Care Home: Haverholme House Care Home

Similar services:

• Abbey The
• Snydale Care Home
• Larchfield Manor
• Hawkhills
• Beeches The - North Yorkshire County Council
• Carentan House
• Ravensworth Lodge

What the care home does well The atmosphere at the home is friendly and homely and people can make choices about how they spend their day. People have a good range of activities in which to participate. Friends and relatives are welcome to visit at any time which was observed during the day. People spoken with told us the meals were much improved and they had enough to eat and drink. There are a number of longstanding staff who demonstrate a very dedicated attitude to their work and strive to provide good standards of care. They have developed close, positive relationships with people which was evident during the day. Some essential equipment has been replaced such as a sluice, heating pump and dishwasher. What the care home could do better: Due to the failure of the registered provider to comply with two of the requirements made at the last full key inspection visit we will be commencing our enforcement procedures and will be issuing a warning letter for those requirements still outstanding. Areas these relate to are care plan records and staff supervision. The warning letter will reflect the timescales detailed in this report. The registered provider must comply with the warning letter within the timescales identified. Other areas which require improvement are: Assessments need to be completed for all people admitted to the home to ensure their current needs are recorded. Care plans need to be up to date and include all assessed needs, and the staff need to evidence that people who use the service have participated in their formulation and agreed their content. Where staff have assessed risk, clear support plans must be put in place to minimise those risks, this will enable people to take acceptable risks in their daily lives but also be protected from harm. The home should try and ensure a consistent staff team. Recruitment of new qualified staff has been problematic and there has been turnover of staff in the last year which can affect relationships, key worker allocations, staff skills and overall staff morale. Care staff levels need to be increased to ensure people receive their care when they request it and the staff are not overstretched. Support at meal times needs to be reviewed to ensure that people who need assistance with feeding receive individual support from staff which will promote safe practice and promote people`s dignity. Medications in the home should be stored at the correct temperatures to ensure they aresafe for use. Care staff members should receive a minimum of six supervision sessions per year, this will give staff an opportunity to share information and for their work to be monitored. The way the quality of the service is monitored and managed must be improved so the shortfalls we picked up during the visit will be picked up routinely by staff and management. A system of regular audits should be introduced and the manager needs to address any shortfall as part of an improvement plan to ensure the home is run effectively. Areas in the kitchen must be cleaned more regularly to ensure safe and hygienic practices are maintained. Broken moving and handling equipment such as the hoist and Stand-aid must be repaired promptly or new equipment provided to ensure people do not have to wait for assistance with their personal care and toileting needs. Equipment such as wheelchairs and mobile hoists should be included on the cleaning schedules to ensure hygienic practices are maintained which promote people`s dignity. Old and disused equipment and furniture must be stored safely prior to removal. Containers of used cooking oil must be disposed of promptly. This will ensure people`s safety. Random inspection report Care homes for older people Name: Address: Haverholme House Care Home Broughton Road Appleby Scunthorpe North Lincolnshire DN15 0AD one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jane Lyons Date: 2 0 0 5 2 0 1 0 Information about the care home Name of care home: Address: Haverholme House Care Home Broughton Road Appleby Scunthorpe North Lincolnshire DN15 0AD 01724862722 01724282378 Telephone number: Fax number: Email address: Provider web address: www.aermid.com Name of registered provider(s): Name of registered manager (if applicable) Mr Robert Dollin Type of registration: Number of places registered: Conditions of registration: Category(ies) : Aermid Health Care (UK) Limited care home 48 Number of places (if applicable): Under 65 Over 65 0 48 0 dementia old age, not falling within any other category physical disability Conditions of registration: 1 0 45 The maximum number of service users who can be accommodated is: 48 The registered person may provide the following categories of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 48, PD, Physical disability - Code PD, maximum number of places: 45, Dementia - Code DE, maximum number of places: 1 Date of last inspection Care Homes for Older People Page 2 of 16 Brief description of the care home Haveholme House Care Home is situated on the outskirts of the village of Appleby near Scunthorpe. It is an older style mansion house, retaining many original features, with a modern extension to the side. The home is registered to care for 52 people. The home has been divided into two facilities people that use the service with nursing needs are located in the main building, which is called Pine Tree Court and service users with residential care needs are accommodated in the newer purpose built extension, which is called Grove Court. All bedrooms are single occupancy and most offer lovely views of the surrounding countryside. The grounds are extensive and well cared for; there are a variety of sitting areas, all accessible for wheelchair users. There is a large car park at the front of the building. The current weekly fees ranged from GBP341.94 to GBP388 per week plus a nursing supplement if required of between GBP101 and GBP139 a week. People that live at the home will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapersmagazines. Information on the specific charges for these can be obtained from the acting manager. Information on the service is made available to prospective and current residents through the homes statement of purpose, service user guide and previous inspection reports. Copies of these documents can be obtained from the home. Care Homes for Older People Page 3 of 16 What we found: The reason for this inspection was to check the progress made against the requirements issued after the last key inspection on the 23rd November 2009. Choice of Home. We looked at four care files for people living in the home. We did not see any evidence that improvements had been made to the format of the pre- admission assessment records, which would allow for more personalised information relating to how much support people need and how they choose to receive their care. The manager showed us a new assessment document he had obtained however the format was still tick box style and therefore would not prompt staff to record more descriptive information about peoples needs. One of the files seen belonged to a person who had been admitted six weeks previously, there was no pre- admission assessment record and the manager informed us that the admission had been an emergency for respite care initially, although the individual was now looking to stay at the home on a permanent basis. This individual had previously stayed at the home in September 2006 and the majority of their care records including the assessment related to this admission. There was no evidence that the assessment record from 2006 had been updated to detail the individuals current needs. There was no evidence that an assessment or care plan from the placing authority had been obtained following admission. We saw evidence in other files that assessments had been completed on admission and that the home had also obtained copies of assessments and care plans from the placing authority, however one of the care files seen contained assessment records and care plans dating from 2007, which should be reviewed. Health and Personal Care At the last inspection a requirement was made to improve the care plans to provide more person centred information and also to ensure there were plans in place to support all identified needs. We looked at four care files during the visit which showed little progress had been made in providing more person centred care plans. Some of the files seen contained a personal preference plan which contained good levels of information about how people choose spend their day e.g times to get up and retire, how they choose to spend their time, frequency of baths etc however many of the care plans seen did not describe detailed tasks to support how people would like to receive their care, for example one individuals care plan for personal care detailed needs full assistance, similarly the plan for nutrition. Few of the care plans seen were signed by the individual receiving the care to demonstrate they have participated in their formulation and they agree the contents. As detailed in the section above one persons care file contained care plans relating to an admission in 2006 and many of these had not been updated to reflect the individuals current needs, staff confirmed in discussions that this persons care needs regarding nutrition, personal care, mobility and pressure damage support had changed. Another Care Homes for Older People Page 4 of 16 persons care file did not contain care plans to support all their needs. Daily records evidenced that the individual regularly received medication for pain control, and the District Nurse visited to change dressings for a leg ulcer however there were no specific care plans about pain management or care required in supporting interventions from the Distict Nurse. All files seen contained a range of risk assessments for areas such as falls, nutrition, mobility, bed rails and pressure damage, these clearly identified the level of risk and had been regularly reviewed. However when risks to a persons safety or health care had been identified as high, care support planning to reduce or monitor those risks was inconsistently applied. Of the files examined all four individuals were assessed as at high risk of sustaining pressure damage, one individual had an appropriate support plan in place, two files did not contain a support plan and the fourth file contained a support plan which detailed that the person had requested and been provided with a low risk support mattress due to issues around comfort, however the plan did not direct staff to monitor the individual to ensure they were not developing any pressure damage and the preventive action they should take. Where people had been identified as high risk of sustaining falls, care planning was also inconsistent. The home uses a pre- printed information sheet recommended interventions which describes support and interventions for all risks categories of falling, we think that the relevant information from this printed document should be detailed in an individual support plan to clearly inform staff what support interventions are required. Daily records were completed, these focus on care delivery and would benefit from more information about how people have spent their day. Evaluation records were completed regularly however for the majority of plans seen the records were no changes and more descriptive records of how the care support is meeting peoples needs would be an improvement. Discussions with people using the service and relatives during the day evidenced that in general they were very satisfied with the care support provided. An issue was identified by the safeguarding team earlier in the year relating to the home not accessing timely support from the community health team regarding a person with deteriorating health needs. There was good evidence in the records and from discussions with staff that people were accessing a wide range of support from the community health team such as G.P.,Distrit Nurse, Dietician and Physiotherapist and records evidenced that staff were making referrals for support from the team at an appropriate time. We looked at medication systems in the home and found in general that they were well managed. Examination of the medication administration charts (MARs) showed they were well completed however transcribing (handwritten entires) should be witnessed by a second staff member to demonstrate accuracy. Progress had been made towards the regular monitoring of the medication fridges and clinic room temperatures, however records showed that the storage temperature for medications in Grove Court regularly exceeded the manufacturers guidance which should be addressed. Daily Life and Social Activities. At the last visit a requirement was made to improve the quality and consistency of the Care Homes for Older People Page 5 of 16 meals provided at the home. There have been significant improvements in this area, all people spoken with commented positively about the meals. There was good evidence that people had been consulted about meals, a Food Meeting had been held on the 5th May which 15 residents had attended, the cook confirmed he was currently developing the summer menus from this consultation. One individual told us that she likes prawns and the cook regularly provides these for her meals and she had requested bread and butter pudding which was now on the menu. At the last inspection people were concerned that cooked breakfasts were no longer available and this has been addressed, these are available each day if requested. Comments from people during the visit include the quality of the meals has improved, Ive no complaints and I went to the meeting about the meals and theyve changed some of the menus already to include the new choices. During the visit we observed meal times in both units. We noted the lunch time at Grove Court was very busy, one staff member was seen assisting two people with their meals whilst one person who uses the service assisted another. Further staff support must be provided at meal times to ensure people receive individual, safe support which promotes their dignity. Complaints and Concerns. No new complaints have been received since the last inspection. At the last inspection we noted that the home had received a large number of complaints from individuals and their relatives regarding errors in the billing system for fees, the manager confirmed that there had been no further issues relating to this. There is an ongoing safeguarding investigation at the home. Environment. The communal areas and bedrooms seen in the home were all very clean and tidy. There were no mal odours. Linen trolleys were stored safely. Improvements to the facilities such as provision of a new heating pump, new dishwasher, new sluice and work to safely secure stretched carpets had taken place. We looked around the kitchen areas, an Environmental Health Officer had carried out an inspection in September 2009 and awarded the home a four star rating however they had made a number of requirements regarding the standards of cleaning in the kitchen. We saw that areas in the kitchen such as the floor, shelving, bain- marie, cutlery container, trolleys and deep fat friers required cleaning and this must be addressed to protect peoples health and safety. At the inspection in June 2008 a requirement was made regarding replacement of an area of kitchen flooring, this was also carried over to the last key inspection in November 2009. At this visit we noted that the integrity of the stained flooring was intact and therefore this requirement has been removed. It is advised that staff monitor the condition of the flooring and report any problems. Equipment in the home such as portable hoists and peoples wheelchairs were seen to be in need of more regular cleaning. There was a shortage of moving and handling equipment in the home, staff confirmed that a portable hoist and Stand-aid had been broken for some time, one of the hoists was stored in a communal room with a label stating awaiting parts 11/03/2010 . Discussions with staff evidenced that one portable hoist and one Stand-aid were available for the whole home, which meant that some people had to wait at times for support with personal care and toileting. Given the Care Homes for Older People Page 6 of 16 distance between the units this has also meant that staff spend time going between the units and waiting for the equipment to be available. Action must be taken to repair the equipment or provide new equipment to ensure peoples needs are met in a timely way. The gardens to the front of the home were seen to be tidy and attractive however many areas to the side and rear of the home are in need of attention. Outside the kitchen and staff room areas of the building large amount of broken furniture and equipment was piled up. A number of containers which held used cooking oil were also stored there. The manager confirmed that there were delays in arranging the removal of the items however this should be made a priority due to the risks to peoples health and safety. Staffing The manager confirmed that he had been unable to recruit any new nursing staff since he had been appointed and the home still relied on agency staff for the shortfall of 24 hours day duty and 24 hours night duty. This means that people do not always receive consistent care support from people they know. Staff retention has also been problematic over the last few months with a number of longstanding care staff having left the home. From observations during the visit and from discussions with staff there was evidence that there were not enough staff on duty to support people in a timely way, especially in the mornings for personal care and at meal times. Staff in both units said they were overstretched and did not have time to spend with people. People spoken with commented very positively about the staff and the support they provided however many confirmed that they had to wait for support at times. Some comments included The staff are wonderful, we do have to wait sometimes but they are always very busy and occasionally I have to wait for staff, they do the best they can , the care is very good. Comments from some of the relatives spoken with during the visit also reflected this issue;the staff are very busy,sometimes we have to wait a while to find someone, but they are really kind and are doing their best and I often get calls to pick up my mums prescriptions because there are no staff to do this. One of the cooks has been absent from the home for some months, during this time the second cook has covered the majority of the shifts. Although the cook considers this arrangement is satisfactory we advise that the manager reviews these hours and ensures that appropriate support is provided to ensure workers in this area receive regular days off. A new gardener has been appointed and has commenced work to tidy up the grounds. Conduct and Management We were informed by the manager prior to the inspection that the home had gone into Administration on the 14th May 2010. All people who use the service, relatives and staff had been informed formally of the situation by letter and the Administrators had appointed a management company Leyton Healthcare to oversee the day to day management of the home. Public notices have been placed on the doors to the home. The manager confirmed that representatives from Leyton Healthcare and also the local placing authority had visited the home earlier in the week and that the home was operating as usual. Care Homes for Older People Page 7 of 16 At the last inspection visit the manager had been in post for two weeks. A requirement was made that he applied to the commission for registration to ensure his fitness for managing the home could be tested.The manager confirmed that he was in the process of gaining registration with CQC, he had undergone an interview with the registration team in April, had been informed informally that he had been successful and was awaiting confirmation.This requirement has been met. All staff spoken with during the visit confirmed that staff morale was low. Staff said this was mainly due to shortages of staff, staffing levels, removal of pay enhancements, equipment shortages and lack of clear management. Comments from staff during the visit include staff are fed up but we are always here for the residents, we have a good team and provide good care but its not easy and I used to really enjoy my work here, but weve been working under pressure for sometime now. At the last inspection we saw evidence that some formal quality assurance and monitoring systems had been introduced and surveys had been issued to various parties including relatives and people who use the service.There was evidence at this visit that action had been taken towards improving the quality of the meals following comments received. Meetings are arranged for staff and people who use the service. There was no evidence at this visit of any regular auditing taking place to allow staff and management to identify any shortfalls in the service and take the necessary action to make improvements to ensure the service is run effectively. Auditing of areas such as care records, staff supervision, dependency levels, facilities and equipment are needed so that the manager can develop an action plan to monitor improvements needed. The manager confirmed that support from the homes senior management had been inconsistent in recent times, due to absence. At the last inspection the staff supervision programme had not been maintained and a requirement was made in respect of this. We looked at a sample of supervision records during the visit and found that little progress had been made towards providing staff with regular formal supervision. For example, two staff members records could not be found, one staff member had received supervision in September 2009 and again in April 2010, another in October 2009 and March 2010. The manager told us that one staff member had been absent from work for some months and had returned earlier in the week; we looked at this persons records which showed that they had received supervision in January 2008 and earlier in the week given a performance improvement plan however there were no written supervision records to support this meeting. Overall there was some good evidence that the manager has been proactive in trying to address many of the requirements and recommendations made at the last inspection visit in November 2009. Compliance was seen to have been achieved in full towards four of the requirements and four of the recommendations, however a number of new requirements have been made following this visit. It is now important that the manager secures the support and direction he needs from the management company to prioritise, organise and implement the improvement work needed to ensure the home is run safely and effectively. Care Homes for Older People Page 8 of 16 What the care home does well: What they could do better: Due to the failure of the registered provider to comply with two of the requirements made at the last full key inspection visit we will be commencing our enforcement procedures and will be issuing a warning letter for those requirements still outstanding. Areas these relate to are care plan records and staff supervision. The warning letter will reflect the timescales detailed in this report. The registered provider must comply with the warning letter within the timescales identified. Other areas which require improvement are: Assessments need to be completed for all people admitted to the home to ensure their current needs are recorded. Care plans need to be up to date and include all assessed needs, and the staff need to evidence that people who use the service have participated in their formulation and agreed their content. Where staff have assessed risk, clear support plans must be put in place to minimise those risks, this will enable people to take acceptable risks in their daily lives but also be protected from harm. The home should try and ensure a consistent staff team. Recruitment of new qualified staff has been problematic and there has been turnover of staff in the last year which can affect relationships, key worker allocations, staff skills and overall staff morale. Care staff levels need to be increased to ensure people receive their care when they request it and the staff are not overstretched. Support at meal times needs to be reviewed to ensure that people who need assistance with feeding receive individual support from staff which will promote safe practice and promote peoples dignity. Medications in the home should be stored at the correct temperatures to ensure they are Care Homes for Older People Page 9 of 16 safe for use. Care staff members should receive a minimum of six supervision sessions per year, this will give staff an opportunity to share information and for their work to be monitored. The way the quality of the service is monitored and managed must be improved so the shortfalls we picked up during the visit will be picked up routinely by staff and management. A system of regular audits should be introduced and the manager needs to address any shortfall as part of an improvement plan to ensure the home is run effectively. Areas in the kitchen must be cleaned more regularly to ensure safe and hygienic practices are maintained. Broken moving and handling equipment such as the hoist and Stand-aid must be repaired promptly or new equipment provided to ensure people do not have to wait for assistance with their personal care and toileting needs. Equipment such as wheelchairs and mobile hoists should be included on the cleaning schedules to ensure hygienic practices are maintained which promote peoples dignity. Old and disused equipment and furniture must be stored safely prior to removal. Containers of used cooking oil must be disposed of promptly. This will ensure peoples safety. 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 set out on page 2. Care Homes for Older People Page 10 of 16 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person should 25/07/2010 make sure that the care plans that are developed by the home are person centered and meet peoples individual needs in a way that is safe and is acceptable to them. The registered person must also make sure that where there is an identified need there is a care plan in position to support this need. This includes areas suck as skin integrity where a risk assessment has been completed and identified a risk to the individual. Previous timescale of 30/01/2010 not met. Warning letter issued. 2 36 18 (1a) and 18 (2) The registered person must 30/07/2010 make sure that all of the staff working in the home receive the minimum recommendation of six formal recorded supervision sessions per year (pro-rata). Previous timescale of 28/02/2010 not met. Care Homes for Older People Page 11 of 16 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Warning letter issued. This will help to make sure that the staff have all of the necessary knowledge and skills to safely carry out their roles. Care Homes for Older People Page 12 of 16 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, 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 Peoples assessments must 20/07/2010 be kept under review to ensure their current needs are detailed and care support plans can be developed to meet those needs. This will ensure that peoples current needs have been properly identified and support can be provided to meet their needs. 2 15 12 People who require support with feeding must be provided with individual support from staff. This will ensure that people receive safe support which better ensures their dignity. 20/07/2010 3 22 23 Portable moving and handling equipment such as hoists must be repaired promptly or replaced to ensure adequate equipment provision. This will ensure people receively timely support and 15/07/2010 Care Homes for Older People Page 13 of 16 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 there are no delays due to a lack of equipment. 4 27 18 Increase the levels of care staff in the home. This will ensure that people receive the care they need in a timely manner and staff are not over stretched. 5 38 16 Ensure all areas in the 20/07/2010 kitchen are regularly cleaned to maintain a satisfactory standard of hygiene in this area. This will protect the health and safety of the people living and working in the home. 6 38 23 Disused furniture, equipment 15/07/2010 and cooking oil must be stored safely prior to removal. This will protect the helath and sfatey of the people who live and work in the home. 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 15/07/2010 1 3 The format of the homes pre- admission/ admission assessment records should be developed to provide staff with a record which allows for more descriptive information about how much support people need and how they choose to receive their care. Care Homes for Older People Page 14 of 16 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 2 9 Handwritten records on medication administration records(MARs) should be witnessed and signed by a second member of staff to demonstrate accuracy. Measures should be taken to ensure that medications are stored at temperatures within the manufacturers guidelines. Care plans should be signed by the individual receiving the care or their representative to demonstrate they have participated in their formulation and they agree the contents. Equipment in the home such as portable hoists and wheelchairs should be included in cleaning schedules to ensure this equipment is maintained to a clean and hygienic standard and peoples dignity is protected. Consider the provision of interim support for the cook to ensure he has appropriate days off. Staff recruitment and retention policies and practices should be reviewed to provide a more stable staff base. A comprehensive system of audits should be developed as part of the quality monitoring programme to identify shortfalls and take the necessary action to make improvements to ensure the service is run effectively. 3 9 4 15 5 22 6 7 8 27 27 33 Care Homes for Older People Page 15 of 16 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 16 of 16 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!