Inspection on 04/06/08 for The Haven

This inspection was carried out on 4th June 2008.

CSCI found this care home to be providing an Poor service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Haven 21/06/10

The Haven 11/06/10

The Haven 12/03/10

The Haven 01/03/10

The Haven 14/09/09

The Haven 26/11/08

The Haven 19/06/07

The Haven 21/11/06

The Haven 29/08/06

The Haven 19/09/05

The Haven 10/12/04

The Haven 27/05/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Haven 6 - 10 North Terrace Seaham Durham SR7 7EU Lead Inspector Miss Nic Shaw Key Unannounced Inspection 4th June 2008 09:00 X10015.doc Version 1.40 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 The Haven DS0000046459.V366573.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. 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 DS0000046459.V366573.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Haven Address 6 - 10 North Terrace Seaham Durham SR7 7EU 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) 0191 5816305 0191 5130377 Haven Hommes 2003 Ltd Sandra Beckwith Care Home 43 Category(ies) of Dementia (7), Old age, not falling within any registration, with number other category (36) of places The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 36 2. Dementia - Code DE, maximum number of places: 7 The maximum number of service users who can be accommodated is: 43 19th June 2007 Date of last inspection Brief Description of the Service: The Haven is a two storey building situated near the seafront at Seaham. It is a well-established care home and can accommodate people over the age of 65 years (36) with the addition of a smaller unit for people over the age of 65 years with dementia (7) making a total of 43 places. Accommodation is provided within single rooms (37) and double rooms (3) each containing washbasins. Toilets and bathrooms can be easily reached from lounges and bedrooms. There are a number of lounge and dining areas and a private garden to the rear of the home. The home benefits from sea views and a promenade walkway to the front across a main road. The current provider is Haven Homes 2003 Limited. The current cost of living at the home ranges between £364 and £412 and does not include hairdressing, chiropody and toiletries. The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that the people who use this service experience poor quality outcomes. Before the visit: We looked at: • Information we have received since the last full visit on 19th June 2007. • How the service has dealt with any complaints & concerns since the last visit • Any changes to how the home is run • The provider’s view of how well they care for people • The views of people who use the service by sending out questionnaires. Eight completed service user questionnaires were received. • The views of staff and relatives through questionnaires. Four staff and one relative sent these back to us. The Visit: An unannounced visit was made on 4th June 2008. During the visit we: • Talked with people who use the service, staff & the manager • Looked at how staff support the people who live here • Looked at information about the people who use the service and how well their needs are met • Looked at other records which must be kept • Checked that staff had the knowledge, skills and training to meet the needs of the people they care for • Looked around parts of the building to make sure it was clean, safe and comfortable • Checked what improvements had been made since the last visit We told the manager what we found at the end of the visit There has been one random inspection of this home since the last key unannounced inspection. This was carried out in December 2007 and showed that the new manager had made much progress in improving the service for people. The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? There are lots more activities for people to enjoy, such as trips out shopping, walks along the sea front and art sessions. The bathrooms have been re-decorated and some new furniture has been provided for the respite care bedrooms. Sixteen domestic hours have been provided to help keep the home clean. The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 7 The manager has looked at and reviewed all of the home’s policies and procedures so that staff are provided with up-to-date information about how to carry out their job. What they could do better: Although there have been vast improvements to the care plans since this manager took over the home, they need a bit more information in them so that staff know what they need to do to meet the service users health and personal care needs. Risk assessments need to be carried out for those people who look after their own medicines. This is to make sure that they get any support they may need in this area, to remain independent. The menu needs looking at as this does not provide people with many choices or wholesome nutritious food. For example; the sandwiches at teatime always consist of either chicken, ham or cheese and pudding is always either ice cream or fruit. The complaints procedure needs to be reviewed and up-dated so it gives people the right information about who else they can complain to. It also needs to be available in different ways, for example on a CD, so that everyone is able to understand it. The manager needs to make sure that all incidents, which involve the safety of service users, are reported to the local authority. This is to make sure that, if needed, a full investigation is carried out involving the local authority, to keep people safe. The building needs attention. For example: although some furniture has been replaced in bedrooms, much of the furniture everywhere else is old and worn and carpets in the lounge, corridors and bedrooms are badly stained. Where new carpets have been put in service users bedrooms these are very badly fitted and look shabby. In some bedrooms they are raised and are very dangerous, as people could trip over them. Lots of the paintwork along corridors is damaged. The manager must make sure she gets a reference from a staff member’s last employer. This is important, as it will help her make sure she only employs suitable care staff. She also needs to sort out her training file as lots of the information in it is about staff who have now left the home. There have been no “regulation 26” visits by the registered provider. These are a legal requirement and are important to make sure that people are receiving a good service. There has been little money spent on improving the home for service users. This means the health and safety of service users is at The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 8 risk, for example, exposed hot pipes and a hot radiator which people could burn themselves on. 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. The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 9 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 Outcomes Statutory Requirements Identified During the Inspection The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Quality in this outcome area is good. We have made this judgement using a range of evidence, including a visit to this service. The admissions process ensures that people are adequately assessed prior to care being offered. This means that service users are offered the right type of care at the home. Furthermore, service users and/or their relatives, have a written contract and therefore know about the terms and conditions of residency. EVIDENCE: The manager always gets a copy of the local authority social work assessment before prospective service users are able to move into the Haven Care Home. She looks at the information in this to make sure that the care home can meet their needs. As well as this, she then visits the prospective service user either in their own home or hospital, so that she can complete her own assessment. The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 11 Service users are always encouraged to visit the home first so that they can decide if it’s the right place for them. One service user said that they had chosen to live in this home. As part of the admissions process, service users are given a copy of the Service User Guide and Statement of Purpose. The manager also asks them what colour they would like their room decorated. One person recently admitted to the home chose lilac for their bedroom and in this way the manager tries to make their move to the care home a positive experience. Five out of six service users said in the questionnaires that they had received enough information about the home before they moved in. When asked if they had been provided with a contract three service users said they had, two people did not comment and one person said that they had not. The manager, however, confirmed that everybody has been given a contract, copies of which are held in the home. The information in the contract given to a new service user was looked at. This includes details about the fees, the role and responsibility of the provider and informs service users about their rights. The service user’s next of kin had signed the contract to show that they had understood and were in agreement with this. The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9&10 Quality in this outcome area is adequate. We have made this judgement using a range of evidence, including a visit to this service. The care plans generally reflect the health and personal care needs of service users, however, they are not always person centred to ensure that the staff provide continuity of care to everyone in the way that they prefer. Staff care practices preserve the dignity and privacy of service users. And medication administration procedures fully protect people. EVIDENCE: Each service user has a care plan. The manager has been working very hard to improve the level of information in these. She has developed a “personal circumstances ” sheet. This provides a pen picture of each person’s abilities. In this it is recorded, for example, whether a person is at risk of developing a pressure sore, what support a person needs at mealtimes and if there is a history of falls, together with what can be done to reduce the risk of these. The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 13 Basic assessments are carried out for physical and mental health needs and pressure sores. The manager has developed these herself, however, they could be improved further. For example, in the pressure sore assessment people are described as having an “average” build and appetite. This needs to be more specific as “average” will have a different meaning to different people. The “daily care plan” provides staff with good information about the service users likes and dislikes. The information in these was generally satisfactory, including the type of bath a person prefers to use, if a person needs assistance to use the toilet and specific personal care preferences, such as removal of facial hair and the use of creams to help with skin condition. However, there was not always a care plan in place for those people at risk of developing a pressure sore. There is also no nutritional assessment carried out on a person’s admission to the home, so that any changes in this area can be monitored. The care plans also focus upon health care needs with little information about each individual’s social and previous lifestyles, which is important when attempting to provide person centred care. In one person’s care plan there was good step by step guidance instructing staff of what they needed to do, for example, “assist with hand washing before meals, sit at the same level when assisting, offer small bite size pieces of food, socially interact, record diet and fluid intake and ensure weight is monitored weekly”. All care plans need to be developed to this standard. Daily records are maintained. However, the records do not always provide information about the care that has been provided. For example, “no problems”, “good food and fluid”. More detailed information is needed as this is used to evaluate whether or not the care plans are working. Service users have access to all NHS facilities. There are regular visits from GP’s and other health professionals including, district nurses, optician and chiropody services, and occupational therapists. There were good detailed records in one care plan about recommendations made by the occupational therapist following their visit. Senior staff are responsible for ordering and administering medication, which is kept in a secure area of the home. The majority of medication is pre-packaged and dispensed by the chemist in a monitored dosage system (MDS). Senior staff read the instruction on the Medication Administration Record (MAR) and check this against the information on the MDS before they administer medication. This was done in a discrete, careful and sensitive way. There The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 14 were no gaps on the MAR sheets seen and clear records were maintained for those people who take Warfarin. This is very important as the dose of this medication regularly changes and so staff need to know exactly what to give and when. Some people look after their own medicines, which is encouraged by the home. However, staff continue to sign the MAR sheet. Staff should not do this as they have not actually seen the person taking their medication. Instead, for all people who look after their own medicines, a risk assessment must be developed and agreed with them. This should include any action taken by staff such as “prompts” to ensure people can remain independent. A prescribed cream had the instruction on the tube “as and when required”. The instruction needs to be specific so that staff know exactly where and when this is to be applied. Senior staff said that they have completed training in medication. Service users said “I feel well cared for”. Four people said in the questionnaires that they “always” get the help and support they need, whilst two people said that they “sometimes” did. Staff treated the service users in a dignified, respectful manner. For example, when speaking to people they made sure that they got down to the person’s level. Service users were not rushed when staff supported them. In one person’s care plan it was good to note that it had been recorded that they needed “alot of communication from staff before and during tasks”. This person has dementia and information like this shows the commitment of the manager to making sure that staff treat service users with dignity and respect when assisting with personal care needs. The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14&15 Quality in this outcome area is adequate. We have made this judgement using a range of evidence, including a visit to this service. Service users have opportunities to make choices in daily routines and social and community activities. This ensures that everyone is able to lead a lifestyle that matches their individual preferences. However service users do not receives a wholesome diet, although mealtimes are a pleasant experience for people. EVIDENCE: Three service users responded in surveys that there were “always” activities and three service users said that there were “sometimes” activities. During the visit staff actively engaged service users in art sessions and some service users were enjoying a game of cards. A reminiscence corner has been developed in the lounge. Service users have been actively involved with creating this. The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 16 Much of the service users art work is displayed on the walls. Where each person sits in the lounge, pictures or photographs are displayed, which reflect that person’s likes and interests. For one person with dementia this involved many photographs of cats, a particular love of theirs. Each morning staff ask people if they would like anything such as sweets or crisps from the local shop. One service user said that they enjoyed going out for a walk along the seafront each day. Another service user helped to put the table clothes on the dining tables ready for tea. The activities file showed that there had been a fireworks display on November 5th, trips to Dalton Park shopping centre and that one person had helped to redecorate their bedroom. Service users also said that they had been for a trip to Harry Ramsdons restaurant for fish and chips. Friends and visitors are able to visit their family member at any time. Some service users also regularly visit their relatives. The majority of people commented positively about the quality of meals. Five service users said in questionnaires that they “always” liked the meals. Service users said “I haven’t had one bad meal yet”, “you can have bacon, egg and sausage sandwiches”, “we get a good dinner” and “lunch was lovely”. The menu for each day is displayed on a menu board in the dining room and service users said that staff always come round each morning and ask them what they would like for lunch. Despite the overall positive comments from service users, menus showed that there is very little variety and choice. For example, of the menus seen, (a sample from 29th April 2008 until 1st June 2008), the choice of sandwiches for tea on 18 occasions was ham, chicken or cheese. Similarly puddings consisted of either a choice of ice cream or fruit. Other than fish on a Friday and the occasional fish fingers, there is no other type of oily fish on the menu, such as sardines or mackerel. This provision of this type of fish is important in terms of providing a healthy diet. One person commented in the questionnaire that they were a vegetarian and that “being a vegetarian makes it difficult”. There is no vegetarian option on the menu. There is little in the way of home cooking, such as pies, cakes, quiches, as only those items on the menu are purchased. The manager said that sometimes even then the food supplies do not match the menu and that she has to go out and buy, for example, fish, so that people can have fish on Fridays. On the day of the inspection the manager was expecting the delivery of food, however, this did not arrive. This meant that the staff had to go out and buy essential provisions such as milk, as there was very little left in the home. The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16&18 Quality in this outcome area is adequate. We have made this judgement using a range of evidence, including a visit to this service. The home has an adequate complaints procedure, so people know that their views will be listened to. Although staff care practices ensure that the service users are protected from abuse, further training is needed in the local authority safeguarding procedures to fully safeguard people. EVIDENCE: Five service users and the relative said in questionnaires that they knew how to make a complaint. One service user said that if they were unhappy about something they would speak to the staff about it first. If this did not resolve things for them, then they would go to the manager. All four staff said in the questionnaires that they knew what to do if a service user, friend, relative or advocate had concerns about the home. There is a complaints procedure which is displayed in the home. However, this is not up-to-date as it does not contain the right information about how to contact the CSCI. It does not tell people that they can make a complaint to the local authority. It is also not available in alternative formats, such as on CD, for service users unable to read. The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 18 There have been two complaints made since the last inspection. The manager has kept a detailed record of the investigation she carried out, together with the outcome. At the moment seventeen staff are completing training in the protection of vulnerable adults. There is a copy of the local authority safeguarding adult’s procedure in the home and staff are reading this as part of this training. There has been one safeguarding issue since the last inspection, which the CSCI was told about. Although the manager had carried out a thorough investigation, and taken the appropriate action, she had not notified the local authority about this, which is important, as this is part of the local authority safeguarding adults procedure. Service users said that they felt safe living in the Haven care home. The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,25&26 Quality in this outcome area is poor. We have made this judgement using a range of evidence, including a visit to this service. The Haven care home does not offer service users a well maintained, safe place to live. EVIDENCE: Although staff said that some new furniture had been provided, this was for the respite care bedroom and other than bathrooms being re-decorated last year, there has been little investment in maintaining the rest of the environment. For example: The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 20 Service users bedrooms: Where carpets have been replaced these are very poorly fitted. For example, not fitted flush to the walls, badly pieced together with gaps and in some cases dangerous with large raised pieces. For one person recently admitted to the home, their bedroom had been furnished with a piece of carpet that had been removed from another area. Again this was badly fitted. In other rooms where the carpet has not been replaced, old stained carpet tiles remain. Some bedroom furniture is dropping to pieces. For example, in one bedroom the handle is missing from the dressing drawer, the bedside table is old and worn and a piece of wood is missing from the cupboard. In this same bedroom the window can only be opened from the outside. In another bedroom the radiator was very hot to the touch and the carpet was raised creating a trip hazard. The manager was asked to sort this out straight away as it was very dangerous for the person using this bedroom. (The manager took immediate action to resolve this issue to safeguard the service user). Toilets and bathrooms: Although these areas have been re-decorated, toilet roll holders and soap dispensers have not been fitted. Some of the paintwork is damaged. The floor in the shower room is badly marked. There is no shower curtain in here and the paintwork is damaged. Also the floor in the toilet by the smoking lounge is badly stained, the grab rail is rusted, a hot water pipe is not covered and the door handle is damaged. The vents in all of the toilets and bathrooms are very dirty and covered in fluff. Lounge/Dining areas/Corridors: The carpet in the lounge is badly stained. Much of the furniture is old and worn. For example, the welsh dresser in the dining room is very badly marked. The dining chairs are heavy and not easy to use. The green easy chairs in the dining room are damaged, the material on the arms has been cut exposing the stuffing. In the visitors room the legs of chairs are badly damaged. The windows in the smoking lounge cannot be opened as they have been painted shut. The carpet in the corridors is dirty. The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 21 General: The lighting along the first floor corridor is quite dim and may cause difficulties for some people. Paintwork on doors is damaged from trolleys and wheelchairs. There is a spacious garden with a green house. However, parts of this area are badly overgrown. One service user said they used to grow tomatoes in the green house but not any more. They also said that sometimes the manager has to cut the grass. The base of the door frame is raised and therefore service users have to step over this if they want to use the garden. This is a potential trip hazard. In the laundry the pipes connected to the sluice are hanging off the wall. Staff knew about infection control and used protective gloves and aprons appropriately. However, not all of the staff have completed training in this. The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 22 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29&30 Quality in this outcome area is good. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are sufficient and staff work as a team. This ensures service users receive person centred care. Furthermore staff training is good, including specialist training to meet the diverse needs of the service users. This enables staff to effectively meeting the care needs of people with dementia. Staff recruitment procedures do not fully protect the service users. EVIDENCE: Staff said that “the boss is good with training”. They said that she puts notices and information about future training courses in the office and so long as they give enough notice, she plans it so they can attend. Staff have had training in dementia, palliative care, cancer care, preventing falls and fractures, as well as moving and handling and emergency aid. Eighteen of the twenty staff have the NVQ level 2 qualification in care, or above. The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 23 The manager has a training file. However, many of the records held in here were for staff who have left the home and therefore do not give accurate information about staff training. There has been a high turn over of staff, eight have left in the last year. This was discussed with the manager who confirmed this was as a result of her challenging bad practise when she took over the home. As a consequence those staff who did not wish to change their practice have left. Staff said that there were either “usually” or “always” enough staff on duty. On the day of the inspection this consisted of the manager, one senior staff, two care staff, one domestic and two kitchen staff for the current 15 service users. Staff spoken to understood about person centred care. Senior staff described how they made sure that this took place, for example, by close supervision of new staff when carrying out moving and handling tasks to make sure that they used the correct slings and moving and handling aids with service users. Service users are satisfied with the care that they receive. Five service users commented in the surveys that the staff “always” act and listen to what is said”. Others told us that “the staff are alright” and “lovely”. Staff files showed that a job application is completed and two written references and Enhanced Criminal Records Bureau check obtained prior to a new person working in the home. However, the manager did not in one instance obtain a reference from one person’s most recent employer. This is important to make sure they are suitable for the job. The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 24 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36&38 Quality in this outcome area is poor. We have made this judgement using a range of evidence, including a visit to this service. Although service users benefit from a qualified manager who promotes their welfare and best interests, as a result of the poor condition of the environment their health and safety is not protected. EVIDENCE: The registered manager has almost completed the Registered Manager Award. In order to up-date her knowledge and skills she is completing other training, such as safeguarding adults, alongside her staff. Service users said about her, The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 25 “Sandra’s a lovely woman” and everyone said that they could approach her if they were unhappy. In order to make sure that service users receive care in a person centred way, the manager and senior staff carry out observations of staff care practices. Staff also confirmed they have regular supervisions with a senior member of staff. The manager gives out questionnaires to service users, relatives and visiting health professionals in order to obtain their views about the service. However, there is no annual development plan for the home. The registered person has not been monitoring the service through Regulation 26 visits and there is no evidence of long term strategic planning or support from the registered provider. Resources have been cut to an unacceptable level, for example the lack of investment in the environment and the quality of food purchased by the registered provider. A detailed record is kept of accidents and incidents and the manager carries out an analysis of these to make sure, if needed, preventative measures are put in place. However, service users health and safety is at risk from the lack of investment in the service, for example the poorly fitted carpets. Service users are encouraged to manage their own money. Recently the local authority has carried out an audit of service users finances. As a result of this audit, the home now maintains three signatures on the service user’s financial transaction sheet, for all transactions. The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 26 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 1 1 X X 1 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 1 1 3 3 X 3 The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 15(1) Requirement Care plans must continue to be developed. For example: If a person is at risk of developing a pressure sore a care plan must be developed to ensure staff know what to do to prevent this from happening. Nutritional assessments must also be carried out when people are admitted to the home so that staff can monitor if there have been any changes. Daily records must be detailed enough to show the care that has been delivered. This to ensure the care plans can be properly evaluated. Risk assessments must be completed for everyone who looks after their own medication. This is to ensure that their independence is promoted whilst at the same time protecting their welfare. Staff must not sign the MAR sheet if they have not seen someone take their medication. “As and when” instruction on DS0000046459.V366573.R01.S.doc Timescale for action 31/12/08 2 OP9 13(2) 31/07/08 The Haven Version 5.2 Page 28 3 OP15 16(2)(i) 4 OP16 22 creams must be avoided. This is to ensure that staff know exactly when and where to administer prescribed creams. Service users must be provided with a wholesome, nutritious varied menu. This is to ensure that their health and well being is promoted. The complaints procedure must include up-to-date information about how to contact us and that they can also make a complaint to the local Authority. The complaints procedure needs to be available in alternative formats so that people can understand it. All potential safeguarding issues must be reported to the local authority. This is to ensure that service users are fully protected. The registered provider must produce a comprehensive refurbishment plan, based on an audit of the environmental needs in the home and detailing timescales for implementation to improve the environment. This must include:Service users bedrooms where there are gaps in the carpet and where paintwork and furniture is damaged. Lounge and dining areas including the quality of dining chairs, carpets and furniture. Bathrooms and toilets, particularly paint work, vents and lack of toilet roll holders and soap dispensers. 31/07/08 31/08/08 5 OP18 13(6) 31/07/08 6 OP19 OP21 OP24 23 31/08/08 7 OP20 23(2)(o) The garden must be well DS0000046459.V366573.R01.S.doc 31/08/08 Version 5.2 Page 29 The Haven 8 OP25 23(2)(p) 9 10 OP26 OP30 OP29 18(1)( c )(i) 19(1)(a) 11 OP33 24(1)(a)& (b) 12 OP33 26 13 OP34 25(2)( c ) 14 OP38 13(4) (c ) maintained and accessible to people living in the home. The lighting in corridors must meet recognised standards (lux 150) so that people can see properly. . All staff must be provided with training in infection control. The manager must obtain a reference from the staff member’s previous employer. This is to ensure that they are suitable to work in the care home. There must be an annual development plan for the home. This is so that service users can be assured that the home is run in their best interests. The registered provider must visit the home at least once a month and prepare a written report on the conduct of the home. This is to ensure that the home is run in the best interest of the service users. The registered provider must supply information as to the financing and the financial resources of the care home. This is so that service users can be assured that the home is financially viable. The exposed hot pipes and raised carpets, which are a trip hazard, as discussed in the environment section of the report must be addressed. This is to ensure service users health and safety is promoted. 31/12/08 31/10/08 31/07/08 31/10/08 31/07/08 31/07/08 31/08/08 The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 30 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 OP30 Good Practice Recommendations The manager should sort out the staff training file so that only up-to-date information about current staff is available. This will help her when planning her training programme. The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 The Haven DS0000046459.V366573.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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