Care Home: Little Haven

What the care home does well Littlehaven has a good assessment and admission process to ensure that people are fully involved in the decision and process to move to the home. Each person has a care plan that was developed with their input using a detailed assessment process. Plans are well created and closely reflect the specific needs of the person. This means that staff have clear information on how to support their needs and lifestyles. Staff closely monitor the health and wellbeing of the people living in the home and work in partnership with other agencies to ensure that their individual care needs are met. Staff recognise the risks posed to people, offer support and guidance to ensure they are aware of their personal health and safety. There is a low staff turnover and residents can therefore be confident that they will receive support from people they know. The manager and small staff team are committed to ensuring that all of the needs of individuals are met; this is done through consultation, observation, previous knowledge and an understanding of specific needs and preferred lifestyles. We received very positive comments about Littlehaven and the care provided. One resident wrote, “Always clean. Always a meal prepared. Always one’s Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 shirts washed.” A relative wrote on their survey, “The home is always clean, the carers genuine and always a warm welcome for every visit. Littlehaven provides all the comforts of a proper home for the residents at the same time giving support and assistance in every direction it is required.” Another relative’s comment said, “Littlehaven staff give the support my X needs in a professional manner i.e. regular medication times and good food provided each day.” The home is kept clean, safe and decorated to a good standard meaning that people live in comfortable and homely surroundings. Bedrooms are furnished to meet people’s needs and wishes and individuals can personalise their rooms as they prefer. What has improved since the last inspection? The home has dealt with all the requirements and recommendations from the last inspection. Risk assessments for people using the service had been updated at regular intervals or where a person’s needs had changed. There have been improvements concerning medication administration and recording. Any ‘as required’ medication was signed for appropriately on the administration charts and there was a record of homely remedies being used by each resident. Some further work is needed however as discussed below. The owning company has written a policy on the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). This relates to new legislation which came into force in April of this year and concerns the protection of people`s rights when using care services. The manager has also attended training on the subject. What the care home could do better: Each person needs an up to date contract so that they have accurate information about all costs and facilities they can expect to receive. Some improvements are needed in relation to the management of medication to ensure safer practice and minimise the risk of error. All stock medication must be checked regularly and recorded. The home also needs to keep a clear record of any disposed medication. On the whole staff are safely recruited, but the employer must make sure that full employment histories are explored and recorded. This applies to all existing and future staff working in the home. This will further ensure that people using the service are protected from unsuitable workers. The manager`s working hours, staff roles and designated person in charge each day must be identified on duty rosters for clarity and legal purposes. Key inspection report CARE HOMES FOR OLDER PEOPLE Little Haven 66 Laleham Road Catford London SE6 2HX Lead Inspector Claire Taylor Key Unannounced Inspection 28th July 2009 11:20 DS0000025598.V377813.R03.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 2 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 Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Little Haven Address 66 Laleham Road Catford London SE6 2HX 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) 0208 6974246 0208 697 4246 sadie@elizabethpeters.co.uk Elizabeth Peters Care Homes Limited Mr Martin Muriuki Mrs Sadie McLeish Care Home 4 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (4) of places Little Haven DS0000025598.V377813.R03.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 Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD (of the following age range: 55 years and over) The maximum number of service users who can be accommodated is: 4 1st August 2007 2. Date of last inspection Brief Description of the Service: Little Haven is a care home for four people who have mental health problems and are aged 55 or over. The home is one of four owned by a local provider, Elizabeth Peters Care Homes Ltd. It is within a short walking distance of Catford town centre, although there are smaller shops available locally. There are four single rooms over three floors. The home could accommodate a wheelchair user on the ground floor but there is no lift to reach the upper floors. There is a kitchen/lounge on the ground floor and a small garden at the back of the home. The fees for a place at the home ranged from £550.00 to £650.00 at the time of this inspection. The home makes the reports of the Commission’s inspections available to residents in the office of the home. Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars – good service. This means the people who use this service experience good quality outcomes. We as it appears throughout this inspection report refers to the Care Quality Commission. Prior to our visit, the home returned its Annual Quality Assurance Assessment (AQAA) when we asked for it. This is a self-assessment that must be completed once a year. It is used to tell us about the services provided, how well outcomes are being met for people using the service and any planned developments. The AQAA was brief and some details are included in this report. We spent a day at the home and the registered manager was available throughout the inspection. We met and spoke to the four residents living in the home and two members of staff. We case tracked two peoples records of care. Case tracking means we looked in detail at the care people receive. We also looked at various records in relation to the staff and the way the home was being run. All this information helps us to develop a picture of how the home is managed and understand what it is like to receive support and care at Littlehaven. Two people living in the home completed have your say comment cards and we also received surveys from two relatives and four staff. All those who contributed to the inspection process are thanked for their time and for sharing their views about the home. What the service does well: Littlehaven has a good assessment and admission process to ensure that people are fully involved in the decision and process to move to the home. Each person has a care plan that was developed with their input using a detailed assessment process. Plans are well created and closely reflect the specific needs of the person. This means that staff have clear information on how to support their needs and lifestyles. Staff closely monitor the health and wellbeing of the people living in the home and work in partnership with other agencies to ensure that their individual care needs are met. Staff recognise the risks posed to people, offer support and guidance to ensure they are aware of their personal health and safety. There is a low staff turnover and residents can therefore be confident that they will receive support from people they know. The manager and small staff team are committed to ensuring that all of the needs of individuals are met; this is done through consultation, observation, previous knowledge and an understanding of specific needs and preferred lifestyles. We received very positive comments about Littlehaven and the care provided. One resident wrote, “Always clean. Always a meal prepared. Always one’s Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 6 shirts washed.” A relative wrote on their survey, “The home is always clean, the carers genuine and always a warm welcome for every visit. Littlehaven provides all the comforts of a proper home for the residents at the same time giving support and assistance in every direction it is required.” Another relative’s comment said, “Littlehaven staff give the support my X needs in a professional manner i.e. regular medication times and good food provided each day.” The home is kept clean, safe and decorated to a good standard meaning that people live in comfortable and homely surroundings. Bedrooms are furnished to meet people’s needs and wishes and individuals can personalise their rooms as they prefer. What has improved since the last inspection? What they could do better: 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. Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Standard 6 is not applicable as the home does not offer intermediate care. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information is available to help prospective residents and their representatives make an informed choice about whether to use the service. People have 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. EVIDENCE: We read the information people receive about Littlehaven which is known as the Statement of Purpose and the Service User Guide. The content provides information about the aims and objectives of the home. It tells people what support with day-to-day needs, social, leisure and educational opportunities and the environment they can expect to receive. The same group of people have lived in the home for a number of years and there have been no new Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 9 admissions. Suitable policies are in place however to ensure that the home would only admit people whose needs can be met. The care files all contained a copy of the assessment of needs completed by the social worker and the homes assessments. The assessments were detailed looking at the care and support needs, significant history, medication and specific health care support, information about the likes and dislikes of the person and their choice of social and therapeutic activities. We saw that residents’ assessments are regularly evaluated and updated. This shows that people’s needs are monitored and reviewed. We saw that keyworker staff had completed full mental health needs assessments in March and April of this year. These were written in a person centered way and each individual had signed in agreement. There were lots of useful sections to tell staff about the persons particular needs. Examples included their qualities, self concept, and ways of communication, family history and psychiatric support. Each person had an up to date Enhanced Care Programme Approach (CPA) on their file. This clearly detailed their needs and any presenting risk factors. Overall the contracts gave people clear information about the obligations of the provider and the persons responsibilities when staying in the home. Full details about any extra costs needs to be included however so that people have accurate information about any additional services they can expect to pay for. Records showed that one person paid for their taxi fares and this must therefore be included in the contract. Intermediate care is not offered at the home; therefore this standard was not assessed. Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 People using the 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 people living in this home are involved in decisions about their lives and in planning their care and support. Medication practices are generally well managed although some improvements will ensure safer practice. People and their families are consulted about ageing, illness and death in order that their beliefs would be observed and choices followed. EVIDENCE: We looked at three people’s care plans which had each been updated within the last six months. We saw that care plans were being reviewed on a monthly basis to ensure that any changing needs were being addressed and met. Information was well written so that staff have clear guidelines on how to meet assessed needs in a way that the person prefers. The owning company has set up an intranet system and staff can now use the computer to write daily reports, care plans and other necessary records for meeting the needs of Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 11 people who use the service. We looked at some reports which gave a good outline of a persons daily experiences, activities, their health and well being and any significant issues. Each person has a named keyworker staff to support them. As good practice, we suggest that a monthly summary of events is written up for each person so that staff can check what has been happening for the individual and to further ensure they are meeting their needs and aspirations. The staff we spoke with showed an awareness of risks posed to people living at the home, their vulnerability and described ways in which they help them. All care plans contained clear risk assessments for Manual Handling and preventing falls. We saw other risk assessments reflecting activities that people take part in so that there are efforts to minimise risk and promote peoples safety. These covered the full range of assessed risks and matched the needs of each person. Examples seen included personal care, managing finances, smoking, diabetes, accessing the home / wider community and a specific one regarding each person’s mental health and well being. In response to our last inspection, risk plans had been reviewed at timely intervals and where needs had changed. There are good systems in place for monitoring each residents physical well being. Examples concerned one resident’s recent changed mobility needs after they suffered a fall and fractured their hip. Care plans had been reviewed accordingly to ensure that staff took further action to meet their support needs. This included a nutritional monitoring chart and revised moving and handling care plan. Records also told us that staff seek advice promptly if they have concerns about an individuals health. We saw that one person had experienced increased pain in their hip and that the home arranged for the person to attend an orthopaedic clinic. At our last inspection in June 2007 we found three improvements were needed concerning medication administration and recording. Two had been addressed - ‘as required’ medication was signed for appropriately on the administration charts and there was a record of homely remedies being used by each resident. The manager reported that none of the current people living in the home manage their own medication but if required, they would be given the support they need. We checked the administration charts which were all signed and accounted for. Records were accurate for the receipt of medication but there was no record for the disposal of medicines. A second requirement is that all stock medication must be checked on a regular basis and not just when it is administered. This is to further ensure safe practice and minimise the risk of error. As further good practice, we think that the home should also undertake regular checks on all other medication to maintain an audit trail. In addition regular visits should be undertaken by the supplying pharmacist to offer advice and make similar audit checks. Records showed that two staff had undertaken recent medication training earlier in the month and there were plans for remaining staff to attend refresher training later in the year. We saw staff knock on bedroom doors before being invited in and that people have their own key to their bedrooms. Peoples wishes in respect of what will happen in the event of their illness of death had been established. These were Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 12 thoughtfully personalised with individual choices for the type of funeral, chosen hymn and service. Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from very flexible routines that suit their everyday lifestyle. A variety of activities is offered, and people’s right to choice and control over their lives is well respected, and encouraged. People are provided with and enjoy a range of meals according to their dietary requirements and choice. EVIDENCE: Due to their older age, most people tend to prefer to stay in their home surroundings and this was reflected in each individuals care plan. Discussions with people told us that they can choose how to spend their time and that support from staff is available. The daily records also confirmed that the home was supporting individuals in respect of their personal goals. Care plan records had examples of how staff encourage people to do more for themselves such as household tasks like cleaning their bedrooms and preparing meals. Staff shared some good examples of how they have supported people to make sure they are safe and not vulnerable when they are out in the community by talking about the situations that could put them at risk and how this could be Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 14 avoided. This showed staff helped people to ensure their safety by educating people through discussions. One person ticked on their surveys that they “always” made decisions about what to do each day and two people wrote “usually”. All four residents gave us feedback via the surveys in which they ticked that they “always” receive the care and support they need. In addition that staff listen and act on what they say and are available when required. All knew who to speak to if they were not happy. One person told us they often walked to the local shops to buy a newspaper. Some residents went on a trip to a museum earlier in the year and the home organised a barbecue for residents, family and friends. We looked at some records of residents’ meetings held in the home. These had been arranged every two months and covered a range of discussions such as rules on smoking, holidays, safety when going out, menu choices and activities. This shows that the home makes sure people’s views are obtained about the service and ensures that people are informed about what is going on in the house. Due to the small size of the home, staff ask residents each day for their meal choices and record their requests in a book. People generally have a hot cooked meal at about 5.00pm but mealtimes are flexible and arranged according to individual routines. People ticked on their surveys that they always like the meals in the home and all residents we spoke to said the food was good. The home ensures that dietician support is arranged where a person’s needs may require it. For example, one person has diabetes and information was available concerning their necessary dietary guidelines. We saw a well stocked supply of food although we think the home could improve upon its storage space as discussed further on in the report under environment standards. Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence that their views will be listened to and acted upon. Arrangements for protection are managed well to ensure that people who use the service are kept safe from possible harm and poor practice. EVIDENCE: The owning company has a clear procedure for dealing with complaints and copies are accessible to people using the service, their relatives and other parties. Information is made available in the Service User Guide about how a complaint, concern or suggestion should be made, and how this will be managed. People who returned surveys to us responded that they knew who to complain to if they were dissatisfied with the service. We have received no complaints or safeguarding concerns about the home since our last inspection in June 2007. Residents said that the manager and staff are very approachable and they would feel confident to discuss any problems with them. The manager advised that all four residents can read and we saw on files that each person had been given a copy of the complaints procedure. Records confirmed that staff are properly inducted on abuse awareness and that most staff had received training on safeguarding in February of this year. The company’s safeguarding policy had been reviewed in June of this year and guides staff on who to alert in the event of a safeguarding concern. In response to our previous requirement, the owning company has written a Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 16 policy on the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). This relates to new legislation which came into force in April of this year and concerns the protection of peoples rights when using care services. Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Littlehaven are provided with a clean and homely place to live which is furnished well to meet their individual needs. EVIDENCE: Littlehaven is nicely decorated and well maintained with a welcoming atmosphere, and made comfortable with homely communal spaces. The décor, fixtures and fittings are in good order with furniture to suit residents’ needs. We saw records to show that staff carry out a monthly check around the home to identify if any repairs or improvements are needed. A repairs/ maintenance report form is used to highlight any areas within the premises that need attention. The owning company employ a handyman to carry out repairs and redecorations. Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 18 In the AQAA we were told a number of refurbishments have been made to the home; the manager wrote; “New carpet in front room, stairs and hallway. New back fence, new lock on back door.” All of the people living in the home were happy to show us their bedrooms. Each one was furnished comfortably and reflected their individual lifestyles, interests and tastes. House rules allow people to smoke in their bedrooms and we saw up to date risk assessments for each individual. In one bathroom, a hoist was available for people who have mobility needs. The manager advised that although none of the current people living in the home needed it, the home has kept it for possible future use. We saw that the hoist had been serviced at regular intervals although there was no record of maintenance for a wheelchair used by one of the residents. The manager should therefore arrange for a maintenance check to ensure its safe operation. In the office area we saw a large supply of milk cartons and boxes of tea bags. We think the home could improve its storage space and suggest that bulk food items are stored elsewhere. We looked around the home and saw that it was clean with good hygiene practices in place. Staff had recently attended training on infection control. Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. Peoples needs are met and they are supported because staff get the right training and support they need from their manager. The recruitment practices need some improvement to further ensure that people are kept safe from possible harm or poor practice. EVIDENCE: There is a low turn over of staff, and people benefit from the consistency of a well-established staff team, most of who have worked at Littlehaven for many years. People we spoke to also expressed a confidence in the staff as well as results from our surveys. Staff on duty were respectful and supportive to individuals. The manager and the small staff team have developed good relationships with those who live at the home and have a sound understanding of their needs, wishes and aspirations to enable them to live a fulfilling life. We looked at staff duty rotas, which showed that the home is staffed efficiently, and the staffing structure is planned around peoples routines, lifestyles and assessed needs. There are always between two and three staff each day and staffing arrangements are flexible so that people are appropriately supported. Some improvements are needed with the rotas however as they did not provide an accurate record of who worked. Rotas did not include the manager, Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 20 the full names of the staff or who was in charge. This must be addressed for better clarity and legal purposes. Written comment cards from the four staff were very positive on their experience of working at the home. All staff said that they had appropriate recruitment checks carried out prior to them starting work. They each ticked that their induction to the service covered everything they needed to know very well’ and that training was appropriate. All responded that there were always enough staff to meet peoples needs and that they were always given up to date information on how to support and care for people. We looked at three staff files which included the manager. These contained most of the required legal checks and documentation which shows that the home takes care to recruit staff correctly. Two references were on each file, a completed CRB check, health declaration, proof of identity and records of interview notes. For each staff however, there were some gaps in their employment histories with no written explanation. Full recruitment checks must be carried out on all employees to ensure that people are fully protected and any gaps in employment must be explored and recorded. We further suggest that the homes job application form be revised to request any future employees full employment history and not the previous ten years. In the AQAA we were told that the home is planning to provide more training for staff. We looked at a training matrix which showed what courses staff had completed and when they were due to update. The majority of staff had refreshed key training on medication, infection control, manual handling, fire safety, safeguarding vulnerable adults, food safety and there were planned courses for those staff that needed to update. Records confirmed that five staff have completed an NVQ 2 qualification aand one had undertaken their NVQ level 3. This exceeds the minimum standard for which the home is commended. Some staff had undertaken training in specific topics such as equality and diversity and mental health in later life. Given that one person has diabetes; staff should refresh their training so that they are up to date with best practice and current developments. Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well managed service; and whose interests are at the heart of decision-making. People are often consulted about quality of the services provided and have influence over the way the home is run. Health and safety is well monitored in the home to ensure that action is taken where issues arise for the safety of those living and working in the home. EVIDENCE: The manager, Sadie McLeish has worked at Littlehaven for many years and it was clear she knew each resident’s needs well. She runs the home in conjunction with Mr Martin Muriuki who is also registered as manager for the service. We were advised that he was due to complete the NVQ level 4 Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 22 management qualification in 2 months time. The manager has updated her training and recent courses included the Mental Capacity Act, safeguarding vulnerable adults, first aid, food safety, fire awareness, first aid and moving and handling. Residents and staff feel that management are approachable, available and seek to ensure all their needs are met. Records showed that staff receive regular supervision with the manager as well as an annual appraisal of their work. All staff who completed questionnaires said that they regularly meet with their manager to discuss ways of working. The home has a good quality assurance system and policy for checking the standards in the home. In April 2009, satisfaction questionnaires were offered to the residents, their families and other representatives. We read some of the completed surveys which were all complimentary about the care and the services provided. Other quality monitoring systems are used to ensure that people benefit from a well run service. As well as in house checks carried out by the manager, a responsible individual from the owning company visits the home once a month and completes an audit of the service. Reports were detailed and showed that the owners make sure the conduct of the home is closely monitored and action is taken to make improvements when needed. There were appropriate maintenance contracts for the home concerning gas and electrical safety and the hoist in the bathroom had been serviced. Fire drills are organised at regular intervals and all staff had taken part in a practice fire evacuation. Fire alarms and equipment checks were up to date. Checks on hot water temperatures are carried out regularly to ensure that they are maintained at a safe limit. Risk assessments covering safe working practices have also been completed to safeguard the welfare of people living in the home, staff and visitors. Accurate records are kept for accident and incidents and the home keeps us informed about any reportable events. A new IT system has been set up and is accessible to the staff. Staff have had training to use the computer so that they can maintain the necessary records about the care that people receive. In addition, policies, procedures and other guidance are available to them through the homes intranet system. Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 3 Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 24 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 OP2 Regulation 5a Requirement Each person needs an up to date and completed contract that includes the full terms and conditions for staying in the home. This is to provide people with accurate information about all costs and the facilities and services they can expect to receive. Records must be maintained for the disposal of medication kept on behalf of people who use the service. This is to maintain an audit trail that further ensures safe practice and reduces the risk of error. All stock medication must be checked on a regular basis. To maintain an audit trail that further ensures safe practice and reduces the risk of error. Staffing rotas must be recorded in more detail to include the manager, full names of staff and the designated person in charge. This is so that they provide an accurate and true record of all DS0000025598.V377813.R03.S.doc Timescale for action 31/12/09 2. OP9 13 (2) 31/10/09 3. OP9 13 (2) 31/10/09 4. OP27 17 31/12/09 Little Haven Version 5.2 Page 25 staff working in the home. 5. OP29 19 All of the required 31/01/10 information and vetting checks must be obtained prior to staff beginning work. Full employment histories with an explanation of any gaps must be explored and recorded. This makes sure that all people who work at the home are safe to do so. 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 OP7 Good Practice Recommendations A monthly summary of events is written up for each person so that staff can check what has been happening for the individual and to further ensure they are meeting their needs and aspirations. The home should complete its own check on all medication on a regular basis. This will further ensure safe practice and minimise the risk of error. Regular visits should be undertaken by the supplying pharmacist to offer advice and carry out audit checks on medication. This will further ensure safe practice. That the wheelchair used by one person in the home is serviced and that subsequent maintenance checks are carried out. To ensure its safe operation The home could improve its storage space so that any bulk food items are stored elsewhere. Staff should refresh their training on diabetes as it is specific to the needs of one person. This is so that they are up to date with best practice and current developments. 1. OP9 2. OP9 3. OP22 4. 5. OP22 OP30 Little Haven DS0000025598.V377813.R03.S.doc Version 5.2 Page 26 Care Quality Commission Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.london@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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