Care Home: Haven Lodge

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What the care home does well Care plans are well written and are sufficiently detailed in order to guide and direct staff practice. Care plans are kept under regular review and are updated and changed when needed. People are well supported to access healthcare services as required such as the dentist, general practitioner and optician. Specialist services such as mental health support are arranged for people as and when needed. Haven Lodge is a new purpose build care facility, its furnishings are of high quality. The manager is committed to providing a good quality service for those who live at the home. The Annual Quality Assurance document completed by the manager prior to our visit was sufficiently detailed and provided an honest reflection of the service provided. The Registered Person is aware of areas of required improvements and is working diligently to achieve these. People who live at Haven Lodge who we spoke with told us they were happy, settled and had made friends at the home. Relatives told us of `teething` problems they had experienced when the home first opened, however, people reported to us a number of improvements they had noted over the past few months. What has improved since the last inspection? This is a new service which was registered with The Care Quality Commission in July 2009. This is the first inspection of this service. What the care home could do better: In order to ensure that full information has been obtained in order to determine if the home are able to meet the needs of people the home must ensure that all preadmission documents/assessments are completed in full. This is so that these assessments provide clear and accurate information about the needs and wishes of people who are being admitted into the home and to further ensure that the placement is suitable and able to meet the needs of people who are being admitted. The home should concider employing someone to undertake the role of a `lounge assistant`. This person would be able to provide additional support, reassurance and guidance to residents in these areas. This role would compliment the existing staff team and is not intended to replace those staff already in post. Staff have received training in key areas, however, staff should be provided with training on how to support and respond to people whose behaviour may challenge. Staff would also benefit from training in The Mental Capacity Act. This is in order that staff can ensure that the rights of people who live at the home are known, recorded and acted upon as required. The Registered Provider must ensure that all times there are suitably qualified, skilled, competent and experienced staff in such numbers as are appropariate for the health and welfare of service users. The home must further ensure that staff are aware of their role and responsibilities, in order that they work together as a team so that the needs and wishes of those living at the home are met. Staff should attend refresher fire drill training in order to ensure that they have clear knowledge of action to be taken in the event of fire emergency. Furthermore, fire drill records must be fully completed in order to demonstrate who initiated the drill and to record any identified problems and to also record who has been involved We reviewed accidents and incidents which had occurred at the home. Accident reports had not always been fully completed . It is required that accident reports must be fully completed, these must include information about what reviews are in place and what action has been taken in order to prevent recurrence. The Registered Person shall ensure that any unnecessary risks to health or safety of those living at the home are identified and so far as possible eliminated. Risk Assessments for the use of bed rails must be in place and fully completed in order to evidence that all potential elements of risk are known and where possible eliminated.Consent for the use of bed rails should also be obtained in order to evidence individual`s understanding of the purpose of this equipment. The Registered Person shall give notice to the Commission, without delay, of any event which adversely affects the wellbeing of people who live at the home. The manager must submit an application to us in order that we can determine their `fitness` to manage a care home. Key inspection report Care homes for older people Name: Address: Haven Lodge Harbour Road Portishead North Somerset BS20 7HE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Odette Coveney     Date: 1 3 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Haven Lodge Harbour Road Portishead North Somerset BS20 7HE 01275399939 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.schealthcare.co.uk Southern Cross (Portishead) OPCO Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 81 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 81. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) maximum 54 places Old age, not falling within any other category (Code OP) maximum 27 places Date of last inspection Brief description of the care home Haven Lodge is owned by Ashbourne senior living, which is part of the Southern Cross Healthcare group. The organisation was established in 1996 and through acquisition Care Homes for Older People Page 4 of 35 Over 65 0 27 0 54 0 0 Brief description of the care home and growth is now has care services in England, Scotland, Wales and Northern Ireland. Haven Lodge is a modern, purpose built care home situated near to the harbour in Portishead and is within reach of its local shops and amenities. The home has gardens with safe access for service users.The nearest railway station is the Nailsea Station approximately 5 miles away. Regular bus services stop near to the care centre. There is easy access to the M5 and Bristol. The home provides 81 single rooms, all with en-suite shower facilities. A the time of our visit there were a total of 33 people in residence. 13 of these were people living within the residential care floor of the home, the 20 other residents were people living in the area of the home for people who have nursing and dementia support needs. As well as the 81 care beds offered at the home the third floor contains 14 closed care apartments, this is not registered with us and is totally separate from the care home. Information about the range of fees were not obtained during this visit, these are variable and are dependenet upon the assessed needs of individuals and are available upon request. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection took place over 20 hours and was completed over three days by one inspector from the Care Quality Commission. The purpose of the visit was to establish if the home is meeting the National Minimum Standards and the requirements of the Care Standards Act 2000 and to review the quality of the care provision for the individuals living in the home. The manager was present during the inspection and fully participated in the process. Evidence was gained from a whole range of different sources, including: Information provided within the Annual Quality Assurance of the service. Directly speaking with people who live and work at the home as well as people who were visiting the home. We also completed a review of some individuals care records. We completed a tour of the home, undertook an examination of some of the homes Care Homes for Older People Page 6 of 35 records and also through observation of staff practices and our interactions with the people who live and work at the home. A total of 12 surveys were returned to us prior to our visiting the home. Five of these were from people who live at the home, the other seven were from people who had relatives living at Haven Lodge. Most of the feedback we received within these were positive about the care provided by staff who work at the home. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: In order to ensure that full information has been obtained in order to determine if the home are able to meet the needs of people the home must ensure that all preadmission documents/assessments are completed in full. This is so that these assessments provide clear and accurate information about the needs and wishes of people who are being admitted into the home and to further ensure that the placement is suitable and able to meet the needs of people who are being admitted. The home should concider employing someone to undertake the role of a lounge assistant. This person would be able to provide additional support, reassurance and guidance to residents in these areas. This role would compliment the existing staff team and is not intended to replace those staff already in post. Staff have received training in key areas, however, staff should be provided with training on how to support and respond to people whose behaviour may challenge. Staff would also benefit from training in The Mental Capacity Act. This is in order that staff can ensure that the rights of people who live at the home are known, recorded and acted upon as required. The Registered Provider must ensure that all times there are suitably qualified, skilled, competent and experienced staff in such numbers as are appropariate for the health and welfare of service users. The home must further ensure that staff are aware of Care Homes for Older People Page 8 of 35 their role and responsibilities, in order that they work together as a team so that the needs and wishes of those living at the home are met. Staff should attend refresher fire drill training in order to ensure that they have clear knowledge of action to be taken in the event of fire emergency. Furthermore, fire drill records must be fully completed in order to demonstrate who initiated the drill and to record any identified problems and to also record who has been involved We reviewed accidents and incidents which had occurred at the home. Accident reports had not always been fully completed . It is required that accident reports must be fully completed, these must include information about what reviews are in place and what action has been taken in order to prevent recurrence. The Registered Person shall ensure that any unnecessary risks to health or safety of those living at the home are identified and so far as possible eliminated. Risk Assessments for the use of bed rails must be in place and fully completed in order to evidence that all potential elements of risk are known and where possible eliminated.Consent for the use of bed rails should also be obtained in order to evidence individuals understanding of the purpose of this equipment. The Registered Person shall give notice to the Commission, without delay, of any event which adversely affects the wellbeing of people who live at the home. The manager must submit an application to us in order that we can determine their fitness to manage a care home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is assuring peoples care needs are assessed prior to admission, however the written assessments have not always been fully/consistently completed. People have the opportunity to visit, before deciding to move in the home. Information is provided to allow prospective new residents the opportunity to make an informed choice about moving into the home. The home is aware that some minor amendments are needed to the Statement of Purpose. Contracts are in place and these reflect the terms and conditions of the placement. Evidence: The home has a Statement of Purpose that is specific to the individual home and the resident group they care for. It clearly sets out the objectives and philosophy of the service supported by a service users guide. The Statement of Purpose details what the prospective residents can expect and gives a clear account of the specialist Care Homes for Older People Page 11 of 35 Evidence: services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. We did note that the information about the management team related to the previous manager and previous operations manager and therefore was in need of some updating. We brought this to the attention of the current manager who told us that he would arrange for it to be updated and forwarded to us. The homes Statement of Purpose also confirms that people are able to have a trial period of up to four weeks at the home in order for them to assess the quality, facilities and suitability of the home and to decide whether the home is able to meet their needs. A meeting takes place four weeks after admission into the home in order to discuss the plan of care and to make a decision whether to make the placement a permanent one. There is a clear process to ensure that the service is able to meet the assessed care needs of prospective people moving to the home. There is an admission procedure, which is included in the Statement of Purpose and full assessments of needs for the most recent people being admitted into the home were undertaken. For those people living at the home who are funded by the local authority we saw that the home had in place a comprehensive care management assessment in order to make a decision on whether the home and the skills of the staff team are able to meet the individuals needs. For those people living at the home who are privately funded we saw that the home had developed comprehensive care plans, these are based on the homes initial pre admission assessment and also from information obtained through observation and discussion with the individual since there admission into the home. We did note that for some people who had been admitted in September/October 2009 not all of the admissions documentation had been completed as fully as it should be. For example dementia assessments for three people were not in place, and for another person this document had not been fully completed. Full information must be obtained in order to determine if the home is able to meet the needs of people who are admitted into the home. The home must ensure that all pre-admission documents/assessments are completed in full. For recent admissions into the home we saw letters in individuals files formally offering them a place at the home, once accepted the home worked diligently to produce a care plan. Care plans for new residents were seen to be generally well written and sufficiently detailed in order to inform and guide staff practice. A relative of an individual who had been admitted into the home within the last month told us that they were extremely happy with their parents care, they told us that Care Homes for Older People Page 12 of 35 Evidence: Staff were attentive and caring and that Nothing is too much trouble. They told us about the admissions process for their relative, they believed the homes assessment to be comprehensive and fair and a good reflection of their relatives needs. For all of the files we reviewed we saw that each person had a contract in place, one is provided to the home from the placing/contracting local authority, this outlines the financial arrangements for the placement. The other contracts in place were those which have been developed by the home. These outline the terms and conditions of the placement between the home and the resident. We saw that these were sufficiently detailed and provide clear information for people about the service. Within the completed Annual Quality Assurance Assessment (AQAA),which had been completed by the home and returned to us prior to our visit, the home had recorded their plans for improvement for the forthcoming twelve months, which are; We believe we have a firm foundation for improvement. We will continue to listen to our residents and their families to ascertain how effective the home operates and make changes and improvements appropriately. Care Homes for Older People Page 13 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person living at the home has a care plan in place, which is kept under review. Care plans provide sufficient information on specific care needs and the home is working towards a more person centred approach. People who live at Haven Lodge told us that they are happy at the home. People are fully protected by the homes systems for the safe administration of medication. Evidence: At this visit we reviewed the care, and associated documents for a number of people, some were for people who had lived at the home for a few months, others were for people who had recently moved into the home. Within these we saw that each individual has a care plan but the practice of involving residents in the development and review of the plan is variable. Care plans are reviewed and updated as required, this is done on a minimum of a Care Homes for Older People Page 14 of 35 Evidence: monthly basis, or sooner should peoples needs change. There are people who live at the home have a diagnosis of dementia and others who are supported with their nursing care needs. Care plans were detailed and recorded the preferred care for people, these were individual to each person and provided clear direction for staff. There are people who live at the home who are supported with their finances by relatives and the local authority in the form of a power of attorney and guardianship arrangements. It is recommended that copies of these powers and what this means for the individuals concerned should be obtained and retained, this will show what the responsibilities and the limitations of this role are. During our visit we reviewed daily record sheets, these are in place to record the general well-being and day to day support and emotional wellbeing of people living at the home. We saw that entries were well written and contained clear factual information, entries were dated and signed by the person who had written them. Five people who live at Haven Lodge had completed a survey prior to our visiting them, within the survey people said they felt supported by the staff, that staff listen to them and act upon their requests for assistance. People we spoke with told us that they were happy at the home, that they had made friends. Due to the nature of the service provided at the home there are a number of people who have short term memory problems and some people we spoke with were unaware that they were living in a care home. People looked well kept and looked after. During our visit we spent time in the communal areas and also spent time with people in their private rooms, we were able to observe staff going about their day to day duties. We saw that staff were patient and polite in their approach. People who live in the home were spoken to politely and staff listened to people and supported them appropriately in their requests for assistance. Whilst we were at the home we could hear someone crying and appearing to be in distress. We searched this person out and found them in the lounge being comforted and supported by a member of staff. This staff member was kind and gentle in their approach and the resident was reassured by their presence. We saw in healthcare records maintained by the home that people were accessing primary services as needed, such as the dentist and optician. We saw that people are also accessing specialist services as required. We saw in records that people had been seen by the tissue viability nurse and psychiatrist. We also saw that people are supported to attend appointments at hospital consultations. Care Homes for Older People Page 15 of 35 Evidence: We checked the systems in place for the recording and administration of medication. We found that people living in the home are registered with a local doctors practice. Medicines are supplied to the home using a blister pack system. All the medicines used in the home are given by a qualified member of staff. We checked the medication systems used to make sure that they meet the required standards. The home uses a local pharmacy for their medications and gets support from them. Good practice guidelines are followed such as having a photograph of the person needing the medication on their chart. The pharmacy provides printed medicine administration record sheets for staff to complete when they give medicines. These are kept with each persons medicines, along with a copy of the homes medicine policy. Medicines were given from the labeled packs provided by the pharmacy. Staff signed the administration record as they gave the medicines. We checked a sample of medicines and these indicated that they had been given as prescribed by the doctor. The records of administration had been completed fully. When we spoke to a member of staff who gives out medication at the home they were very clear about their role and responsibilities in this area, They were clear about what to do in the event of a person refusing their medication and also what they should do if an error was made, demonstrating a sound understanding in this area. Within the completed Annual Quality Assurance Assessment (AQAA),which had been completed by the home. The home had recorded that their plans for improvement for the forthcoming twelve months, which are; Once we start to implement our policies and practices we will be in a position to assess what we could do better. Care Homes for Older People Page 16 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The majority of activities are in house and provided on a daily basis. Visitors are made to feel welcome. Meals are home cooked and well presented. Evidence: Discussion with residents, staff and entries in the visitors book showed that the home actively supports the residents to maintain contact with families, friends and advocates. One person told us that her family visits very regularly and that the home would contact her family anytime she wanted them to. One relative spoken with on the day stated that there are no restrictions to time of visiting and that they visit their relative almost everyday. They are satisfied with the Home and the services provided; Staff are very welcoming, I cannot fault them. The home provides meaningful activities for the people living in the home. A relative who was visiting brought to our attention the homes leaflet, this informs the reader about the services and facilities which are to be provided at the home, the relative pointed out that the leaflet said that the home has a mini bus, it does not. We Care Homes for Older People Page 17 of 35 Evidence: asked the manager about this who told us that he was aware of this error and the leaflet will be amended when it is re printed. Prior to our visit we received three surveys which had been completed by relatives/carers of people who live at the home. Within these they informed us; Haven Lodge provides pleasant surroundings, friendly helpful staff and good meals. Haven Lodge employs good, caring, dedicated staff, however, I do not feel that ratio of staff to patient is adequate. I believe the home had people in before it was ready, it was not organised and at that time there were far too few people to look after the people in their care. We were able to speak to the person who made these comments, they told us that since the new manager was in post things had become more organised. Relatives we spoke with told us that they had confidence in the new manager, that he was approachable and that he responded promptly and effectively when issues have been raised to him. At this visit we discussed with the manager the role of a lounge assistant. We have seen this being successfully implemented within homes who are promoting the initiative of dignity champions. This person would be designated to be located within a lounge, in order to engage with the people in this area, to respond to requests for assistance and information. We have seen that when people are supported promptly this minimises anxiety in people and can de-escalate situations before they occurred. This role would not replace care, nursing, ancillary or activities staff but would aid these people. It is recommended that the home consider the role of a lounge assistant in order that they may be able to further support residents in these areas. During our visit we spent time with the activities co ordinator, who was very motivated and appeared to fully engage with their role. She told us about the support that people have on a one to one basis to participate in an activity, she also told us about the group sessions that are held with residents, such as reminiscence and craft work. During our visit people told us about the events they had enjoyed over Christmas, such as cake decorating, making cards and the Christmas carol concert. Whilst we were at the home we saw people relaxing, painting, reading, knitting and participating in a quiz. People appeared contented. At this current time when external entertainers visit the home all of the activities take place on one floor of the house, it is important that all residents can enjoy these events should they wish to. The home must ensure that arrangements are in place to ensure that all residents have fair and equal access to the entertainment provided by external agencies within the home. Care Homes for Older People Page 18 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sound and robust complaints and adult protection protocols in place at the home. The manager and senior staff would benefit from alerters safeguarding of vulnerable adults training. Individuals can be assured that any complaints they have will be listened to and acted upon. Minor accidents and incidents were recorded. However, there have been occasions when incidents affecting the well-being of people who live at the home had not been reported to the Commission or the local authority. Evidence: The home have clear policies and procedures in respect of dealing with and responding to complaints. Information for relatives and those who live at Haven Lodge is provided within the homes Statement of Purpose and its service users guide in order that people are aware of how to raise issues of concern. Information is also provided in the front entrance of the home about who to contact should they not be satisfied with the service provided at the home. Prior to our visiting Haven Lodge we were aware of a number of concerns which had been raised to us and the local authority. The home had been asked to investigate and respond to some of the issues formally. These were also discussed in meetings with representatives of North Somerset Council to ensure that people living at the home were safe. The management team for Haven Lodge have been open and transparent Care Homes for Older People Page 19 of 35 Evidence: and have provided information as requested. The home has acknowledged that lessons had been learned and new systems of work within the home have been implemented. The home has in place a record of complaints that have been received and it was seen that issues brought to the attention of the current manager have been dealt with effectively and fairly. Whilst at the home time was spent with people who live there, people employed at the home and visiting relatives. Those people we asked knew who to speak with if they wished to raise any areas of concern. Relatives also told us that meetings had been held with them and the manager and that these meetings had been a useful forum upon which to raise issues and to discuss any concerns that they had. People said that the manager was responsive and interested to hear their views in order to improve the service to those who live at Haven Lodge. Records of recently employed staff members were viewed and contained personal information and record of identity. Other information seen included, record of previous employment, and satisfactory Criminal Records Bureau disclosures. A review of staff files evidenced that not all staff have received training in protection of vulnerable adults, however, a clear audit of staff training and a planned programme evidenced that this is an area of importance to the home and training in this area would be completed by staff as required. It is recommended that the manager and senior staff are given priority for the safeguarding alerters training. When we reviewed accidents and incidents which had occurred at the home we found that generally the home had acted promptly and in the best interests of people. However, there were incidents which had not been reported to both ourselves and the local authority, although the issues are historical it is important that these are reported in order that a review can take place of the actions which were taken by the home and to ensure that appropriate action was taken to ensure people are safe. Care Homes for Older People Page 20 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those who live at Haven Lodge live in a home that is purpose built and safe. The quality of furnishings are of a high standard and suitable for those who live there Evidence: Haven Lodge is owned by Ashbourne senior living, which is part of the Southern Cross Healthcare group. The organisation was established in 1996 and through acquisition and growth now has care services in England, Scotland, Wales and Northern Ireland. Haven Lodge is a modern, purpose built care home situated near to the harbour in Portishead and within reach of its local shops and amenities. The home has gardens with safe access for service users.The nearest railway station is the Nailsea Station approximately 5 miles away. Regular bus services stop near to the care centre. There is easy access to the M5 and Bristol. The home provides 81 single rooms, all with en-suite shower facilities. At the time of our visit there were a total of 33 people in residence. 13 of these were people living within the residential care floor of the home, the 20 other residents were people living in the area of the home for people who have nursing and dementia support needs. Care Homes for Older People Page 21 of 35 Evidence: As well as the 81 care beds offered at the home the third floor contains 14 closed care apartments, this is not registered with us and is totally separate from the care home. During our visit we viewed a number of individuals rooms, we saw that they were well furnished and decorated tastefully. We saw that each room had good quality furnishings, people had also personalised their rooms with plants, photographs and mementos from home. On each floor of the home is a lounge and a smaller self contained room which is being used for activity or for residents to have a quiet area in which to relax. These areas looked comfortable. On each floor we saw that there was a dining room within each dining room there are facilities to make drinks and snacks, all main meals are provided by the main kitchen which is located on the top floor of the house. There is a self contained garden with lawned gardens a raised flower bed and patio areas. We noted in this area that there were CCTV cameras in place. The images from this are transferred into the office. We were informed that these were solely for security purposes. We recommended that notices are displayed informing people that these are in place in order that people were aware of their purpose, on the second day of our visit we saw the home had obtained signage to be displayed. There is a hair salon on site and a hairdresser visits the home each week for people who would like to use this facility. There are adaptations in place throughout the home and specialist equipment including hoists, bathing aids, mobility aids, sensory aids and handrails. All equipment is serviced and checked for safety as required in order that it is fit for use. We did note that bed rails are in place for a number of people, for their safety, however, many people did not have a fully completed risk assessment in place for this piece of equipment, nor had consent been obtained for the use of this equipment. These both must be in place to evidence that all factors for the health, safety and welfare for the individual have been considered. Toilets are situated in readily accessible parts of the home near to communal areas and bedrooms. The bathrooms and toilets were clean, and were well stocked with hand towels and soap to help minimize risk from cross infection in the Home. We viewed the laundry area on the top floor of the house, industrial machinery is used, Care Homes for Older People Page 22 of 35 Evidence: this area was well managed by the laundry assistants and no odours were present. The Home looked clean and tidy in all areas that were viewed. Within the completed Annual Quality Assurance Assessment (AQAA),which had been completed by the home they had recorded that their plans for improvement for the forthcoming twelve months were; To continue to monitor and address any shortfalls. Care Homes for Older People Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those living at Haven Lodge are supported by staff who are caring and who have an understanding of the needs and wishes of people living at the home in order to support the people in their care. The home must ensure that there are sufficient numbers of staff on duty who understand their role in order to ensure that that peoples needs are being met. Staff have received training in key areas, however, staff and those living at the home would benefit if training were provided in areas such as challenging behaviour and The Mental Capacity Act. Evidence: During this visit time was spent with a number of staff, staff who had different roles and responsibilities. People told us what they do and gave us examples of this. When we reviewed duty rotas we could see that there appeared to be sufficient numbers of staff on duty, however, we did question the actual workloads undertaken. It is important that staff are utilised effectively in order that the needs of people who live at the home are met. A relative we spoke with told us that there had been occasions where their family member was still in bed late in the morning, when they had queried this with staff on duty they had been told that they had been very busy. Two members of staff we spoke with said that qualified staff focused on medication Care Homes for Older People Page 24 of 35 Evidence: administration and did not always support residents with their personal care. We asked two qualified staff what their job entailed and whilst they did say they supported people with washing and dressing this was only confirmed to us after we had prompted them. Through our observations of staff it was clear that staff were hardworking and busy, we noted on two occasions over the three days we were at the home that residents were waiting for their morning and afternoon cup of tea, when we asked about the delay we were informed that it was on its way, in the end the member of staff employed to undertake activities went around with the tea trolley, this is not their responsibility. We are also aware that during our visit that only two of the three floors of the home were occupied. The home informed us of their plans to open up the third floor. Staffing levels and effective staffing is crucial to ensure that people are receiving the care and service they need. It is required that the home must review their staffing levels and staff roles in order to ensure that staff are aware of their role and responsibilities,so that they work effectively together as a team in order that the needs and wishes of those living at the home are met. At this visit the staff records for three staff members were fully reviewed and eight staff members were spoken with as part of the inspection process. Through examination of staff records we found that the manager operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of residents. Written references, protection of vulnerable adults checks and criminal record bureau checks had been undertaken for staff prior to their commencement at work. In staff files we found that all had clear job descriptions, these provided clear information about the roles and responsibilities of the post and the expectations from the employer. These also outlined the job purpose and the qualities and skills required for the position, however, it was not always fully evident that staff worked together as a team. When starting employment at the home staff complete an induction, we saw that the homes induction covers areas such as role and responsibilities, policies and procedures, health & safety along with responding to concerns, complaints and protection. We saw that the most recently employed members of staff to the home had commenced their induction. This induction is of a quality expected and is provided in line with the Skills for Care common induction standards. Within care plans, daily records and risk assessments we saw that there are some people who live at the home who have some complex needs in respect of their behaviour. We saw that there have been occasions where staff have dealt with difficult situations. Staff had been responsive to individuals needs and those we spoke to demonstrated a good understanding of the needs of people in their care, however, Care Homes for Older People Page 25 of 35 Evidence: staff have not received any specialist training to support people whose behaviour may be challenging at times. A requirement has been made by us that staff should be provided with training on how to support and respond to people whose behaviour may challenge, this is to ensure that they have the skills to respond to difficult situations in the most appropriate manner. We also require that staff would benefit from Mental Capacity Act training in order that they can be sure of the rights of people who live in the home in order that they are supported appropriately to make decisions, where able, about issues which affect their life. We reviewed staff training audits and saw that the home is committed to investing in their staff and to equip them with the skills they need in order to support those who live at the home. We saw that the organisation has a structured plan to ensure that staff complete both core training and specialist training. Within the audit, as well as certification seen in staff files and confirmation from staff we saw that people have completed training in; manual handling, pressure care, medication, death/loss, communication, fire instruction, nutrition and infection control. Over forty staff have completed training in order to have an understanding of dementia, this training included differing types of dementia, signs and symptoms to be aware of and how to have an understanding of effective communication. We were informed that this was a priority and that further training in this area is planned for staff. The manager informed us of a support group meeting which had been arranged for relatives, a speaker who is a specialist in dementia care had been arranged to talk with people, to provide information sharing and an opportunity for relatives to ask questions and to gain further insight into how the illness affects the people they care for. There are eleven staff with a National Vocational Qualification at level two or above in care. Within the completed Annual Quality Assurance Assessment (AQAA),which had been completed by the home they had recorded that their plans for improvement for the forthcoming twelve months were; To establish practice based supervision to monitor staff clinical performance. We will re-emphasis and provide training to staff to deliver a person centred care approach and introduce a staff development programme. We will also explore the possibility of recruiting bank staff to compliment our existing staff group. Care Homes for Older People Page 26 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Accidents and incidents could be better recorded and when required these must be reported onto the appropriate bodies. Improvements are required within the recording of fire drills, we also suggest that further training in this area would benefit staff. Evidence: Mr Tooldeo Gooljar is a qualified RMN with many years experience in managing care services for older people. Mr Gooljar commenced work at the home in November 2009, initially to provide direction and guidance to the manager who was in post. When the manager left the service also in November Mr Gooljar took over the day to day management of the service. We discussed with the manager the registration process in order that we can determine his fitness to manage the care home. The manager assured us that he had applied for a Criminal Records Bureau check and that he was in the process of completing his application for the Registered Managers post and that this would be submitted to us promptly in order that the process can Care Homes for Older People Page 27 of 35 Evidence: commence. Staff stated that the manager was approachable and would listen to their comments and acted accordingly. Within a survey completed by a relative of an individual who lives at the home prior to our visiting the home they said; There has been a marked improvement since the new manager came to Haven Lodge. In general everything is getting smoother like the relationships between staff, manager and especially the relatives of residents. The home has good systems in place to manage any monies they hold on behalf of the residents. During this visit we spent time with the administrator responsible for this task. It was clear that this person was aware of their role and responsibilities in this area and they are robust in their auditing processes. She informed us that only herself and the manager had access to the safe. Money checked corresponded with the amount held for safekeeping, receipts for purchases made are in place. We also saw that the home has in place personal allowance contracts in place in order to ensure that residents have access to funds and services as needed, this is good practice. When we reviewed staff files we saw that people are formally supervised; areas discussed include training, care of the residents and health and safety responsibilities. We reviewed accidents and incidents which had occurred at the home, those seen by us were not always situations that could be expected to occur. Accident reports had not always been fully completed in order to show what had happened, what injuries had been sustained and what the home had done to support the person involved and measures taken in order to try to prevent recurrence. There was an incident recorded where a resident had unexplained bruising to their arms. As this resident has a dementia they are unable to say how this had occurred. The home did not act appropriately when this had been noted. Within incident records we also saw that there were four different occasions where staff had been injured by residents. This further underpins our requirement that staff must undertake training on how to respond to difficult and sometimes challenging situations in order the those who display this behaviour can be supported in an appropriate and safe way for all concerned. None of these incidents had been reported to us. The home was reminded of its responsibility in this area and a requirement in respect of this has been made. The home is completing the appropriate checks on the fire equipment and recording of training and testing of equipments were satisfactory. Over the three days we were at the home the fire alarms were activated on two occasions, one was a false alarm and the other was a planned fire drill. On both occasions staff were disorganised and no Care Homes for Older People Page 28 of 35 Evidence: one seemed to take charge of the situation or evaluate the effectiveness of the drill and the evacuation process. We saw recorded that staff have attended fire drills, however, the effectiveness of this is to be questioned. It recommended that staff undertake fire drill refresher training in order to ensure that they have clear knowledge of action to be taken in the event of fire emergency. when we looked at records of fire drills that had taken place at the home we saw that these records had not been fully completed to evidence who had participated in the training, who initiated the drill and what actions can be taken to improve the process. The home had on display a current liability insurance certificate. Care Homes for Older People Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The Registered Person shall not provide accommodation to a service user unless the needs of the person have been assessed by suitably qualified or trained person. The Registered Person must maintain a copy of the assessment. This is in order to ensure that full information has been obtained in order to determine if the home is able to meet the needs of people they must ensure that all pre admission documents/assessments are completed. 20/01/2010 2 18 37 The Registered Person must 03/03/2010 ensure that The Commission is notified of incidents which affect the wellbeing of individuals who live at the home. This is in order that we can Care Homes for Older People Page 31 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action review how situations have been dealt with, to ensure that situations are managed effectively and do not subject people to unnecessary risks. 3 22 13 The Registered Person shall 19/02/2010 ensure that any unnecessary risks to health or safety of service users are identified and so far as possible eliminated. Risk Assessments for the use of bed rails must be in place and fully completed in order to evidence that all potential elements of risk are known and where possible eliminated. 4 27 18 The registered Provider 03/03/2010 must ensure that at all times there are suitably qualified, skilled, competent and experienced staff in such numbers as are appropariate for the health and welfare of service users. This is to further ensure that staff are aware of their role and responsibilities, to work together as a team in order that the needs and wishes of those living at the home are met. Care Homes for Older People Page 32 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 5 30 18 The Registered Person must 19/04/2010 ensure that people employed to work at the care home receive training appropriate to the work they are to perform. This in order to support those people who live at the home who have behaviour that may challenge, and to also ensure that staff are aware of individuals rights in line with the Mental Capacity Act legislation. 6 31 9 Fitness of the Registered Manager. A person shall not manage a care home unless he is fit to do so. The manager must submit an application to us in order that we can assess and determine his fitness to manage the care service 05/04/2010 7 37 17 The Registered Provider must maintain records as specified in Schedule 3. Accident reports must be fully completed, these must include information about what reviews are in place and what action has been taken in order to prevent recurrence. 03/03/2010 Care Homes for Older People Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Closer monitoring of the daily personal care reports, to ensure that these are being completed as required, ensuring that people are being supported fully in this area. The home must ensure that arrangements are in place to ensure that all residents have fair and equal access to the entertainment provided by external agencies within the home. The home to consider the role of a lounge assistant in order that they may able to further support residents in these areas. It is recommended that the manager and senior staff complete the safeguarding vulnerable adults training as a priority. The home must contact and report historical safeguarding issues to the local authority in order that these may be reviewed to ensure that appropriate action had been taken by the home to protect and safeguard people. Consent for the use of bed rails should also be obtained in order to evidence individuals understanding of the purpose of this equipment. Fire drill records must be fully completed in order to demonstrate who initiated the drill, to records any identified problems, to record who has been involved. Staff should attend fire drills to ensure that they have clear knowledge of action to be taken in the event of fire emergency, 2 12 3 14 4 18 5 18 6 22 7 38 8 38 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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