Inspection on 30/06/08 for The Haven Colchester

This inspection was carried out on 30th June 2008.

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

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 Colchester 26/07/06

The Haven Colchester 22/11/05

The Haven Colchester 01/02/05

The Haven Colchester 08/10/04

The Haven Colchester 24/02/04

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

CARE HOMES FOR OLDER PEOPLE The Haven Colchester 84 Harwich Road Colchester Essex CO4 3BS Lead Inspector Deborah Kerr Unannounced Inspection 30th 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 Colchester DS0000017966.V367408.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 Colchester DS0000017966.V367408.R01.S.doc Version 5.2 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 the.haven@btconnect.com Comfort Care Services (Colchester) Limited Ann West Care Home 29 Category(ies) of Dementia - over 65 years of age (29) registration, with number of places The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 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 2006 Date of last inspection Brief Description of the Service: The Haven is registered to care for 29 older people with dementia. The home offers long term or respite care. The Haven is a purpose built detached property in a residential area of Colchester. The accommodation is mainly on the ground floor, providing good access for people with physical disabilities. There are two lounges serving different parts of the building and a communal dining room. With one exception, bedrooms offer en-suite facilities. Three bedrooms are located on the first floor and are accessed by a stair lift. There is a small garden and a parking area to the front of the property and an enclosed garden at the back. Fees range from £367.13 to £ 610.00, items considered to be extra to the fees include private chiropody, hairdressing, toiletries and manicures. This was the information provided at the time of key inspection, people considering moving to this home may wish to obtain more up to date information from the care home. CSCI inspection reports are available from the home and our website at www.csci.org.uk The Haven Colchester DS0000017966.V367408.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 2 stars. This means the people who use this service experience good quality outcomes. This was a key inspection, which focused on the core standards relating to older people. The inspection was unannounced and lasted nine and three quarters of an hour on a weekday. This report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from eight relatives, two staff and two health professionals ‘Have Your Say’ surveys and the Annual Quality Assurance Assessment (AQAA), issued by the CSCI. This document gives providers the opportunity to inform the CSCI about their service and how well they are performing. We (CSCI) also assessed the outcomes for the people living at the home against the key Lines of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. Time was spent talking with people who live in the home, three relatives and three members of staff. The proprietor, manager and administrator of the home were available during the inspection and fully contributed to the inspection process. What the service does well: The Haven continues to ensure people’s needs are fully assessed before moving into the home, and their relatives and representatives are welcomed as visitors and consulted about the care provided. The home provides a friendly, happy and relaxed atmosphere for those who live there, in a clean and comfortable environment. This was confirmed in feedback obtained from relatives during the inspection and in ‘Have Your Say’ surveys, they continue to be happy with the care their relative receives. Comments included, “my relative couldn’t be in better hands” and “all the staff are wonderful, I am impressed with the skills of all the staff and their loving caring nature to my relative”. Other comments included, “I am always kept informed about my relative and measures being taken with their health” and “the staff treat my relative with care and compassion” and “I am very happy with the care of my relative, they are always nicely dressed and clean”. Comments received in a health professional’s survey reflected “in the forty years of my profession I have never come across a better and caring service provider. The staff should be congratulated on their caring and compassionate handling of the service users”. The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? Six requirements and four recommendations were made at the previous inspection. Information provided in the AQAA and verified at this inspection confirmed that action has been taken to address four of the requirements and three of the recommendations. Previous requirements related to medication, activities, staffing levels, staff supervision, residents access to personal monies and safety of the people living in the home. There have been improved arrangements for the provision of activities, which means people using this service are being offered the opportunity to engage in more meaningful and enjoyable activities. It was noted previously that the arrangement of chairs along the walls of the new lounge did not encourage residents to communicate with each other or engage with the television. A flat wide screen television has been purchased which is to mounted on the wall above the fireplace, which will make viewing programmes easier. Previously there has been an issue about people being able to access their money when they wanted it, as only the management team had access to the safe. A duplicate key has now been cut for senior staff so that people can access their personal allowance and related records when the management team are not on the premises. A previous requirement was made to ensure that staff working at the home are appropriately supervised. Records indicated that regular supervision takes place, this was confirmed in conversation with staff. Documentation reflects that sessions include discussion of general work objectives, performance and development and identify training needs. It was previously recommended that as a home specialising in dementia care, the registered persons should ensure that staff continue to develop skills in this area through a training programme. Training records, and discussion with staff confirmed that they had attended training on dementia awareness. Additionally, the manager was advised to show the start and finishing times on the duty roster so that the hours actually worked by each person could be easily calculated. Examination of the duty rota reflected the designation of the each member of staff and clearly showed the hours worked. To ensure the health and safety of people living in the home and minimise the risk of residents coming into contact with hazardous substances the laundry door is closed and locked, when there is no one in attendance. The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 7 What they could do better: Consideration should be given to providing information about the home and how to make a complaint in a format suitable for people with a visual and/or other sensory impairments. Stringent auditing of medication and further staff training will ensure people using this service will receive their correct levels of medication and maintain their health and wellbeing. Observation and discussion with staff confirmed they are aware of the need to treat people with respect and dignity when delivering personal care. However, current practice of assisting people to change into their night wear, following periods of bed rest in the afternoons due to time constraints does not reflect the home’s philosophy to promote people’s dignity and choice. Staffing levels and deployment of staff need to be reassessed to ensure there is sufficient staff available to meet peoples’ needs at the busiest times of the day. Support plans need to be developed to provide guidance to staff to ensure they have a consistent approach when supporting people with behaviours that can be challenging to others. Although staff were confident that they were able to manage episodes of verbal and/or physical aggression, they were not consistent in their approach, neither had they received training to ensure they have the skills and knowledge to understand and manage episodes of challenging behaviour. The home is nicely decorated throughout providing a clean, safe and comfortable environment, however more could be done to promote an enabling environment for the people who live there. The walls and doors throughout the home, particularly in the newer extension are all pale colours, with no distinguishable features, which can be confusing for people with dementia. Good signage would help people identify key areas, such as bathrooms and toilets. Distinguishing features, for example, different coloured doors, doorknockers, pictures and photographs would help people identify their personal rooms. The carpet near the staff toilet and leading from a resident’s room, is rucked which is a potential tripping hazard and requires attention to ensure the safety of people living and working in the home. Staff files are well organised and contain the relevant documents required under regulation. However, where staff had commenced employment with a Protection of Vulnerable Adults (POVA) first check, there was no printed evidence of this on their files to confirm this had been received. Where an Umbrella Body system is used, it remains the responsibility of the proprietor or manager of the establishment (and not the Umbrella Body) to make decisions on whether a person is or is not suitable to work in the service. To do this the Umbrella body should pass a copy of the POVA First to the proprietor or manager to provide evidence that the check has been made and The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 8 that there are no reasons recorded as to why the individual should not be working with vulnerable people. To ensure the safety and welfare of the people living and working in the home action needs to be taken to ensure that doors fitted with closures can automatically close if the fire alarm sounds. A tour of the building identified that room number 6 had a chair holding the fire door open, which the manager identified was not working. Additionally doors to room’s 8-11 had been wedged open. 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 Colchester DS0000017966.V367408.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 Colchester DS0000017966.V367408.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): 1, 2, 3, 4, 5, 6, People who use the service experience good quality outcomes in this area. People considering moving into this home and their representatives will be provided with the information, they need to make a decision if the home is suitable for them. They will have their needs assessed and will be provided with a contract, which clearly tells them about the service they will receive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Before people move in to the home they are provided with detailed information, which enables them to make an informed decision about whether the home will meet their needs. Information about the home has recently been reviewed and updated to provide comprehensive information about the home, including an A-Z guide of the services available. The statement of purpose clearly sets out the objectives and philosophy of care, detailing the specialist services provided, quality of the accommodation, qualifications and experience of the staff and how to make a complaint. The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 11 At the time of the inspection there were twenty-seven people living in the home. The AQAA reflects that eighteen people have impaired vision and two have impaired hearing. Consideration should be given to providing information about the home and how to make a complaint in a format suitable for people with a visual and/or other sensory impairments. Prospective residents are invited to view the home and discuss their requirements with the management team. They are also invited to spend time at The Haven before making a decision if this is the right placement for them. Information provided in the AQAA and verified at the inspection confirmed that before people move in to the home a detailed assessment is carried out to identify their individual needs. Care plans of three people living in the home were looked at as part of the inspection process, all three contained the required assessments, which provided a comprehensive overview of their health, personal and social care needs. Staff files and the training schedule for 2007/2008 reflected that people working in the home have received training, which provides them with the required qualifications, skills and experience to meet the needs of the people living in the home. This was tested through discussion with staff during the inspection who demonstrated a good understanding of people’s individual needs. People living in the home have been provided with a copy of their contract setting out their terms and conditions of residence, which had been agreed, signed and dated by the individual, or their relative. The home does not provide intermediate care. The Haven Colchester DS0000017966.V367408.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, People who use the service experience good quality outcomes in this area. The health and personal care people receive is based on their individual needs, however, more stringent auditing of medication and further staff training will ensure people using this service will receive their correct levels of medication to maintain their health and wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified during the inspection confirmed that staff provide care and support based on detailed care plans and assessments relating to mental and physical health as well as nutrition, risk of falls, skin integrity, pressure area care and moving and handling. Examination of three peoples care plans confirmed these are very detailed and contain comprehensive information, which covers all aspects of the individual’s health, personal and social care needs. The descriptive part of the care plan is held in a filing cabinet in the office upstairs, these are not easily accessible by staff. However, the proprietor updates the care plans on a regular basis and provides staff with regular bulletin updates, which keeps staff up to date with information about each persons needs. The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 13 Observation and discussion with staff confirmed that they are aware of the needs of the people in their care. They were able to provide a verbal account of the needs and preferences of each individual. The daily charts, which record the weight, food and fluid intake and elimination, of individuals are held in a number of different files or in people’s rooms. This makes it very difficult to monitor the individual’s health and well being, for example examination of elimination charts showed that these were not accurately recorded and suggested that an individual had not opened their bowels for a period of 24 days. The AQAA has identified that an area the service needs to improve is to increase monitoring and evaluation of service users needs. To address this issue care plan diaries have been introduced for each resident, which contain all the required health charts and daily records in one folder. Additionally, at the front of the diary there is a section, which when completed would provide staff with an overview of the care needs of the person, with regard to the level of support they require to meet their needs and preferences. This will make it easier for people who are not familiar with the individual to deliver personalised and consistent care. The daily records need to be improved to reflect how the individual has spent their day, rather than entries ‘all care given as stated in care plan’, which does not describe the well being of the individual. For example, good daily records should incorporate what has worked for the individual that day, where there has been progress, achievements or any concerns about their health and welfare. People living in the home are supported to have access to health care services. Dates and details of appointments are clearly recorded in the care plans. Healthcare needs of the people using the service are managed by visits from the local General Practitioner (GP) and district nurses. Additionally, where required, specialist support is sought from community health services with regards to psychological health and behavioural issues. Records of meetings and reviews reflect that people living in the home and their relatives are invited to participate in the development of care planning strategies. Observation and discussion with staff confirmed they are aware of the need to treat people with respect and dignity when delivering personal care. However, due to time constraints staff described assisting people to change into their nightwear, following periods of bed rest in the afternoons. This practice does not reflect the homes philosophy to promote people’s dignity and choice. Discussion with the proprietor and manager, confirmed they have recently reviewed staffing levels and deployment of staff to ensure there are sufficient staff at the busiest times of the day. They agreed to review this again to ensure this practice does not continue, unless the individual chooses to change into their nightwear of their own accord. The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 14 Feedback about the service obtained from relatives during the inspection and in ‘Have Your Say’ surveys confirmed they continue to be happy with the care their relative receives. Comments included, “my relative couldnt be in better hands” and “I feel most of my relatives needs seem to be catered for very well”. Other comments included, “I am always kept informed about my relative and measures being taken with their health” and “the staff treat my relative with care and compassion” and “I am very happy with the care of my relative, they are always nicely dressed and clean”. During our visit we looked at Medication Administration Records (MAR) charts and blister packed medication belonging to people living in the home. Each persons MAR chart had a front page with their name and photograph to avoid mistakes with identity. Examination of the current monthly MAR charts identified fifteen separate occasions where people’s medication had been given however, staff had not signed the MAR chart to reflect this. On one occasion, the code ‘O’, for other, had been used on the MAR chart however, there was no explanation on the reverse of the MAR chart to reflect why the medication had not been administered. On another occasion an individuals MAR chart had not been signed, and the corresponding medication was found still in the blister pack. There was no explanation on the reverse of the MAR chart why medication was not administered, or if this had been refused. Additionally, on another occasion medication was found still in the blister pack, however staff had signed to reflect this had been administered. The provider was left an immediate requirement to deal with these issues to ensure people using this service receive the correct levels of medication. Issues about medication would normally affect the rating in this outcome group, however, to be fair and proportionate, the proprietor has notified us (The Commission) following the inspection, in writing, of what they have done to address these issues. They have put new measures in place, which have reduced the risk to people using the service and which will continue to monitor medication practises. No person living in the home is currently prescribed controlled drugs, The proprietor was advised that should controlled drugs be prescribed for one or more persons, it is a legal requirement that the home must have a separate metal cupboard of specified gauge with a double locking mechanism, which is fixed to a solid wall, with either rawl or rag bolts. The Haven Colchester DS0000017966.V367408.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, People who use the service experience good quality outcomes in this area. Improved arrangements for the provision of activities mean people using this service are being offered the opportunity to engage in meaningful and enjoyable activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Annual Service Review (ASR) completed by us (The Commission) on 5th December 2007 reflected that feedback from relative’s surveys thought people living at the home lacked stimulating activities. The need for suitable activities has been an ongoing requirement since July 2005. Information provided in the AQAA, discussion with relatives during the inspection and samples of comments taken from relative’s surveys reflect that there has been an improvement in the level of activities provided in the home. Comments included, “I am kept informed about my relative’s life at the home and informed about activities and any entertainment arranged” and “all the staff are kind, caring and take time to attend to individual residents needs and interests, such as reading poetry and playing board games” and “activities have improved, we have been asked to bring in old photographs for ‘yesteryear’ sessions to promote conversation and discussion amongst the residents”. The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 16 The notice board displays details of visiting entertainers, forthcoming events and a daily activities programme. People were observed involved in flower arranging and a music therapy session. An activities book seen confirmed activities are taking pace and who took part. Recent activities included exercise to music, memorabilia session, sing a long, flower arranging, music therapy, games and puzzles, reminiscence, ball games and a cinema afternoon showing classic films. The home has become a member of the National Organisation for Providers of Activities for Older People (NAPA). NAPA is a registered charity with a keen and active interest in providing high quality activity provision for older people. They provide training, information newsletters and inspiration bulletins of different activities for people to take part in. The home has purchased a box of items to enhance activities in the home, including flash cards and memory joggers of film stars, puzzles, skittles, match cards, music equipment and armchair basketball. The AQAA reflects an activity co-ordinator has been appointed to increase focus on planning social events and activities. Information in the AQAA also identifies the need to continue to evaluate and expand the social activities programme. There are plans to provide further staff training based on developing skills related to encouraging interaction and providing social activities, for people with dementia and to introduce therapeutic treatments, such as reflexology and aromatherapy. Information in the homes brochure and the AQAA states that the home assists residents to maintain contact with links to the local community, family and friends. This was confirmed observing and speaking to a number of relatives and friends visiting people in the home during the inspection. Visitors are made welcome and confirmed they are able to visit at any reasonable time. Additionally, a relative commented “we receive a newsletter, which keep us up to date with events in the home”. The lunchtime and evening meal were observed. Meals are served in two separate dining areas. Three people chose to eat their meals in the smaller dining area, and were observed interacting with each other and the staff. The remaining residents were served their food in the dining room. Where an individual required support to eat their meal this was done sensitively and at a pace suitable for the individual to enjoy their food. Menus seen provided a good range of meals with two choices of main meal and sweet each day. Where individuals required a soft food diet, their meals were pureed, each food item was pureed individually to ensure the individual could identify the different tastes and textures. Food seen was nicely presented and appetising, people spoken with confirmed they were enjoying their meal. Relatives ‘Have Your Say ‘surveys confirmed residents are receiving a good balanced diet, comments included, “my relative is well fed and care is taken to give them food they like” and “I am impressed that each resident is treated as an individual, in their dress, interests and choice of meals”. The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 17 Time was spent with the cook, who demonstrated a good understanding of the dietary needs of the people living in the home. All foods are being stored in accordance with food safety standards and the required documentation of temperature checks for fridges and freezers are being kept. Environmental Health carried out in an inspection of the home in October 2006, making a requirement to replace the edges of kitchen work surfaces. This has not yet happened, however the proprietor produced a quote for the kitchen to be refurbished. The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 18 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, People who use the service experience good quality outcomes in this area. People who use this service have access to robust and effective complaints and safeguarding adults procedures, however plans need to be developed to provide guidance to staff to ensure they have a consistent approach when supporting people with behaviours that can be challenging to others. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that neither the home or the Commission have received any complaints about the service. The home has a clear and effective complaints procedure and an appropriate adult safeguarding policy in place. Staff spoken with are aware of residents rights and how to refer a complainant to a senior member of staff. They were clear about their duty of care and what they would do if they had concerns about the welfare of a resident. Relatives ‘Have Your Say’ Survey’s and discussion with people visiting the home during the inspection confirmed they know how to make a complaint about the service, should the occasion arise. Comment’s included, “I am in contact with the home every day and know everyone I need to know, if I have any concerns or complaints” and “I have no concerns about the home”. The pre admission assessments for two individual’s tracked as part of the inspection process identified that they could present behaviours that are The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 19 challenging to others living and working in the home. Although staff were confident that they were able to manage episodes of verbal and/or physical aggression, they were not consistent in their approach. The residents care plans identified that specialist advice had been sought from the Community Psychiatric Nurse (CPN) to assess these residents. Charts have been implemented to monitor the individuals mood, however there was no support plan in place, which identified known triggers to behaviours or which provided guidance to staff of agreed action they needed to take to support the individual. Staff have not received training to ensure they have the skills and knowledge to understand and manage episodes of challenging behaviour. They did confirm they had received Protection of Vulnerable Adults (POVA) training and what this meant in relation to the people living in the home. They considered protecting residents from abuse is a priority to ensure a happy safe environment. Certificates confirmed POVA training had been provided at the end of 2006. The proprietor confirmed that they were in the process of arranging dates for refresher POVA training and said they could also access managing challenging behaviour through the same company. The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 20 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, 22, 24, 25, 26, People who use the service experience good quality outcomes in this area. The physical design and layout of the home enables people who use the service to live in a well maintained and comfortable environment, however more could be done to encourage independence by creating a more enabling environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that The Haven is a purpose built home situated in attractive and secure gardens close to Colchester town centre and all local amenities. The courtyard garden in the centre of the property has recently been landscaped and a summerhouse erected for people to use in the nicer weather. The home is nicely decorated throughout providing a clean, safe and comfortable environment, however more could be done to promote an enabling environment for the people who live there. The walls and doors throughout the home, particularly in the newer extension are all pale colours, with no distinguishable features, which can be confusing for people with dementia. The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 21 Good signage would help people identify key areas, such as bathrooms and toilets. Distinguishing features, for example, different coloured doors, doorknockers, pictures and photographs would help people identify their personal rooms. All bedrooms are single and with the exception of one room have en suite washing and toilet facilities. Rooms are provided with good lighting and safe radiators and are nicely decorated reflecting the individual personalities and interests of the occupier. Additionally, the home has two assisted baths and two walk in showers. There is a programme of ongoing maintenance, with plans for a new kitchen to be installed and work is in progress upgrading bathing facilities. The carpet near the staff toilet and leading from a resident’s room, is rucked which is a potential tripping hazard and requires attention to ensure the safety of people living and working in the home. A previous requirement was made for the arrangement of chairs in the lounges, to be reviewed for the benefit of residents who want to watch television. The television is currently positioned in a corner of the lounge. The chairs are still positioned around the room, making it difficult to view the television from certain parts of the lounge, particularly where there is a dividing pillar in the centre. To address this issue a wide flat screen television has been purchased, which is to be mounted on the wall above the fireplace. This will make it easier for people to watch television. Appropriate aids and equipment to transfer immobile people safely and comfortably and to encourage independence are available throughout the home. These include grab rails in all corridors, bedrooms and bathrooms. The home is suitable for people who use a wheelchair, with the exception of the offices on the first floor, which are only accessible by a stair lift. Where people are assessed as a high risk of occurring pressure areas they have been provided with pressure relieving equipment. The premises were clean and free from offensive odours. A comment received in a relative’s ‘Have Your Say’ surveys, confirmed this, “the home itself is always clean and fresh smelling”. The laundry facilities seen were clean and tidy with appropriate equipment to launder clothing and bedding and soiled linen. Appropriate hand-washing facilities of liquid soap and towels are situated in bathrooms and toilets where staff may be required to provide assistance with personal care. Random testing of water temperatures reflected that the water supply is below the maximum recommended 43 degrees centigrade, which minimises the risk of people living in the home scolding themselves when washing their hands, taking a bath or shower. The Haven Colchester DS0000017966.V367408.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, People who use the service experience adequate quality outcomes in this area. Staff in the home are trained, skilled and in appropriate numbers to support the people who live there, however to ensure peoples safety written confirmation of POVA first checks must be obtained and kept in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rota reflects twenty-four hour care is provided to the people living in the home. Discussion with staff and confirmed on the rota reflects the minimum number of staff throughout the day is four, with three waking night staff. Additionally, a fifth person is being rostered to organise activities. Staff confirmed the staffing levels are sufficient to meet the needs of the people living in the home, although they felt there were times due to the increased needs of the residents they could do with an extra member of staff. This was discussed with the proprietor and manger who have recently reviewed staffing numbers and have altered shift patterns to ensure that there are enough staff at the busy periods of the day. Additionally, the management staff structure has been reviewed to enable managers to work alongside the staff team. A previous recommendation was made for the duty roster to show staff working times. Examination of the duty rota reflected the designation of the each member of staff and clearly showed their start and finish times. The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 23 Information received in a health professionals ‘Have Your Say’ survey provided positive feedback about the staff. They commented, “in the forty years of my profession I have never come across a better and caring service provider. The staff should be congratulated on their caring and compassionate handling of the service users. They seem to provide a caring environment, in adequate numbers to deal with their clients needs, I do not know the skills and experience of the staff, but they appear competent at their jobs”. This was also confirmed in a relative’s survey, who commented, “all the staff are wonderful, I am impressed with the skills of all the staff and their loving caring nature to my relative”. Staff files and information obtained in staff ‘Have Your Say’ surveys confirmed recruitment checks had been carried out prior to appointment and staff felt they had been recruited fairly. The files are well organised and contained the relevant documents required under regulation. However, where staff had commenced employment with a Protection of Vulnerable Adults (POVA) first check, whilst awaiting the full enhanced Criminal Records Bureau (CRB) check, there was no printed evidence of this on their files to confirm this had been received. The proprietor advised that their umbrella body informs them by telephone when the POVA first comes through. Where an Umbrella Body system is used, it remains the responsibility of the proprietor or manager of the establishment (and not the Umbrella Body) to make decisions on whether a person is or is not suitable to work in the service. To do this the Umbrella body should pass a copy of the POVA First to the proprietor or manager to provide evidence that the check has been made and that there are no reasons recorded as to why the individual should not be working with vulnerable people. New care staff who have received a clear POVA First check can only be employed subject to induction and supervisory arrangements. The proprietor and staff confirmed that they are supervised and shadowed by another member of staff during their induction period and until their CRB is received. Additionally, all new staff are required to complete an ‘Induction in Care’ workbook. Examples of workbooks seen reflect these encompasses the Skills for Care Induction standards and the General Social Care Code of Conduct. The workbooks cover an introduction to the service, the policies and procedures and ways of working with people using the service. Staff are expected to write an account of their own learning, which is overseen by the head of care, who also assesses their overall competency. Information provided in the AQAA stated staff undertake specialist training to enable them to provide care and support to people using the service. This was confirmed through discussion with staff and in information received in two staff ‘Have Your Say’ Surveys. Staff said they enjoyed working at the home, as the people are friendly and there is a good atmosphere. They confirmed training is provided continually, which is relevant to job, helps them to understand and meet needs of residents and which kept them up to date with new ways of The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 24 working. They also said they were kept up to date with information about residents and that they had received good induction training. Most recent training has included dementia care, safe handling and administration of medication, first aid, fire safety, food hygiene, moving and handling, health and safety, Control of Substances Hazardous to Health (COSHH) and infection control training. Information provided in the AQAA and verified at the inspection confirmed that staff are trained to National Vocational Qualification (NVQ) standards level 2 and 3. The home employs a total of twenty four care staff, twenty two have completed NVQ Level 2 or above, with two staff currently working towards completion. Additionally the management team have completed NVQ 4 and the Registered Managers Award (RMA). These figures reflect that the service has achieved the National Minimum Standard (NMS) target of 50 of care staff to hold a recognised qualification. The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 25 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, 35, 36, 38, People who use the service experience good quality outcomes in this area. People living in the home can be assured that the home is run in their best interests by a competent and qualified management and staff team. They can be assured that the effectiveness of the service is being continually monitored and improved through the homes quality assurance system. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection visit to the home there has been a change in the management structure. The former registered manager of the home has taken on the role of administrator. A new manager has been appointed who has twenty years experience of working in the care sector. The proprietor continues to be actively involved in the day-to-day management of the home. Each of the management team has the relevant qualifications and experience for their role and management of the service. The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 26 The manager completed the AQAA, which provides clear and relevant information. The AQAA informed us about changes that have been made to improve the service and identifies where improvements need to be made and how these are to be implemented. The proprietor, administrator and manager demonstrated a clear understanding of the work required to improve and develop the service. Information provided in the AQAA stated an annual quality assurance assessment is undertaken to ensure the views of people who use the service are considered and standards are met. The most recent quality assurance concludes the service delivers a high standard, quality of care for people with specialist needs within a safe and comfortable environment and the people using the service are satisfied with the care and services they receive. This was confirmed in comments from relatives, which included, “in nearly all cases I would say the high level of efficiency needs little improvement, I feel that we have been very lucky to find such a good home for my relative, we have absolutely no complaints” and “the home looks after the health and well being of the residents very efficiently and the fact that the staff and management give it such a lovely homely atmosphere is particularly pleasing”. The AQAA states the management team ensure all relevant policies and procedures are adhered to and that people using the service are provided with legal representation, financial and professional services, as required. The administrator holds small amounts of residents’ personal money, deposited by their relatives. Previously there has been an issue about people being able to access their money when they wanted it, as only the management team had access to the safe. A duplicate key has now been cut for senior staff so that people can access their personal monies when the management team are not on the premises. Records of three people being tracked as part of the inspection showed a clear audit trail of all financial transactions. Monies held for each person were checked against the balance sheets and were found to be accurate. A previous requirement was made to ensure that staff working at the home are appropriately supervised. Records indicated that regular supervision takes place, this was confirmed in conversation with staff. Documentation reflects that sessions include discussion of general work objectives, performance and development and identify training needs. To ensure the safety and welfare of the people living and working in the home action needs to be taken to ensure that doors fitted with closures can automatically close if the fire alarm sounds. A tour of the building identified that room number 6 had a chair holding the fire door open, which the manager identified was not working. Additionally doors to room’s 8-11 had been wedged open. The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 27 The fire logbook confirmed that the fire alarm is tested weekly using different zones and regular fire training and drills take place, with a record of the staff in attendance and outcomes of the drill are recorded. The most recent Gas and Electrical Safety Certificates, including Portable Appliances Testing (PAT) were seen and records showed that equipment is being regularly checked and serviced. The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 28 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 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 X 3 3 3 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 3 X 3 3 X 2 The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 29 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 OP9 Regulation 13 (2) Requirement The manager must ensure that medication is being properly administered and clear records kept. This will ensure that people receive the correct levels of medication. This is a repeat requirement from key inspection 26/07/07 The current practice of assisting people to change into their night wear, following periods of bed rest in the afternoons due to time constraints does not reflect the homes philosophy to promote people’s dignity and choice. Staffing levels and deployment of staff need to be reassessed to ensure there is sufficient staff available to meet peoples needs at the busiest times of the day and to promote their dignity. Where people living in the home present behaviours that can be challenging to others, training needs to be provided and plans developed with strategies of how staff manage physical and /or DS0000017966.V367408.R01.S.doc Timescale for action 30/06/08 2. OP10 12(4) (a) 21/08/08 3. OP18 13 (6) 21/08/08 The Haven Colchester Version 5.2 Page 30 verbal aggression and unpredictable behaviours. This will ensure staff have the skills and knowledge to manage and understand behaviours that can present as challenging to others, and to safeguard the individual and others living and working in the home. 4. OP29 19 (1)(b) Schedule 2 People working in the home must have all the required employment checks required by regulation. Where an Umbrella Body system is used, it remains the responsibility of the proprietor or manager of the establishment (and not the Umbrella Body) to make decisions on whether a person is or is not suitable to work in the service. A copy of the POVA First must be obtained to provide evidence that the check has been made and that there are no reasons recorded as to why the individual should not be working with vulnerable people. These must be available for inspection at all times. 21/08/08 5. OP38 23 (4) The manager must take 30/07/08 adequate precautions against the risk of fire, including making arrangements for containing fire. Action needs to be taken to ensure that doors fitted with closures can automatically close if the fire alarm sounds. This will ensure the safety and welfare of the people living and working in the home The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 31 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 OP1 Good Practice Recommendations Consideration should be given to providing information about the home and how to make a complaint in a format suitable for people with a visual and/or other sensory impairments. The daily records need to be improved to reflect how the individual has spent their day, rather than entries ‘all care given as stated in care plan’, which does not describe the well being of the individual. For example, good daily records should incorporate what has worked for the individual that day, where there has been progress, achievements or any concerns about their health and welfare. More could be done to promote an enabling environment for the people who live there. The walls and doors throughout the home, particularly in the newer extension are all pale colours, with no distinguishable features, which can be confusing for people with dementia. Good signage would help people identify key areas, such as bathrooms and toilets. Distinguishing features, for example, different coloured doors, doorknockers, pictures and photographs would help people identify their personal rooms. The carpet near the staff toilet and leading from a resident’s room, is rucked which is a potential tripping hazard and requires attention to ensure the safety of people living and working in the home. 2. OP7 3. OP19 4 OP19 The Haven Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Colchester DS0000017966.V367408.R01.S.doc Version 5.2 Page 33 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!