard the health and safety of the residents. Staffing levels must be adequate to meet the needs of the residents and keep them safe at all times. The registered person must establish a means to monitor and improve the quality of care in the home. The registered person must ensure that all staff are supervised regularly to monitor 30 September 2005 7. 19 23(2) 31 December 2005 8. 25 13(4) Immediate -31 August 2005 9. 26 13(4) Immediate - 30 September 2005 10. 27 18(1) 30 September 2005 30 September 2005 31 October 2005 11. 33 24(1,2) 12. 36 18(2) The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 22 their practice and training needs. 13. 38 13(4) Chemicals used in the home must be stored in a locked facility to protect residents from the risk of harm. (Timescale of 7 January 2005 not met.) An immediate requirement was left at this inspection and the provider was aware of the timescale set. Immediate - 8 August 2005 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 36 Good Practice Recommendations Each staff should be supervised six times per year. The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Unity House, The Point Weaver Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Haven C53 C04 S2444 The Haven V242106 020805 Stage 4.doc Version 1.40 Page 24 - 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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