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Inspection on 30/09/05 for The Haven Residential Home

Also see our care home review for The Haven Residential Home for more information

This inspection was carried out on 30th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides accommodation for people to take short-term and longterm care. The residents state that they are happy with the care being provided by the home.

What has improved since the last inspection?

There have been no improvements identified since last inspection.

What the care home could do better:

There were 14 requirements identified at this inspection. The home needs to address the following areas to ensure that they meet the National Minimum Standards. The recruitment, induction and training of staff- all staff must be provided with appraisals and supervision. The administration of medication- a quality monitoring procedure needs to be introduced to the care home. The managers must improve communication within the care home. The management team must monitor the care practice to ensure that the Care Home Regulations are being met.

CARE HOMES FOR OLDER PEOPLE The Haven Residential Home 266 Eastgate Louth Lincs LN11 8DJ Lead Inspector Mr Ken Hague Unannounced Inspection 09:00 30 September 2005 th 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 Residential Home DS0000061417.V257942.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Haven Residential Home DS0000061417.V257942.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Haven Residential Home Address 266 Eastgate Louth Lincs LN11 8DJ 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) 01507 604197 01507 601190 Haven HealthCare (UK) Ltd Care Home 33 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (2), Old age, not falling within any of places other category (31) The Haven Residential Home DS0000061417.V257942.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 06/06/05 Brief Description of the Service: The Haven residential care home is located a short distance from the centre of the market town of Louth. The care home consists of a large main building, which was formerly a vicarage, and two detached bungalows. One of these is a modern building, the others being the conversion of a former courthouse. There is a large car park at the rear of the home which is surrounded by well maintained gardens. The care home is registered to provide care for 33 service users, 31 code elderly and 2 code mental disorder. The home offers long-term care, respite care and holiday stays. All accommodation is provided in single rooms. The Haven Residential Home DS0000061417.V257942.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection received a complaint from a member of the public. The complaint referred to care practice at the home and was referred to the Lincolnshire County Council Social services under the vulnerable adult protection procedures. The Commission for Social Care Inspection and the Lincolnshire County Council contracting section carried out a joint investigation. The conclusions from the complaint investigation is dealt with in a separate report In addition to investigating the complaints an unannounced inspection was carried out. This report sets out the requirements identified at the unannounced inspection. The inspector visited the home on three days between the 30th of September and the 10th of October 2005. A total of 37 hours was spent in the care home. The main method of inspection used is called case tracking which involved selecting three residents and tracking the care they receive through the checking of their records, discussion with them, the care staff and observation of care practices. A tour of the premises was conducted and care records were inspected. Four members of staff, the acting manager, five service users and one relative were interviewed. What the service does well: What has improved since the last inspection? There have been no improvements identified since last inspection. The Haven Residential Home DS0000061417.V257942.R01.S.doc Version 5.0 Page 6 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 Residential Home DS0000061417.V257942.R01.S.doc Version 5.0 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 Residential Home DS0000061417.V257942.R01.S.doc Version 5.0 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&6 There are satisfactory procedures for the introduction and assessment of people to the service, ensuring that care needs are met. Residents and relatives are on the whole happy with the care provided and feel that their needs are being met. The home does not admit residents for intermediate care. EVIDENCE: Resident’s individual care files seen at this inspection contained detailed assessments, these had been completed prior to the residents being admitted to the home. Staff and residents confirmed that the assessments had taken place prior to planned admissions. Staff demonstrated a good knowledge of the needs of the residents. Residents and relatives spoken to said that the home was meeting their needs. The Haven Residential Home DS0000061417.V257942.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10 Resident’s care plans set out their health needs and social needs but some care needs were not being met, some staff were not following the medication policy of the home. The managers of the home have failed to insure that all residents are treated with respect and that their right to privacy is upheld. EVIDENCE: Each resident has an individual plan, which contains information relating to their care needs. Care plans seen had been recently rewritten demonstrating that the care needs of the resident had been reassessed. Two members of Staff and a relative stated that they had found a resident on more than one occasion soaked in urine. The incontinence pad had not been changed and checked in accordance with the instruction on the residents care plan. Two members of staff stated that a stock level check of medication had revealed that the quantity of medication for a resident did not match the quantity recorded on the MAR sheet. There were five tablets more than the quantity recorded on the resident’s medical record. Staff stated that this would suggest medication and have not been given a properly to this resident. It was of further concern that the five tablets had disappeared from the medication cupboard when a second check was made. A member of staff stated that she had witnessed a colleague signing MAR sheets for medication to be given on The Haven Residential Home DS0000061417.V257942.R01.S.doc Version 5.0 Page 10 the following day. The Commission for Social Care Inspection received a notification in September 2005 that a member of staff had given the wrong medication to a resident in the care home. The management of the care home has not protected the dignity of residents. Three members of staff a and a relative stated that a resident had been left soaked in urine on numerous occasions. This had been reported to the home’s management no appropriate action had been taken. During the inspection the Inspector observed a second resident whose clothes were dirty and stained denying him his right to dignity and respect. Three residents complained to the Inspector that a member of staff was disrespectful and rude to them and did not provide them with services as set out on their individual care plan. Two residents stated that they were frightened of this member of staff. The Haven Residential Home DS0000061417.V257942.R01.S.doc Version 5.0 Page 11 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): 13,14 & 15 The home provides a regular activities programme but this could be expanded to include more variety. Meals provided offer variety and choice. The actions of a member of staff did reduce residents ability to have choice and control over their lives. EVIDENCE: The home has an activity programme but this offers only limited activities. Staff stated the activity programme needs to be expanded to ensure that all residents are stimulated. Residents stated that they were satisfied with the menu of the care home. They confirmed their individual dietary needs were being met. Care records contain the likes and dislikes of individual residents. One resident stated “the food is a very good and there is always plenty to eat.” A resident complained that on returning to the care home from a family outing one member of staff failed to provide her with tea. Two residents stated that they did not feel able to decide when to go to bed at night and were reluctant to ask for help during the night shift when a particular member staff was on duty. The Haven Residential Home DS0000061417.V257942.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The home has failed to protect residents from poor care practice. The management have failed to take appropriate action when they were made aware of poor care practice. The acting manager has failed to inform the proprietor of serious complaints. Staff were not confident that if they raise complaints these would be addressed and actioned by the homes management team. EVIDENCE: The Commission for Social Care Inspection was made aware of complaints relating to poor care practice brought to the attention of the Acting manager by staff and a relative. These included a service user allegedly left in urine saturated beds. A staff member not answering a Call bell. A staff member shouting at residents making them afraid of her and reluctant to ask her for help. Three members of staff stated that they had spoken to the acting manager concerning the care practice of this member of staff. A relative confirmed that she had raised the same issues with the management of the home. The management team failed to investigate and address these issues. The acting manager agreed that she had failed to keep the proprietor of the home informed of the problems. Staff stated “we have no confidence in the whistleblowing policy of the home.” The Haven Residential Home DS0000061417.V257942.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not Inspected EVIDENCE: The Haven Residential Home DS0000061417.V257942.R01.S.doc Version 5.0 Page 14 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 &30 Staff have not been recruited in accordance with the National Minimum Standards. Residents have been left at risk as complaints relating to poor care practice has not been addressed and the recruitment policy of the home is not being followed. The home has failed to provide training to ensure that staff are competent to carry out their work. EVIDENCE: An inspection of the individual files for members of staff provided evidence that criminal records bureau checks or POVA first checks were not obtained before employment was commenced. There were not two written references on the files of all employees whose files were inspected. There is no interview procedure in place to ensure that all applicants are interviewed consistently ensuring that all of the information necessary to make a decision to offer employment is obtained. No checks were being made to establish why there were gaps on individual application forms. The interview itself is not recorded. Health care checks on some employers files were not signed or dated, there was no evidence of equal opportunity being offered. The inspection of staff records, discussions with staff members and the acting manager provided evidence that specialised training is not being provided to care staff. There was no ongoing training program in place. The Haven Residential Home DS0000061417.V257942.R01.S.doc Version 5.0 Page 15 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, 36,37 &38 The evidence from this inspection is that the home was not run in the best interest of service users. Staff are not receiving supervision and appraisals in accordance with the National Minimum Standards. Resident’s rights and best interests have not been safeguarded by the homes record-keeping policy and procedures. The food hygiene policies of the care home have not been followed by all staff. EVIDENCE: The Haven care home is managed by an acting manager assisted by a deputy manager. No application has been received by the Commission for Social Care Inspection from the acting manager to become the register manager. At the time of this inspection there was a lack of evidence of leadership from the acting manager, deputy manager and senior carers. The staffing rota did not state which member of staff is in charge of the shift in the absence of a deputy or acting manager. The staff stated they did not know who was in charge when the deputy manager and acting manager were not in the building. The The Haven Residential Home DS0000061417.V257942.R01.S.doc Version 5.0 Page 16 management of staff during these periods was informal. The Haven care home is made up of three buildings, and there was no management structure in place to ensure that a senior member of staff visits all three buildings during every shift. The inspector found one member of staff working in a building unsupervised, completing records stating that checks had been made throughout the night before his shift had ended. The inspection of records and discussions with staff produced evidence that appraisals and supervision are not being provided in accordance with the National Minimum Standards. A member of staff working in the kitchen was seen to be handling cooked fish with his bare hands. The acting manager was advised of this and stated that she would speak with him. The accident book was examined and it was not evident that any analysis of the accidents was taking place i.e. were there any patterns to the accidents. In addition to this it was noted that one resident suffered a head injury and no action was taken as carers felt this was okay. It is not for care workers to make these decisions; trained medical staff need to be consulted. The acting manager wasnt able to produce evidence of a quality assurance system being used in the care home. The Haven Residential Home DS0000061417.V257942.R01.S.doc Version 5.0 Page 17 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 N/a x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 x x x x x x x x STAFFING Standard No Score 27 3 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x x 1 1 2 The Haven Residential Home DS0000061417.V257942.R01.S.doc Version 5.0 Page 18 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. Standard 1 OP8 Regulation 12 Requirement the registered person must ensure that the care home is in conducted so as to promote and make proper provision for the health and welfare of service users the registered person must make arrangements for the handling, safekeeping, administration and disposals of medication the registered person must make suitable arrangements to ensure that the care home is conducted in a manner which respects to privacy and dignity of service users. the registered person must ensure that service users are enabled to make decisions with respect to the care they are to receive and their health and welfare the home must use its complaints procedure and investigate all complaints. It must also advise complainants of the outcome. the registered person must protect residents from abuse DS0000061417.V257942.R01.S.doc Timescale for action 30/12/05 2 OP9 13-2 01/12/05 3 OP10 12-4 01/12/05 4 OP14 12-2 01/12/05 5 OP16 22-5 01/12/05 6 OP18 13-1 (6) 01/12/05 The Haven Residential Home Version 5.0 Page 19 7 OP28 18 8 OP29 19-1 9 OP30 18-1 (c} 10 OP31 10 11 12 13 OP33 OP36 OP37 24 18-2 12-1 14 OP38 12 the registered person must ensure that at all times suitably qualified competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare service users the registered person must not employ a person to work at the care home unless he has obtained in respect of that person information and documents as specified in scheduled 2 the registered person must ensure that the persons employed to work at the care home receive appropriate training for work they have to perform. the registered provider must carry on or manage the care home with sufficient care competency and skill the registered provider must have in place the quality assurance system the registered provider must ensure staff receive appraisals and supervision. the registered provider must ensure the policy and procedures and care records ensure the protection of service users the registered provider must ensure that the health and safety policy at the home is followed. 20/03/06 01/12/05 28/03/06 01/12/05 01/12/05 01/02/06 01/12/05 01/12/05 The Haven Residential Home DS0000061417.V257942.R01.S.doc Version 5.0 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Haven Residential Home DS0000061417.V257942.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Haven Residential Home DS0000061417.V257942.R01.S.doc Version 5.0 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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