Inspection on 26/04/06 for The Haven Nursing Home

This inspection was carried out on 26th April 2006.

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

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

Other inspections for this house

The Haven Nursing Home 22/05/07

The Haven Nursing Home 26/10/05

The Haven Nursing Home 11/05/05

The Haven Nursing Home 02/11/04

The Haven Nursing Home 28/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE The Haven Nursing Home New Road Ash Green Coventry CV7 9AS Lead Inspector Yvette Delaney Key Unannounced Inspection 26th April 2006 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 Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 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 Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Haven Nursing Home Address New Road Ash Green Coventry CV7 9AS 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) 02476 368100 02476 644008 Regal Healthcare Homes Ltd Mrs Valerie Lewis Care Home 61 Category(ies) of Dementia - over 65 years of age (61), Old age, registration, with number not falling within any other category (61) of places The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th October 2005 Brief Description of the Service: The Haven Nursing Home is registered to provide nursing care for up to 61 elderly residents, this includes registration to provide dementia care. Regal Health Care Homes Ltd owns the home. The home is located on the outskirts of Bedworth, with the City of Coventry close by. The Haven was originally a school; this was converted and extended to provide single storey accommodation for elderly residents. There are fortyfive bedrooms in the home sixteen of which are for shared accommodation. Communal facilities include a large lounge diner, a smaller lounge diner, quiet room and a small sitting room at the front entrance to the home. The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection for this inspection year 2006/07. The registered manager and administrator for the home were available throughout the inspection. The inspection visit was unannounced and took place over two days between the hours of 10.00 am and 9.30 pm on day one and 10.00 am to 2.00 pm on the second day. The registered manager and administrator were available throughout the first day of the inspection. Records relating to resident care, staff training and recruitment, health and safety and care practices were observed throughout the day. A tour of the home was undertaken with the administrator and included visiting bedrooms and communal areas. Four residents were identified for case tracking. Eleven residents were spoken with and one relative. Thirteen staff were spoken with, which includes the cook, the administrator and registered manager for the home. A pre-inspection questionnaire was completed by the registered manager and returned to the Commission for Social Care Inspection (CSCI). Information in the questionnaire details that current charges for this home are £447. The manager was asked to distribute questionnaires regarding the service to residents, relatives and health care professionals. The completion of these is voluntary but proves useful in assessing the views that people who live in the home or experience the service through visiting the home may have. The Commission at the time of writing this report had received seven responses from relatives. One comment received states: “Mother appears happy and content treating the Haven as her own home. Recently unable to visit due to ill health, I can rest content knowing she is in good hands and getting good care. Also I am confident in being notified of any problems arising. At a sad time this place is indeed The Haven” What the service does well: The attitude of the staff toward the residents is good and staff were seen talking to the residents at different times during the day. A response in one of the comment cards received said that: “Staff are always talking and dancing with the relatives and friends that are there, they go around, all of them, to make sure they are alright.” The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 6 The registered manager ensures that residents are only admitted to the home following a full pre-admission assessment and assurances given that the home will be able to meet their needs. The care planning system used in the home is informative and would support staff in meeting the care needs of residents admitted to the home. What has improved since the last inspection? What they could do better: 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 Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The quality of this outcome group is good this judgement has been made using available evidence including a visit to the home. Residents’ are suitably assessed prior to admission to the home and residents and relatives are assured that their needs will be met. EVIDENCE: Four care plans examined evidenced that the registered manager assesses potential residents to ensure that the home has the resources and ability to meet their care needs before being offered a place. Summaries identifying the care needs of residents referred by the different care management teams namely Social Services or Primary Care Trust were available on file. Evidence of ongoing care reviews for residents were also available. Individual records are kept for each resident and inspection of the records for four of the residents had full assessment information recorded. The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 9 A relative for a recently admitted resident said that her relative had recently moved from another home and she had been involved in the assessment prior to admission to this home. The visiting relative said that the staff were meeting agreed care needs and that her relative was more responsive and alert since moving into the home. The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 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, 8, 9 and 10 The quality of this outcome group is adequate this judgement has been made using available evidence including a visit to the home. Resident’s health, personal and social care needs are set out in individual care plans but some care practices are of poor standard and medication procedures need to improve to ensure the safety of residents at all times. EVIDENCE: The home is currently working closely with the Primary Care Trust as part of a team involved in reviewing and developing care practices in care homes. The Staff Nurse who represents the home showed and explained to the inspector work that had recently been completed linked to the activities of daily living and assessment of resident needs and the development of risk assessment. Four residents were identified at the time of inspection to be assessed through the case tracking process, these residents were seen and interaction between them and staff were observed throughout the day. The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 11 Care plans examined show that they are detailed and describe the specific needs of residents. The information available was sufficient to support staff in meeting the needs of residents. Statements were read which provided evidence of an evaluation of the care given and monthly review of residents care needs had been carried out with input from relatives and residents where appropriate. There was evidence of completed risk assessments in all the care plans examined. Risk assessments examined include nutrition, continence and determining the risk of a resident falling. One resident liked to walk but was also at a high risk of falling as detailed in the care plan this resident received constant observation and support when walking and also wore protective clothing to lessen the risk of injury. The resident was observed to be wearing head protection. Daily written statements reflected how the health, social and personal care needs had been met and the type of day the residents had. Written statements were not consistently dated and timed to provide an effective audit trail. There are currently no residents with pressure sores. Care plans examined detailed plans of care for the care of pressure areas and prevention of pressure sores. Risk assessments had been completed for the four residents. One resident had a sore on his leg, which was weeping but did not have a dressing applied as instructed in the care plan. There is evidence in care profiles of access and advice being obtained from specialist nurses, which include the Tissue Viability Nurse and the Community Psychiatric Nurse and the GP on the care and treatment of residents. The Home accommodates a high percentage of residents who have a high level of dependency. Two residents were observed to be receiving their daily nutritional intake through a tube inserted into their stomach, care given was appropriate and all equipment required was available and clean. Resident’s were observed to require the support of more than one carer, specialist equipment, which includes beds and hoists are available to support meeting individual needs. Nutrition assessment and weight charts were maintained for all residents and evidence showed that these were closely monitored and appropriate action taken to manage any concerns with weight loss. The home has a dedicated medication room and secure storage. Medicines that were no longer required were recorded and returned to the pharmacy for The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 12 disposal. There is a detailed policy and procedure, which should support staff to practice safely when managing medicines. The home does not have a robust checking in procedure and do not see the prescription prior to dispensing, which would help to improve practices. The majority of medicines administered from the Monitored Dosage System were given correctly but many audits failed as nursing staff did not record the quantities carried over from previous cycles. Audits demonstrated that not all the medicines had been administered as prescribed. Medicines had been signed as administered when they had not been and some gaps were seen on the Medicine Administration Record (MAR) chart. It could not be demonstrated whether the medicines had been administered and not signed or not administered and the reasons for nonadministration recorded. This indicates that the nursing staff are not referring to the MAR chart before the administration and signing directly after the transaction in all instances. The home has a dedicated refrigerator but the maximum, minimum and current temperatures were not recorded daily to ensure the medicines are stored within their product licence. Eye drops, insulin and Glucogel (Hypostop) was being stored in the fridge and some temperature recordings indicated that the actual temperature was registering 0°C and it is important not to freeze insulin and Glucogel. A number of insulin’s both ampoules and monitored dose ‘pen style’ dispensers had been removed from their original packaging. For some of the insulin’s there were no instructions available and no indication as to which resident the insulin belonged. Two ampoules had been labelled with the first name of two residents. The registered manager was proactive in her response to concerns raised about the management of medicines in the home and was keen to improve practices to ensure resident’s needs are met and their safety maintained. Residents in the home are dependent on care staff to support them in maintaining privacy and dignity. Residents looked cared for with attention to their personal hygiene and oral hygiene. Both residents and relatives spoken with said that the care they received was good. Residents who were able to express themselves said that they are cared for and felt that staff respect their privacy. Care staff were observed speaking to residents politely and in a friendly manner. The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 13 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 The quality of this outcome group is good this judgement has been made using available evidence including a visit to the home. Resident’s daily lifestyle in the home related to meals and stimulation demonstrates understanding of the therapeutic and emotional needs of the elderly with high dependency needs and residents with dementia. EVIDENCE: On the day of inspection an external entertainer visited the home to entertain the residents. The entertainment involved residents and staff using musical instruments, singing and also passing a balloon to each other as a form of gentle physical exercise. The activity session was well attended residents and staff joined in the singing and the session was very interactive with resident enjoying themselves. The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 14 The Activity Organiser, care staff and the external entertainer encouraged residents to join in and gave support where it was needed. Discussions were held with the Activities Organiser who was very enthusiastic and ensured that a full activity and entertainment programme was available. One to one activities were carried out with residents who have complex needs and those who did not wish to join in group activities. Relatives, friends and other visitors are encouraged to visit throughout the day and maintain contact and involvement in the care of their relative. Visitors were observed to visit the home at the time of inspection. A conversation was held with one relative who was very positive about the home. Times of visiting were varied throughout the day and there were no restrictions. The relative spoken with was happy with the home and expressed that this was the first time for three years that she felt she could go abroad for a holiday. Relatives commented that they were free to visit their relative at any time and were able to take them out if they wished. Proactive links are well established with the local community. The activity coordinator spoke about fetes and barbecue’s that had taken place and a programme of activity had been planned for the year. Trips out are planned to Warwick Castle, the local garden centre and pub lunches. Visits are made to the home by local schools and church representatives. A conversation with a resident showed that he was encouraged and supported to continue with his own personal interests of painting and music. Photographs were displayed on the doors to resident’s bedrooms. On some of the doors more than one photograph was displayed and these were used as a collage to tell a story about individual residents lives. One resident had previously owned a pub. Photographs showed him at different ages and included photographs of the pub. This was an example of good practice and could also provide effective therapy for residents with short-term memory loss and dementia. During a tour of the premises it was noted that there is a high percentage of shared bedrooms in this home. Sixteen of the 45 bedrooms available are shared, which is 35 of the accommodation available. Residents who do not know each other share these bedrooms. Distinct areas of identified separate living areas space was not clearly identified in all bedrooms. Care workers were observed, closing the doors to residents’ rooms before undertaking personal care tasks. The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 15 Verbal communication with two of the residents identified for case tracking was not possible due to their complex needs. Observations were made of residents’ reaction and response to care and interaction between staff. Through observation and conversations with other residents during lunch and throughout the day the majority of residents were seen to be relaxed and said they were happy with day to day life in the home. Residents received a snack meal of soup and sandwiches at lunchtime on the day of inspection and the main meal was served in the evening. The inspector joined the residents for lunch the meal looked appetising, was tasty and well presented. Mealtime was observed to be a social occasion with residents talking, supporting each other and enjoying their meal. A choice was available at both lunchtime and suppertime. It was not clear how residents were provided with a choice at mealtimes. The administrator for the home showed the inspector colour photographs of plated to day planned menus. The plans are to show residents pictures of the food choices for the day, which should support them in making an informed choice. A tour of the kitchen demonstrates that the area was clean. Records to demonstrate cleaning procedures carried out are not maintained consistently. Discussions with the cook demonstrate that this is on the occasions when someone is covering her shift in her absence. The manager is aware of this and intends to take action and then monitor the situation. The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 16 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 The quality outcome for this group is good this judgement is made using available evidence including a visit to the home. Complaints and concerns are investigated and ongoing training for staff related to adult protection supports the rights and protection of residents from abuse, which increases their feeling of safety and quality of life in the home. EVIDENCE: A detailed complaints procedure is available and accessible to residents, staff and visitors in the home. One relative spoken with said that if they had any concerns they would speak to the manager. Comment cards received from relatives expressed that were aware of how to make a complaint if they needed to. During the course of this inspection the Commission has received one complaint, which has been formally passed to the Registered Manager for the home to investigate. The outcome of this investigation will be shared with the Commission and details of the outcome will be included in the next report. The manager said that the home had not received any complaints and this was reflected in the pre-inspection questionnaire received. A procedure for responding to allegations of abuse is available with clear guidance for staff to follow. Training records showed that staff had attended recent adult protection training sessions. The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 17 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, 21, 22 and 26 The quality outcome for this group is adequate this judgement is made using available evidence including a visit to the home. The environment is maintained and adapted to support residents in having a positive experience of living in the home. EVIDENCE: A tour of the home identified that redecoration has continued in the home to include some bedrooms and corridors. Paintings of murals of flowers and different colours used in the corridors provide a form of signage for different areas in the home. This approach will support the orientation of residents when moving around the home. Some bedrooms viewed remain in need of decoration. Progress has not been made on the plans for renovation and extension of the home although building work is still to progress. The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 18 The lounges are used daily by a large number of residents with varying care needs. These areas look crowded although the furniture has been arranged to provide small sitting areas. The lounge area was very busy and provided limited space for those residents who liked to walk about. There were two areas, which cause concern in the main lounge on the ground floor, these being the open access to the kitchen, which could be accessed by wandering residents. The other is how obvious it was that residents were being toileted in adjacent toilets situated just off the main lounge. It was difficult for staff to be discreet and the practice seen gave an institutional feel to the home. There is a lack of bathing and shower facilities in this home which has been identified by the owner and manager. This shortfall will be addressed in the plans put forward to extend the home. The majority of residents have the use of only two assisted bathrooms, which are situated in the same area of the home. There are other bathing facilities, which are not used by residents as assisted facilities are not provided and residents cannot get in and out of them. The home provides equipment necessary to assist residents to maintain their mobility and independent access around the home. Hoists, transfer belts and Zimmer frames were seen in use. Care staff were observed not to use appropriate moving and handling techniques when using the hoist and moving residents. On two occasions the hoist was left in front of two residents unattended and although they were not ready to be transferred. The hoists were left in a position that could cause injury if resident was to lift their head or attempted to stand up. A suction machine and tubing although checked every day by nursing staff was dirty and needed cleaning. Work is needed on the gardens to the rear and side of the home to make this area accessible to residents. A visit by the local fire service was made to the home on 30 January 2006. Two areas related to the fire doors were identified for action and the work has been completed. A small electrical heater noted in a room used as a small quiet lounge did not have a low surface temperature covering and was in need of PAT testing. Observations in the laundry area show that it needs to be improved, for instance, the room was not organised and the system for managing clean and soiled linen or clothing was not followed. The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 19 Designated laundry staff are employed and distinct clean and dirty areas are identified. Procedures carried out by staff did not follow the procedure for the home related to the prevention of cross infection. Staff were putting dirty clothing and soiled linen into the washing machines without wearing protective clothing of aprons and gloves. The area for storing clean clothing and linen was not organised and there were boxes and bags of clothing, tights, socks and slippers, which were being used for communal wear. This is not good practice and a system is needed to ensure that residents have their own clothing returned to them. Two residents spoken with said, the laundry wasnt too bad, they wear their own clothes, but are dissatisfied when their clothes cant be found, as they have to wait for the staff to find the missing garments. A response from a relative in one of the comment cards received commented: “The only part of the system that seems at fault is the laundry. Despite name tags clothes go missing regularly and we have to replace.” The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 20 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 The quality outcome for this group is adequate this judgement is made using available evidence including a visit to the home. Information related to the training of staff ensures that skilled care staff are available to support meeting the health and personal care needs of residents. Recruitment practices were not sufficiently robust to ensure sufficient and suitable staff are employed within a safe and monitored environment. EVIDENCE: The files for three members of staff were examined and group and one to one discussions were held with six care staff who were responsive and very receptive to the discussion. At the time of the visit the staff team consisted of the registered manager, an administrator, seven registered nurses, three senior carers twenty-two care staff, one cook, one kitchen assistant, two laundry staff and one cleaner. On duty on the morning shift of the day of inspection visit were the registered manager, the administrator, one registered nurse, nine carers, a cook a kitchen assistant and a cleaner. Staffing levels were down on the day of inspection; the home manager was included in the care staffing numbers and was designated to be in charge of one of the floors. The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 21 The first two weeks rota for April was examined. Time allocated for the manager to manage the home was not indicated. In discussion the manager said that this was due to a member of the nursing staff being on holiday. It was not evident from rotas how and if dedicated time is allocated to managing the home. Four designated care staff and one registered nurse provide care at night. A duty rota identifies the names of the staff, how they are to be deployed and the role of the worker. Staff rotas also evidence the home covers any staff absence with their own staff, bank staff or agency staff. A total of 230 hours of agency and bank staff have been used over a two-week period. Care staff spoken with said that staff were flexible and provide additional cover if possible. A comment received from a relative expressed concern about staffing levels: “Often the ‘floor’ is very stretched with not enough staff. All staff work very hard.” Discussion with the staff and examination of documentation confirm twelve care staff have obtained a National Vocational Qualification (NVQ) level two or three. Three of the four care staff spoken with were qualified to NVQ level two or three. Staff spoken with were enthusiastic about training and said that opportunities were available to attend training. All staff were up to date with mandatory training requirements. Discussion with staff evidence that most have completed dementia care training, and all have undertaken training in moving and handling, basic food hygiene and first aid. Care staff were able to confirm attending a range of training, which include Peg feeding, male catherisation for registered nurse and nutrition. Information about training and development provided and attended by staff was confirmed in staff training records. Although there is evidence of a thorough induction programme care staff were only able to confirm receiving a three day induction period. The staff recruitment records and files of three staff examined, identified some shortfalls in the staff recruitment process. Gaps in employment history were not fully explored and appropriate references had not been obtained for one of the staff. The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 22 Criminal Record Bureau (CRB’s) disclosure certificates were held for one of the four staff and initial PoVA first checks were available for the remaining three staff. These staff members were working under supervision as they are directly involved in resident care. The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 23 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): 31, 33, 35 and 38 The quality outcome for this group is good this judgement is made using available evidence including a visit to the home. The overall management approach in the home promotes and protects the health, safety and welfare of residents and staff. There are a number of areas related to the homes management and operation, which needs to be improved to ensure the safety of residents at all, times. EVIDENCE: The registered manager is due to complete the Registered Manager’s Award (RMA) in June this year. Further training planned is the completion of an indepth dementia care course, which she will start in October this year. The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 24 There are clear lines of accountability in the home and discussions with care staff and relatives demonstrate that they are aware of the lines of accountability. Observations made indicate that the manager is approachable and has good interaction with residents, relatives and staff an open door policy is practised. Visitors to the home stated that they found the managers and other nursing and care staff approachable. Concerns were raised as to how much time the manager is able to dedicate to managing the home. A comprehensive formal quality assurance package was evidenced. The package was recently used to send questionnaires out to relatives of residents in the home. The outcome of these were favourable and the results shared with the Commission. Policies and procedures used in the home are also linked to the quality assurance tool used. Monies are held by the home on behalf of a number of residents for safekeeping and are stored safely and securely. Residents’ money is held separately in individual pockets and individual ledgers are maintained. Records are held of all financial transactions, but the system is not clearly defined, for instance the system used by staff when money is received out of office hours is not in keeping with Data Protection Act 1998 and records are not well organised. A small electrical heater noted in a room used as a small quiet lounge did not have a low surface temperature covering and was in need of PAT testing. Records examined include maintenance, contracts and servicing documentation for electrical equipment, gas, clinical waste and all other services supplied to the home. Resident aids and equipment have also been serviced, this includes hoists seen in use during the inspection visit. As previously discussed in the environment section of this report, observations during the day noted that care staff were not using appropriate moving and handling techniques when using the hoist. The hoists were left in a position that could cause injury to the resident. A suction machine and tubing was noted to be dirty. The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 25 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 2 X 2 3 X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X X 2 The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 26 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 The registered manager must ensure that daily records are dated and timed to demonstrate that individual residents health, personal and social care needs have been met provide details for ongoing review and a proactive audit trail. All prescriptions must be checked prior to dispensing and a system installed to check the dispensed medication and the MAR charts received into the home. The quantities of all medicines received or balances carried over from previous MAR charts must be recorded to enable audits to take place and demonstrate staff competence in medicine management. The MAR chart must be referred to before the administration is signed or the reason for nonadministration recorded immediately afterwards. Timescale for action 31/08/06 2 OP9 13(2) 30/06/06 3 OP9 13(2) 30/06/06 4 OP9 13(2) 30/06/06 The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 27 5 OP9 13(2) Staff drug audits must be undertaken for all staff that handle medicines on a regular basis to demonstrate staff competence in medicine management. Appropriate action must be taken when discrepancies are found. All medicines available for administration must be labelled by the pharmacist. 31/07/06 6 OP9 13(2) 30/06/06 7 OP9 13(2) The refrigerator temperatures 30/06/06 (maximum, minimum and current) must be recorded daily and all must lie between 2°C and 8°C to ensure the medicines requiring refrigeration are stored in compliance with their product licences to guarantee their stability. The registered person must ensure that all personal care needs including assisting residents to use the toilet are carried out in a suitable private area and in a manner that respects resident’s privacy and dignity. The garden area to the side and rear aspect of the home must be made suitable, safe and accessible to residents. 31/07/06 8 OP10 12 9 OP19 23 31/08/06 10 OP19 16, 23 The manager must provide a 31/08/06 timed action plan to the Commission for the proposed building works. This must include details for the replacement of carpets, furniture and furnishings on completion of the work. Outstanding from 26 October 05 11 OP21 16, 23 The registered person must DS0000042690.V290835.R01.S.doc 31/08/06 Version 5.1 Page 28 The Haven Nursing Home 12 OP26 13, 16 13 OP27 18(1)(a), 3(a)(b) 14 OP27 18(1) forward to the Commission a timed action plan for ensuring that there are a sufficient number and appropriately located assisted bath/shower facilities suitable to meet the needs of residents. The registered person must 31/07/06 ensure that the procedures carried out in the laundry follow guidelines for the control of infection and that the laundry area is maintained in a clean, organised and suitable fashion. The numbers and skill mix of 31/08/06 staff must be appropriate at all times to meet the health and welfare needs of service users. The registered manager must review the dependency levels of residents and increase staffing levels accordingly. The information held on the staff 31/07/06 rota must be expanded to identify the hours when the registered manager works and how these hours are allocated between management duties and covering the floor. Recruitment procedures in the home must be reviewed to ensure a robust and consistent approach to staff recruitment and employment practices, which evidences that staff are safe to work with vulnerable adults. Evidence must be available which demonstrates the arrangements for providing management cover when the registered manager is providing cover for the ‘floor’. The registered person must maintain records of the purpose DS0000042690.V290835.R01.S.doc 15 OP29 19, Sch.2 31/07/06 16 OP31 12 31/07/06 17 OP35 9(a) 31/08/06 Page 29 The Haven Nursing Home Version 5.1 18 OP38 13 for which residents’ money was used and retain receipts for items or services purchased on behalf of the resident. The registered person must ensure that all electrical equipment is maintained and suitable for use in the home. The electrical heater identified in the home must be checked to ensure that it is safe for use. The registered person must ensure that the suction machine used to support individual residents needs is checked to ensure that it is clean to minimise the risk of cross infection as well as maintained and working properly. The registered person must ensure that all staff are trained in the correct and safe use of moving and handling equipment particularly when preparing to use the hoist. 30/06/06 19 OP38 13(3), 16 31/07/06 20 OP38 13(5), 16 31/07/06 The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 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 2 Refer to Standard OP7 OP30 Good Practice Recommendations The registered manager must ensure that daily records are dated and timed to provide a proactive audit trail. The registered manager should ensure that staff are aware of what their induction process involves and over what period. The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Haven Nursing Home DS0000042690.V290835.R01.S.doc Version 5.1 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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