Care Home: Havering Court Nursing Home

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What the care home does well As part of the inspection, contact was made by phone with a funding authority that has responsibility for some residents accommodated in the home. They expressed no current concerns about the care being provided; and that issues raised were well received and acted upon accordingly. We found that the home was clean and tidy with no offensive odours, even at the early start of the visit. Routines in the home were very flexible and when we arrived some residents were having breakfast, and others were still comfortably asleep in their bedrooms. The nutritional needs of the residents are well considered and food and mealtimes are seen as being important for all people living in the home. Comments included: "The food is nice, there is always a choice". " I have only been here a short time but have found the food to be very good. I especially liked the pie, mash and liquor". All residents and their families can be assured that at the time of their death, staff would treat them and their family with care, sensitivity, respect and in accordance with their wishes. Comments made in cards sent to the home include: "His last days with you made him comfortable and dignified which was what we both wanted. Thank you for respecting our wishes" "You showed her love compassion and treated her with dignity". What has improved since the last inspection? All the requirements made at the last key inspection have been met. There has been a significant improvement in the standard of care plans and other health related records. Staffing levels have been reviewed in line with individuals assessed nursing and care needs. Staffing and resources are being more effectively deployed and utilised across the home. The garden area is well maintained and there is now a sensory garden which is enjoyed by many of the residents. There is now limited use of agency staff, particularly at night. Bank staff are used to cover shortfalls in staffing due to sickness, annual leave and vacancies. The manager is aware of the need to increase the number of staff with National Vocational Qualification (NVQ) to level 2 or above. He is registering five members of night care staff who will undertake their training during the night. What the care home could do better: The manager must ensure that care plans are updated as a result of monthly reviews, so that any changing needs are reflected accordingly. The manager must ensure that all parts of the home are maintained in a good decorative state. Priority must be given to the redecoration of the corridor walls, doors and doorframes to which the timescale given applies. This will add to the quality of the living environment. The manager must ensure that there are robust systems in place for the recording of controlled drugs in line with legal requirements. Daily recordings must be more in line with outcomes identified in the care plans, and also that the implications of the Mental Capacity Act are routinely taken into account in both care planning and daily recordings. It is strongly recommended that where a resident has an allergy to either medication or food; it is recorded more prominently on the front sheet of the residents file. CARE HOME ADULTS 18-65 Havering Court Nursing Home Havering Road Havering-atte-Bower Romford Essex RM1 4YW Lead Inspector Gwen Lording Unannounced Inspection 11th August 2008 08:15 Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Havering Court Nursing Home Address Havering Road Havering-atte-Bower Romford Essex RM1 4YW 01708 737 788 01708 740 783 buckmed@bupa.com www.bupa.com BUPA Care Homes (BNH) Ltd Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Manager in post – not yet registered with the Commission Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (16), Physical disability (36) of places Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category 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: 16) 2. Physical disability - Code PD (maximum number of places: 36) The maximum number of service users who can be accommodated is: 52 9th October 2007 Date of last inspection Brief Description of the Service: Havering Court is a purpose built residential care home with nursing, which is operated by BUPA, a large private company that runs similar homes across the UK. The home is registered for 36 younger adults who have a range of physical disabilities, and 16 older people. It is situated in Havering - atte Bower, a semi-rural area, which is an approximately 15 minute bus journey from the nearest rail link in Romford Town Centre. The home is set in spacious ground and woodlands, which provide pleasant views from bedroom windows. The accommodation is spread over a ground and a lower ground floor, with access via a lift and stairs. The lower ground floor has 14 bedrooms of varying sizes, bathrooms and showers and a large lounge with French windows onto a pleasant patio and garden. The main kitchen, laundry, and staff rooms are also on this floor. The remaining bedrooms are on the ground floor, along with a large lounge/dining area, staff office, bathrooms, and communal sitting areas. Many of the service users have very high dependency needs due to the level of physical disability, and in addition some have learning disabilities. Nursing and personal care are provided on a 24-hour basis. On the day of the Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 5 inspection the range of fees for the home was between £545:00 and £1,390:00 per week. Additional costs for items such as hairdressing, chiropody and in some cases physiotherapy are charged separately. A copy of the Statement of Purpose and Service User Guide to the home is made available to both residents and their families. A copy of the most recent inspection report is displayed in the main reception and copies are available on request. Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. This was an unannounced inspection which started at 8.15am and took place over six and a half hours. The inspection was undertaken by two inspectors, namely the lead inspector Gwen Lording and Sandra Parnell-Hopkinson. The home’s manager and designated head of care were available throughout the visit. This was a key inspection in the inspection programme for 2008/2009. Havering Court provides care to older people and younger physically disabled people. As the majority of the residents are younger adults, the National Minimum Standards applicable to a care home for younger adults have mainly been used during this inspection. However, consideration has also been given to the National Minimum Standards for Older People. Discussions took place with the manager, head of care, activity co-ordinator, maintenance person, kitchen and laundry staff, and the home’s administrator. We spoke to a number of residents on each floor; and where possible residents were asked to give their views on the service and their experience of living in the home. Nursing and care staff were asked about the care that residents receive and were also observed carrying out their duties. A tour of the premises, including laundry and main kitchen was undertaken. The files of several residents on both floors were case tracked, together with the examination of other staff and home records. This included medication administration, staff training and recruitment files, maintenance records, complaints/ compliments, and accident/ incident records. Information was taken from an Annual Quality Assurance Assessment (AQAA); which was completed by the manager and returned to us prior to the inspection. This is a self-assessment process, which all providers are required to complete once a year. Additional information relevant to this inspection was also obtained from Regulation 26 monitoring reports and Regulation 37, notification of events. Surveys were sent out to the home prior to the inspection for completion by residents and staff. There was a limited response but all commented positively about the quality of care being provided. One relative responded on behalf of the resident: “I have great respect and admiration for this home. It is the first time since my Dad has been in care that I have felt confident that his needs are met and exceeded”. As part of the inspection process the views of funding authorities that place residents in the home were sought and are commented on in this report. Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 7 We asked several people living in the home how they wished to be referred to during the inspection. The majority expressed a wish to be referred to as ‘resident’. This is reflected accordingly in the report. We would like to thank the residents and staff for their input during the inspection. What the service does well: What has improved since the last inspection? All the requirements made at the last key inspection have been met. There has been a significant improvement in the standard of care plans and other health related records. Staffing levels have been reviewed in line with individuals assessed nursing and care needs. Staffing and resources are being more effectively deployed and utilised across the home. Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 8 The garden area is well maintained and there is now a sensory garden which is enjoyed by many of the residents. There is now limited use of agency staff, particularly at night. Bank staff are used to cover shortfalls in staffing due to sickness, annual leave and vacancies. The manager is aware of the need to increase the number of staff with National Vocational Qualification (NVQ) to level 2 or above. He is registering five members of night care staff who will undertake their training during the night. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 9 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2, 3 & 4 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Comprehensive pre-admission assessments are undertaken for all residents. This means that staff have the detailed information to enable them to determine whether or not the home can meet a prospective residents needs. EVIDENCE: There is a comprehensive pre-admission assessment process in place and residents are not admitted to the home unless a full needs assessment has been undertaken. The home admits people who have very complex needs and the manager ensures that admissions only take place if he is confident that staff have the required skills, ability and qualifications to meet the assessed needs of the prospective resident. We looked at the files of 12 residents, 2 of whom had recently been admitted to the home. All files showed evidence of the home having undertaken a comprehensive pre-admission assessment and some showed evidence of either the prospective resident, or his/her family having visited the home prior to Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 12 admission. Also on the day of this inspection, visitors were seen being shown around the home on behalf of a prospective resident. Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 & 9 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Residents’ health, social support and personal care needs are set out in individual care plans and provide staff with the information they need to satisfactorily identify and meet residents’ needs. Monthly monitoring of care plans is undertaken however, it is important that care plans are updated as a result of reviews so that changing needs are reflected accordingly. The home maximises independence wherever possible and staff provide residents with information, assistance and support to make decisions about their own lives. Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 14 EVIDENCE: We looked at the files of 12 residents and each of the residents had a comprehensive care plan which covered general areas such as communication, night care and sleep, continence care, moving & handling and mobility. Where a resident had a specific need such as catheter care, tracheotomy care, suctioning, nasal gastric/peg feed or wound care, then the necessary care plan was also in place. Generally the care plans were very detailed and gave a real sense of the individual resident. We saw evidence that care plans are reviewed on a monthly basis, but it was not always evident that these reviews were as thorough as they could be. For example a care plan showed that a resident required blood to be monitored on a monthly basis, and this plan had been reviewed. However, there was no evidence that the necessary blood monitoring had taken place. Because of this we spoke to the nurse who was in charge of the unit on the day, and with the head of care. The head of care looked at various records and confirmed that the care plan had not been complied with, but also that he thought that the care plan was incorrect in asking for monthly monitoring. We asked the head of care to contact the resident’s GP to check if it was necessary for monthly blood monitoring, and the GP informed the head of care that the monitoring should be every 6 months. The care plan was immediately amended to show the correct information, and arrangements put in place for the 6 monthly monitoring to be undertaken that evening by the night staff. It is essential that the monthly monitoring of care plans is undertaken on an effective basis and that care plans are updated as a result of these reviews. Daily records were generally comprehensive around health and personal care needs, but were not always reflective of the outcomes identified in the care plans. Also that the implications of the Mental Capacity Act 2005 are taken into account in both the care planning and the daily recordings. This was discussed with the manager during the inspection. We also left a copy of the Commission’s guidance on the Mental Capacity Act 2005 with the manager. Many of the residents at Havering Court have very high care needs which include residents who may have tracheotomies, nasal gastric feeds, peg feeds, catheters and complex medical conditions. To ensure that trained staff can meet these complex needs, link nurses have been appointed to take the lead on areas such as phlebotomy, tissue viability, infection control, tracheotomy care, nasal gastric care and peg feed care. The ability of the service to provide this high level of nursing care does mean that the need for residents to be transferred to hospital is reduced. Residents were observed to be clean and well dressed, and there were no offensive odours anywhere in the home. We also saw that residents with very high medical needs, and the necessary Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 15 equipment, were being given the care and assistance required for them to spend time in the lounges with other residents according to their wishes. We saw evidence of good risk assessments being put into place, and these included the use of bed rails, wheelchairs, special reclining chairs and lap restraints. Again, because of the implications of the Mental Capacity Act 2005 we discussed the current use of restraints with the manager, and left him a copy of the Commission’s guidance on the use of restraints. As part of this we also discussed the use of assistive technology, which could include mattress alarms, chair cushion alarms and other such aids, which could alert staff to a resident experiencing difficulties in his/her bedroom but being unable to use the emergency alarm system to summon assistance. The service promotes opportunities for residents to maintain their independence and understands the importance of supporting residents to have control of their lives and make their own decisions. Individual staff were observed providing residents with information, assistance and support, and were respectful of their right to make decisions. The routines of daily living and activities were flexible and varied to suit the differing needs of residents in the home. A recent initiative is a monthly residents/ relatives committee with minutes and an agenda. This gives people living in the home an opportunity to express their views and influence the development of the service. Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15, 16 & 17 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Opportunities for social and leisure pursuits and personal development are actively promoted and supported by staff for all residents to enable them to participate in the community in which they live. The nutritional needs of the residents are well considered so that food and mealtimes are seen as being important and enjoyable for all residents. People are provided with meals that are reflective of their choice, cultural and dietary needs. EVIDENCE: Since the last inspection the home has developed a cinema within the home, and this has been combined with the sensory room. Thought has gone into the decoration of the corridor leading to the cinema as it is displaying posters etc. Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 17 of film stars and films. The home has an extensive library of dvds, audio tapes and videos. An X-box has also been purchased by the home, much to the delight of some of the residents. One in particular was seen to be enjoying playing with this, and she was keen to show us her skills. Residents have access to computers and this area is currently being reviewed to allow residents to access a web cam to aid their communications with family and friends outside of the home. For residents who generally have to, or wish to spend time in their bedrooms the activity co-ordinators ensure that they spend time with these residents on a one to one basis. One resident told us that one of the activity co-ordinators spends time with her on most days of the week. However, we were told by one of the activity co-ordinators that they do not work at the weekend, but that they were looking at developing this area. It was apparent that residents can choose when to get up and when to go to bed, as on our arrival at the home at approximately 08.15 a.m. many residents were still asleep in their bedrooms. A visit was made to the main kitchen and the inspector was able to discuss the storage/ preparation of food and menus with the chef and a member of kitchen staff. They were able to demonstrate a good knowledge and understanding of the importance of well balanced and well presented meals. Kitchen staff were aware of those residents requiring special therapeutic diets and other/ foods to meet religious or cultural dietary needs, for example Halal. There is a daily vegetarian option and fresh salads and fruits available at each meal. A cooked breakfast is provided each day and on the day of the visit thirteen residents had chosen one variety or other of this. The use of full cream milk, butter and cream is used wherever possible to supplement the diets of those residents with reduced food intake/ diminished appetite. We observed both breakfast and lunch being served, and tables were nicely laid with cloths, napkins, cutlery and flowers. Meals appeared appetising and well presented with residents being given choices. Sufficient numbers of staff were on hand to give the necessary and appropriate assistance required by an individual. A resident told us that ”the food is really nice, there is always a choice but sometimes the portions are too big for me to eat it all.” There is a ‘Night Bite’ menu available and the take up is variable. Popular choices appear to be beans on toast, spaghetti and jacket potatoes. Residents’ birthdays are routinely celebrated with a birthday cake and are always asked if they have any special meal requests for that day. Evenings where themed meals are prepared are very popular and have included, Chinese and Mexican foods and cheese and wine events. There is a weekly programme of activities for all of the residents and these include outings from the home, visits to local pubs and restaurants, garden parties, external entertainers visiting the home and group activities such as games, bingo and quizzes. An art group has been set up, and in discussions with residents, and from observation of some of Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 18 their art work, it was evident that they enjoy these sessions. The home is currently looking at partnership working with external agencies around the provision of an exhibition, and also the development of a drama class. Beauty therapy sessions are also undertaken at the home, and again residents enjoy this therapy together with hairdressing services. Where there are family links and friendships, residents are encouraged and supported by staff to maintain these links with their family members and friends. Residents and friends are encouraged to visit and can choose to have a meal with their relative/ friend. All residents are on the electoral register and some have requested support to make postal votes. Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19, 20 & 21 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Residents personal and healthcare needs are monitored and this ensures that their needs are recognised, understood and met. Personal support is provided in a manner, which suits individuals needs and preferences. There are clear medication policies and procedures for staff to follow, so as to ensure that residents are safeguarded with regard to medication EVIDENCE: Residents spoken to confirmed that they were happy with the support they receive around their personal care needs. One resident told us: “All the staff are kind. They listen to what I say and how I like things to be done”. Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 20 Another resident said: I am in bed most of the time. The staff always pop into my room to check I am okay, whenever they pass”. There are policies and procedures for the handling and recording of medication. An audit was undertaken of the management of medicines in the home, and a random sample of Medication Administration Record (MAR) charts were examined. Discussions with staff and the review of medication records show that staff are following policies and procedures. However, during examination of the Controlled Drugs Register on one floor, it was noted that whilst the register was signed for 22/07/08 it had no corresponding witness signature. The amount of drugs were checked by us and this was in accordance with the amount recorded in the register. This was addressed with the manager during the inspection and we emphasised the importance of robust recording and monitoring of this legal record. We are confident that this was an isolated omission and steps will be taken to ensure that this omission is not repeated. Where a resident had an allergic reaction to either medication or food this was recorded on the care plan, but not in a prominent position. This was addressed during the inspection so that the allergy was recorded more prominently and highlighted on the front sheet of a resident’s file. A record was also being maintained on the (MAR) chart. We saw evidence that residents are being weighed on a regular basis, generally monthly but more frequently if necessary. Also that referrals were being made to dieticians or nutritionists when necessary. All residents also had visits to or from the optician, dentist, chiropodist and GP. Visits to and from other health or social care professionals were also arranged as necessary. Some care plans contained details around end of life wishes, but this is still an area which needs attention. However, we are confident that residents and their families receive, and will receive, care in accordance with their wishes in a caring and sensitive manner. The home has received many cards and compliments on the care given, and these included “thank you for the help and support you and the team at Havering Court provided when D was with you. I was very impressed with the professionalism and commitment of all involved.” Another was “thank you. I cannot express in words how I feel. He had so much love and attention. His last days with you made him comfortable and dignified which was what we both wanted. Thank you for respecting our wishes.” Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The manager and staff make every effort to sort out any problems or concerns. Residents and their relatives can be confident that their complaints and concerns will be listened to, taken seriously and acted upon. All staff working in the home have received training in safeguarding adults to ensure that there is a proper response to any suspicion or allegation of abuse. People using the service can be assured that they will be protected from abuse, neglect and self-harm through staff awareness, training and regular supervision. EVIDENCE: We looked at the complaints log and found that all complaints are taken seriously and are dealt with in accordance with the home’s policy and procedure. In discussions with some of the residents we were told that they knew how to complain, who to and that they would complain if they had need to. One resident told us: “I came here in April, and have nothing but praise for the staff who are excellent. They really care and take time to come in and talk to me as I do not like leaving my room very often.” Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 22 Another said: “I would speak to the manager - we see him every day. If not I would tell one of the nurses”. There were also a number of compliments seen. One letter from a relative stated: “(X) is very happy at the home because the way staff are putting extra effort into making his life so pleasant”. All staff have undertaken training in safeguarding vulnerable adults and this is included in the induction training for all newly recruited staff. This was evidenced on staff files and the training schedule. Those staff spoken to were able to demonstrate a good understanding of the organisation’s policy and procedure in this area and were conversant with the action to be taken if they had any concerns about the safety and welfare of residents, or if they witnessed any suspected abuse. Staff told us that they had received training in safeguarding vulnerable people, and a member of staff told us that “if I saw a member of staff ill-treating a resident in any way, I would immediately report them to the senior person on duty. Such behaviour is totally unacceptable.” Currently there are no safeguarding issues at the home. Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 25, 28, 29 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs and particular lifestyle of the people who live there. Overall the home is welcoming, clean, well lit and tidy. Redecoration of the corridor walls, doors and doorframes as highlighted will add to the quality of the living environment. EVIDENCE: We did a tour of the premises, at the start of the visit and all areas were visited later during the day. The inspection commenced at 08:15 am and on arrival we found the home to be clean, tidy and there were no offensive odours. However, it was very evident that many areas of the home require redecoration especially with regard to worn, chipped paintwork on many of the Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 24 doors and doorframes. Although the maintenance man told us that he is responsibility for some of the redecoration the work in hand is such that he is not able to do this, especially along with his other duties. We did discuss this with the manager and we told him that the redecoration would be made a requirement within this report, and he has undertaken to address this matter urgently. The garden area is well maintained and there is now a sensory garden which is enjoyed by many of the residents. Some bedrooms were seen by invitation of the resident, whilst others were seen because the doors were open or being cleaned. All of the bedrooms seen were very personalised, well maintained and reflective of the occupant’s culture, religious and personal interests. The home is fully accessible to people with physical disabilities. There are adaptations and equipment in situ which are capable of meeting the needs of all residents. Lounge/dining areas were also well furnished and decorated and there were other areas around the home which gave quiet spaces for residents. We visited the laundry and this was found to be clean, with soiled articles, clothing and foul linen being stored appropriately pending washing. Personal protective clothing and equipment were available and in use. Hand washing facilities are prominently sited and staff were observed to be practising an adequate standard of hand hygiene. Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34, 35 & 36 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Staffing levels are satisfactory and there are sufficient staff on duty to meet the individual assessed needs of the residents. Residents benefit from a committed staff team who have the skills and training to meet their needs. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. EVIDENCE: Staff rotas were inspected and the staffing levels and skill mix of qualified nurses and care staff, on all floors, appeared appropriate to meet the assessed nursing and personal care needs of the residents. On the ground floor the levels were 2 nurses: 8 carers in the morning, and 2 nurses: 5 carers in the afternoon. On the lower ground floor the levels were 1 nurse: 4 carers in the morning, and 1 nurse: 3 carers in the afternoon. Staff were being effectively Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 26 deployed to ensure that residents choosing, or needing to remain in their bedrooms were being cared for appropriately. Effective team working was observed throughout the inspection, staff interacted well, both with each other and the residents. The training records were inspected and showed that staff have received mandatory training in moving and handling, food hygiene, infection control, health and safety and safeguarding vulnerable adults. There is an in house training programme for all staff on the Mental Capacity Act 2005, and its implications on the delivery of care to vulnerable people. Nursing staff have undertaken training in the management and care of tracheotomy, naso- gastric tubes and supra- pubic catheters. We were told that there are now lead nurses within the home for tissue viability, infection control and care planning. The AQAA stated that approximately 25 of care staff are qualified to National Vocational Qualification (NVQ) level 2 or above, and a further ten staff are currently working towards this qualification. The manager is aware of the need to increase the number of staff with this qualification and is registering five members of night care staff. We saw evidence that staff are receiving supervision in groups, 1:1 and through care practice observations, and this was supported through discussions with some staff members. BUPA Care Homes Limited; as an organisation, employs a workforce from diverse cultures and backgrounds. In discussion with staff they were able to demonstrate an awareness of the importance of understanding and appropriately meeting the needs of all residents, wherever possible around equality and diversity issues. The organisation is able to demonstrate that they operate a proactive recruitment procedure in line with equality opportunities. We inspected a sample of staff files and these were found to be in good order with necessary references, enhanced Criminal Records Bureau (CRB) disclosures, and application forms duly completed. All elements of recruitment are accurately recorded and all required documentation is obtained and verified prior to the commencement of employment. Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 38, 39 & 42 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The manager is an experienced and well-qualified person and residents benefit as the home is run in their best interests. Monitoring visits are undertaken by the responsible person to monitor and report on the quality of service being provided in the home. EVIDENCE: The current manager has submitted an application for registration with the Commission and this application is still being processed by the London Registration Team. Mr Buck is very resident focused and has continued to work Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 28 hard since the last inspection to improve services and provide an increased quality of life for residents, and works in partnership with the families of residents and professionals. He has a clear understanding of what further improvements are needed and the key areas, which need further development. The AQAA clearly identifies the plans for improvement to the service over the next year. A representative of the organisation undertakes monthly Regulation 26 monitoring visits to monitor and report on the quality of the service being provided. A copy of the report is maintained in the home and available to the Commission. Currently the manager does not act as an appointed agent for any resident. Residents financial affairs are managed by the individual resident, or their relatives/ representatives. There is a computerised financial system, which is managed by the home’s administrator. Through discussion and records inspected, there was evidence to show that residents financial interests are safeguarded. Secure facilities are provided for the safekeeping of any valuables held on behalf of residents. The home employs a full time maintenance person. We looked at maintenance records for gas, electric, water, lift maintenance, hoist and other equipment maintenance, water temperature checks, bed rails, fire alarm and the emergency alarm testing and all were found to be in good order and up to date. Emergency lighting is also checked regularly and fire exits are checked daily to ensure that these are kept clear of any obstructions. Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 X 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 3 3 X X 3 X Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement Timescale for action 11/08/08 2. YA20 13 (2) 3. YA24 23 The manager must ensure that care plans are updated as a result of monthly reviews, so that any changing needs are reflected accordingly. The manager must ensure that 11/08/08 there are robust systems in place for the recording of controlled drugs in line with legal requirements. The manager must ensure that 30/11/08 all parts of the home are maintained in a good decorative state. Priority must be given to the redecoration of the corridor walls, doors and doorframes to which the timescale given applies. This will add to the quality of the living environment. Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations Daily recordings must be more in line with outcomes identified in the care plans, and also that the implications of the Mental Capacity Act are routinely taken into account in both care planning and daily recordings. It is strongly recommended that where a resident has an allergy to either medication or food; it is recorded more prominently on the front sheet of the residents file. 2 YA20 Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Havering Court Nursing Home DS0000015593.V369266.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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