CARE HOMES FOR OLDER PEOPLE
The Haven - Colchester 84 Harwich Road Colchester Essex CO4 3BS Lead Inspector
Marion Angold Unannounced Inspection 22nd November 2005 10:00 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 - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 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 - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Haven - Colchester Address 84 Harwich Road Colchester Essex CO4 3BS 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) 01206 867143 01206 793166 Comfort Care Services (Colchester) Limited Mrs Mary Louise Innes Care Home 29 Category(ies) of Dementia - over 65 years of age (29) registration, with number of places The Haven - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 29 persons) 26th July 2005 Date of last inspection Brief Description of the Service: The Haven is a detached property in a residential area of Colchester. The accommodation is mainly on the ground floor, with a choice of communal areas. With one exception, all rooms offer en-suite facilities. Three bedrooms are located on the first floor and are accessed by a stair lift. There is garden and a parking area to the front of the property. The extensive garden at the back has recently been reduced in size by an extension to the property. At the time of inspection, The Haven was registered to care for 20 older people with dementia. An application to vary the registration to include another 9 service users with dementia has since been approved. The Haven - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on 23 November, between 10.00am and 6.50pm, within the context of a visit for the purpose of approving an application made by the Provider to increase the home’s registration from 20 to 29 residents. Much of Inspector’s time was focussed on the new rooms and facilities and ensuring that appropriate arrangements had been made to accommodate additional residents. However, key National Minimum Standards, not covered at the last inspection, were also inspected. Both Deborah Nicklin and Mary Innes, Provider and Manager, respectively, were available to assist and a number of other people, living or working at the home, or visiting their relatives, made a significant contribution to this inspection. 24 Standards were inspected on this occasion, of which 18 were met and the remainder presented minor shortfalls. What the service does well:
Decisions about the suitability of the home for prospective residents were based on an appropriate exchange of information. The Provider and Manager had revised and updated the home’s Statement of Purpose and Service Users Guide, and carried out suitably detailed pre-admission assessments of need for people who were new to the home. The Haven offered residents a safe and comfortable environment, suitable for their needs. The new bedrooms, bathroom, shower room and lounge provided a pleasant addition to the home and met the requirements of the Care Homes Regulations 2001 and associated National Minimum Standards. Residents received their medication in a satisfactory manner and benefited from nutritious meals and an open visiting policy. Suitable arrangements were in place to promote the health and safety of people living and working at The Haven. Visitors said their relative was well cared for and happy and thought the support their relative had received in connection with going to hospital had been outstanding. An outside contractor, who had worked on the premises over a period of months, expressed confidence in the way residents were treated and the availability of staff to provide the necessary care. The Haven - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
Care plans were being revised to cover a broader range of needs and strengths, but management acknowledged that they still had some way to go to complete this process for everyone. The home had begun to tailor activities to individual needs and interests, but this approach was in the early stages of development. Continued training is needed to ensure that staff are equipped to provide the level of dementia care expected of a specialist home. Service users were protected by the home’s recruitment practice, although some essential records had not been retained on file. The Haven - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 7 Senior staff were required to carry out a number of quality checks as part of their daily routines. Management had been reviewing and developing aspects of care provision in response to issues raised by the Commission and Local Authority and had shown that they had taken complaints seriously and were keen to provide a good service. However, they still needed to develop a systematic cycle of planning, action and review, based on the regular surveys of the views of residents, their representatives and other key stakeholders in the home. The hands-on approach of management allowed for staff to be supervised in an informal manner, during the course of their work. Management had also introduced a written format for more formal one-to-one supervision, but at the time of inspection this had still to be applied. 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 - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 8 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 - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 9 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 the following standard(s): 1 and 3 Decisions about the suitability of the home for prospective residents were based on an appropriate exchange of information. EVIDENCE: The home’s Statement of Purpose and Service User Guide had been suitably revised to reflect recent changes associated with the extension to the building and proposed increase in the number of residents accommodated. Initial assessments, completed by the Provider, for three relatively new residents covered a range of individual needs. Mrs Nicklin reported that the assessment process had involved consultation with ward staff, relatives and representatives, as well as time spent observing and talking with the prospective residents. The Haven - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 7 and 9 Residents had started to benefit from a more holistic approach to care plans and received their medication in a satisfactory manner. EVIDENCE: The registered persons had introduced a new style of care plans since the last inspection. The revised methodology included a broader range of needs, identified individual strengths and gave clear instructions to staff. Two complete examples were inspected. One of these included an individual profile, as discussed at the last inspection. The other two care plans sampled followed the old methodology where the focus remained on health and personal care needs and management acknowledged that they still had some way to go in applying the new approach to all the care plans. Medication administration was found to be satisfactory, as observed on the day of inspection. Suitable arrangements were in place for storing medication and stocks held were minimal, showing good reordering practice. It was reported that staff attended a short medications course, with the home’s pharmacy, as a minimum requirement for being involved in medication administration, and subsequently undertook more extensive training through one of the colleges.
The Haven - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 11 Staff worked to a comprehensive medications policy and arrangements for medication were clearly stated in the Service User Guide. The Haven - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 12, 13, 14 and 15 Residents had begun to experience a planned approach to activities and more choice in some areas of their lives. Residents benefited from nutritious meals and an open visiting policy. EVIDENCE: One member of staff was engaging a group of residents in some simple art activities during the morning of the inspection and it was reported that one person would be identified on each morning to carry out an activities plan, which was routinely monitored by the duty senior. Care plans had been linked to group activities. For example, it had been noted that one resident liked to remain in their room, but join the other residents for musical activities or entertainment. The facility for people to remain and eat in their rooms, in question at the time of the last inspection, was both specified in the Statement of Purpose and Service User Guide and evidenced during the course of this inspection. The home’s visiting policy was clearly outlined in the Statement of Purpose and it was evident from observation and discussion that visitors were welcomed, offered refreshments and encouraged to participate in two-way communication about the care of their relatives.
The Haven - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 13 A nutritious and plentiful roast lunch was served from a trolley, enabling service users to choose from available options. Staff also talked with service users about what they might like. The chef, who served the meals and demonstrated knowledge of people’s needs and preferences, had already been round to talk with residents during the morning about the menu, a practice that was confirmed independently by staff. The Haven - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 16 and 18 Complaints were taken seriously by the home and residents were afforded greater protection through relevant staff training. EVIDENCE: The home’s complaints procedures were clearly outlined in the Statement of Purpose and Service User Guide and met the requirements of the Care Homes Regulations 2001. The home had received one complaint since the last inspection, which had been made known to the Commission and resolved to the satisfaction of the complainant. It involved one member of staff forgetting to pass on information to the Manager, so that the required action was delayed. A person, who had, for some time, undertaken structural work on the premises, stated that they had not seen residents being treated in a manner to cause them any concern. Visitors said the same. Necessary amendments to the protection of vulnerable adults and whistleblowing policies and procedures had been addressed since the last inspection. Arrangements had been made for all the staff to attend protection of vulnerable adults training on 6/12/05, and confirmation of this having taken place was received after this date. The Haven - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 15 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 the following standard(s): 19, 20, 21, 22, 23, 24 and 25 The Haven offered residents a safe and comfortable environment, suitable for their needs. EVIDENCE: This unannounced inspection took place at the same time as a site visit to consider the provider’s application to increase the registration from 20 to 29 service users. At the time of completing this report, the variation had been approved. The new accommodation comprised two single bedrooms, within the existing building, and seven single bedrooms in an extension, varying slightly in size but approximating to 12 square metres. These bedrooms met the requirements of the Care Homes Regulations 2001 and associated National Minimum Standards in relation to design, safety, lighting, heating, ventilation, fittings, beds and bedding. The hot water outlet in the hand basins had preset valves. The plumber was called in during the site visit to adjust the valves as the water from several outlets exceeded recommended temperatures.
The Haven - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 16 Bedrooms had been decorated and furnished in neutral colours so that service users could introduce their own things. Bedrooms in the extension had a small wardrobe with integrated shelves. The Manager was advised to offer residents additional drawers, if they chose not to bring items of their own furniture. Similar advice was given with respect to chairs, table and mirror. The registered providers agreed to show prospective residents and their families an example of a complete room and make known that they were entitled to all the items, listed under NMS 24, in any room that became theirs. The wide corridor of the extension was complete with handrails, ceiling and wall lights, and cool surface radiators. The extension included an additional lounge, with patio doors leading to the garden. The Provider reported that a sensory garden was planned for this area. With the new lounge, forming part of the extension, the home was meeting the requirements for communal space in a choice of three locations. New armchairs had been purchased for this room. Alterations to the existing kitchen had included new units and appliances. The new accommodation met the requirements for accessibility. Management had engaged an occupational therapist to conduct an annual assessment of the entire premises and taken appropriate action. They were also following the occupational therapist’s recommendations for one person, whose mobility needs had been individually assessed. Documentary evidence that the home and new extension had met environmental and fire safety regulations was provided for the purpose of the variation. Relatives, commenting on the dust being trodden through by the builders still working outside, indicated that the floors were normally clean. Storage for personal protective clothing for care staff was located in both in the original building and the extension. The Haven - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Service users were benefiting from management’s commitment to maintaining adequate staffing levels and to vocational training for all the staff. Continued training is needed to help ensure that staff are equipped to provide the level of dementia care, expected of a specialist home. Service users were protected by the home’s recruitment practice, although some essential records had not been retained on file. EVIDENCE: The registered persons had engaged a new trainer for the National Vocational Qualification Level 2 and had 50 of staff either trained or working towards their qualification. New recruits to the staff team were expected to give a commitment to vocational training. Management were in the process of recruiting new staff in readiness for the proposed expansion of the home. They had calculated staffing ratios for the proposed 29 residents, using the Residential Forum guidance issued by the Department of Health, assuming that all 29 residents had a high level of dependence. Their calculation had indicated a need for 613.54 care hours per week and the home were proposing to provide 672 hours as soon as the first additional resident moved in. This figure did not include the cleaning and cooking hours, provided by ancillary staff, or the hours put in by the Proprietor, Mrs Nicklin. It allowed for four staff to be on duty for most of the day, with an additional person coming on duty at peak times (8am to 12 noon;
The Haven - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 18 2pm to 3 pm) and three awake staff covering nights. A person, who had been contracted to work at the home over several months, mainly on the new building, said it had been their impression that there were always sufficient staff around to tend to people’s needs, as many as five staff on duty at once. Three new staff files and discussion with management about the interviews taking place around the time of inspection evidenced a thorough recruitment process, although particular documents, such as birth certificates, seen by the home for the purpose of obtaining Criminal Record Bureau disclosures, had not been retained on files. The registered persons were advised to ensure that all records relating to staff and required by regulation were retained and available for inspection. The Haven - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 36 and 38 Management had been reviewing and developing aspects of care provision, but had not established a robust system for ongoing quality monitoring and assurance. Appropriate staff supervision was being introduced, but had still to be established. Arrangements were in place to safeguard people living and working at The Haven. EVIDENCE: As part of their daily routines, senior staff were required to carry out a number of quality checks in relation to care provision, for example ensuring that activities were linked to residents’ individual care plans. Management had also introduced an annual assessment of the premises by an occupational therapist
The Haven - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 20 and had been reviewing and developing various aspects of the service in response to issues raised by the Commission and Local Authority. However, they still needed to develop a systematic cycle of planning, action and review, based on regular surveys of the views of residents, their representatives and other key stakeholders in the home. Reports of such quality reviews must be forwarded to the Commission. Staff indicated that the Provider and Manager were supportive and open to questions and ideas and that everyone in the team worked cooperatively. Lines of support and accountability within the team were clear and the handson approach of management allowed for staff to be supervised in an informal manner, during the course of their work. Following the last inspection, management had also introduced a written format for more formal, one-to-one supervision, but this had not been put into regular use. Discussion took place with management about the key elements to be included in supervision and how the sessions should differ from the appraisals they had done. A number of examples of safe working practices were noted during this inspection. These included mandatory staff training, action to regulate water temperatures, appropriate storage and labelling of food, and the checking and servicing of electrical installations. On completion of work to the new extension, satisfactory reports were received from fire and environmental health authorities. The Haven - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 21 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 X STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X 2 X 3 The Haven - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES 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 Requirement Timescale for action 31/01/06 2 OP12 16 2 (m), (n) 3 OP29 17,Sch 4 & 19,Sch 2 18 4 OP30 The registered persons must ensure that care plans are holistic, covering all the needs of the person concerned. This is a repeat requirement but some progress had been made since the last inspection. The registered persons must 31/01/06 provide opportunities for service users to engage in meaningful or enjoyable activities, which they have helped to choose. This is a repeat requirement but some progress had been made since the last inspection. The registered persons must 31/01/06 ensure that they retain on staff files all the documentation required by regulation. The registered persons must 31/03/06 ensure that staff have the training necessary for the work they are to perform. This relates specifically to ongoing training in the care of people with dementia. This is a repeat requirement but some progress had been made since the last inspection.
DS0000017966.V271669.R01.S.doc Version 5.0 The Haven - Colchester Page 23 5 OP33 24 6 OP36 18 (2) The registered persons must develop a robust system for monitoring and assuring the quality of service provision, based on the views of service users and their representatives. Copies of their quality reviews must be forwarded to the Commission. The registered persons must ensure that staff working at the home are appropriately supervised. This is a repeat requirement. 31/03/06 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Haven - Colchester DS0000017966.V271669.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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