Care Home: The Haven

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What the care home does well People living in the home receive good care and support in a comfortable and homely environment. "I am very happy at The Haven and......if, as I would be at home, would not get the attention I get here wrote one person living there" A relative also wrote "Since Marie has taken over the running of the care, the standards have increased 100%. The residents are taken out far more and all their needs are met." Information is available on what the home has to offer as well as what people need to know about their terms and conditions.People live in a relaxed environment and are able to spend their days as they wish with care plans that are detailed and show how staff meet individual needs. The staff encourage and promote independence and try to include people more in what is happening in the community around them to give them opportunities for stimulation and social inclusion. "I go out to the shops most days and we`ve been out for meals as well........I do like to go out" said one person. People enjoy a good standard of food in a relaxed atmosphere. "The meals are good and there is enough of it, "said one of the residents. The manager is experienced and capable and understands the needs of individuals with her long experience of mental health care. She also maintains generally good health and safety and protection standards to ensure people are kept safe. What has improved since the last inspection? Since the last key inspection there have been improvements in a few areas. This includes the improvement in the activities offered and the way people are encouraged to join in community activities enabling them to enjoy a more varied and stimulating day and improve their overall well-being. It is also positive to see how the care plans have improved to show more detail about how individuals would like to be cared for by staff in the home. The Statement of Purpose has been changed to provide the information on what the home offers to prospective users of the service. Risk assessments have been completed in a number of areas to determine the risks to people and how staff can support them in minimising risks whilst encouraging independence. Staff new have a contract of employment informing them of their right and obligations and terms of their employment. Staff supervision is held more regularly and of a more structured nature and the manager has improved the recruitment practices to ensure people living there are safeguarded from the employment of unsuitable people. CARE HOMES FOR OLDER PEOPLE The Haven 58 Sherwood Way West Wickham Kent BR4 9PD Lead Inspector Wendy Owen Unannounced Inspection 11th August 2008 17:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Haven DS0000066684.V369064.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Haven Address 58 Sherwood Way West Wickham Kent BR4 9PD 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) 020 8777 3218 thehavenhome@hotmail.com Marie Yolande Thamiandy Garjah Mr Jean Sylvio Garjah Marie Yolande Thamiandy Garjah Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0) of places The Haven DS0000066684.V369064.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 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: 2. Mental Disorder, excluding Learning Disability or Dementia - Code MD The maximum number of service users who can be accommodated is: 6 15th June 2007 Date of last inspection Brief Description of the Service: The Haven has been established since 1996. It has recently undergone a change of Providers. It is registered as a care home for six older people, male or female with mental health difficulties. The Haven provides twenty-four hour support to the service users to enable them to live as independently as possible in the community. The home itself is a two storey semi-detached building located in a quiet residential road close to West Wickham town centre. The private accommodation is located on the two floors and, due to the stairs, the home may be partly unsuitable for those individuals with mobility difficulties. There is a small staff team, which includes a Registered Manager, (one of the Providers) who is also part of the team of care staff. No ancillary staff are employed to work in the home. Current fees range from £454.24-£523.99. Information for prospective residents is available in the form of a Service Users Guide and Statement of Purpose. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 2 star. This means the people who use this service experience good outcomes. This inspection took place over the course of three hours one evening and a second visit a few days later lasting approximately one and a half hours. During the visits we spoke to the people living there, toured the home, had discussions with staff and viewed records. As part of the inspection we also sent out surveys asking about the quality of care with three resident and one relative returned completed. We also had telephone conversations with relatives to discuss the care. We included other information held by us to make a judgement about the service. This included the Annual Quality Assurance Assessment (AQAA) and the information sent to us by the Providers on a recent survey undertaken by them. Both documents provide details about the quality of care provided. We also undertook an unannounced inspection in February 2008. The outcome of this has been included in this inspection report. What the service does well: People living in the home receive good care and support in a comfortable and homely environment. “I am very happy at The Haven and……if, as I would be at home, would not get the attention I get here wrote one person living there” A relative also wrote “Since Marie has taken over the running of the care, the standards have increased 100 . The residents are taken out far more and all their needs are met.” Information is available on what the home has to offer as well as what people need to know about their terms and conditions. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 6 People live in a relaxed environment and are able to spend their days as they wish with care plans that are detailed and show how staff meet individual needs. The staff encourage and promote independence and try to include people more in what is happening in the community around them to give them opportunities for stimulation and social inclusion. “I go out to the shops most days and we’ve been out for meals as well……..I do like to go out” said one person. People enjoy a good standard of food in a relaxed atmosphere. “The meals are good and there is enough of it, ”said one of the residents. The manager is experienced and capable and understands the needs of individuals with her long experience of mental health care. She also maintains generally good health and safety and protection standards to ensure people are kept safe. What has improved since the last inspection? Since the last key inspection there have been improvements in a few areas. This includes the improvement in the activities offered and the way people are encouraged to join in community activities enabling them to enjoy a more varied and stimulating day and improve their overall well-being. It is also positive to see how the care plans have improved to show more detail about how individuals would like to be cared for by staff in the home. The Statement of Purpose has been changed to provide the information on what the home offers to prospective users of the service. Risk assessments have been completed in a number of areas to determine the risks to people and how staff can support them in minimising risks whilst encouraging independence. Staff new have a contract of employment informing them of their right and obligations and terms of their employment. Staff supervision is held more regularly and of a more structured nature and the manager has improved the recruitment practices to ensure people living there are safeguarded from the employment of unsuitable people. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sound systems in place to ensure people have the information they require to make decisions about whether the home is right for them. Staff have the information they need to ensure they can provide the care and support needed by individuals. EVIDENCE: During the unannounced visit in February 2008 we looked at the information provided by the home in the form of the Service Users Guide and Statement of Purpose. The Service Users Guide had been updated at this time but the Statement of Purpose was still in need of some amendments to ensure it contained the information required of the Regulations. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 10 We found copies of the “Guide” in individuals’ rooms for people to view. We also overheard at the last inspection one resident telling the manager that she had read it and wanted it left in their room to look at when she wanted to. A copy of the Statement of Purpose was available in the hallway with copy of the last inspection report. The service user group has remained constant with no new people arriving at the home to live since the last inspection and therefore admissions practices were not inspected. We noted contracts were in place for those people living there with placement agreements for those placed by the local authority. Standard 6 is not applicable. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans and supporting documentation ensure that staff have the information to meet individuals’ health, personal, and social and needs. People can be assured that their health needs are met through robust medication practices and access to healthcare professionals. EVIDENCE: At the last inspection we viewed one care plan that was in the process of being updated to make it more person centred. It showed a clear picture of the individual’s needs and how staff could support them in their everyday life and where they were able be independent. There was also written guidance for staff on how the individual likes to spend their days and their routines. There were a couple of gaps but from reading the information it was possible to gain a good understanding of the person’s needs. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 12 The information contained how they could be supported in moving and handling but risk assessments had not been produced as required at the last inspection. At this inspection we noted that all of the residents have a care plan and we viewed three of these during this inspection. Care plans continued to cover a number of areas and detailed how a person’s needs can be met. It also continued to include routines of the day that enables people to spend their day as they wish. It is positive to note the comprehensive information available, including how personal care is to be provided and the support required. The plans also include details of mental health and this is particularly relevant as this is the category of client which the home is registered to admit. We feel that more information could be provided on what sign and symptoms of relapse there are for each individual to enable staff to recognise these and take action at the right time. Risk assessments were completed for nutrition and falls, although in one case the nutritional assessment had not been completed. The last inspection required moving and handling risk assessments to be completed. There is information on how people like to be moved although not in the form of a risk assessment. It does however, provide information on peoples’ mobility and assistance required. None of the people living there need support of hoists or other lifting equipment with the exception of bath seats which are available for all. Where there were risks the care plan detailed to some extent how the staff could minimise the risks. The care plans also detailed physical health needs and how these could be met. The surveys returned to provide us with feedback for this inspection showed that people are happy with the care provided. A relative felt that their family members needs were met well with the home recognising the need to balance independence with risks. There was evidence from the daily records and diary of various health checks and appointments with NHS teams and specialist support such as psychiatrist, CPN, District Nurse and GP. People are also able to visit the local optician to ensure they have regular eye checks with evidence of chiropodist and dentist. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 13 We recommend that the care plan detailing mental health needs include information of the regular checks by the mental health team and triggers or symptoms that staff should look out for to determine if they are in the process of relapse. We noted that individuals’ weights are monitored and recorded to ensure there are no nutritional problems and that people are receiving adequate diets. In February we undertook a brief audit of the medication procedures. The records were found to be in good order with accurate and completed records of prescribed medication for each person. Staff were also receiving medication training through distance learning courses. During this visit we audited the procedures, practices and the records of all the people living there. Once again we found that there continued to be good practice. The medication is supplied by Boots pharmacy and a printed record is provided. We viewed all the records and found them to be completed well with number pages, allergies and full details on the medication record along with a photograph of the resident. The records of receipt were also completed well together with the records of administration. We found the records crosschecked with those administered. The records also showed where medication had a shelf life the date of opening had been recorded. We also noted where prescribed medication had been handwritten on the medication records there were two signatures plus the amount carried over from one record to the next. There was also evidence of other medication being carried over, although the records for creams were not so evident. We suggest that boxes of medication are dated when opened to enable accurate auditing Homely remedies procedure in place with GP signature and details of what medications they could stock and who they could be administered to. A book details records of medication given. It is clear there are good systems in place to ensure people receive the medication they are prescribed to ensure their continued health and wellbeing. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 14 The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People lead the life they wish and are able to participate in activities that they enjoy. Meals provided are of a good standard of food to ensure people enjoy a nutritious healthy and varied diet. EVIDENCE: When we arrived at the home we found four of the six residents out of the home at a tea dance. On arriving back at the home it was clear that they had had a good time. It was positive to see that the care plans detail individual routines of the day: ie what time they would like to get up and go to bed as well as other information such as how they like to be woken up etc. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 16 Records viewed such as the diary and daily events sheets showed that there are more opportunities to go out and take part in community activities. Records show people going out for meals, to the shops, church and to other activities. Three of the residents also continue to attend a day centre once or twice a week. On reading the minutes of one of the staff meetings the manager pointed out to staff the importance of using their time effectively to engage with people rather than allow the TV to be turned on throughout the morning which has often been the case. This does not deprive them of watching TV if they wish as they could do so in their rooms. One relative wrote, “ Mum is so much better off. She has her own room and is allowed to do what she likes, she still goes into town on many occasions during the week. She loves her independence.” Another told us how pleased they were that since Marie had taken over their relative was going out more. This is an area that they felt was not addressed previously. Care plans also document where individuals enjoy reading or sitting in the lounge chatting to fellow residents. We noted that one of the residents likes to follow their religion and opportunities are made for them to visit church regularly unless they have shown little interest in continuing their faith. Another resident enjoys gardening and takes responsibility for watering the garden pots in the back garden. It is also evident that continued relationships with family members or friends are important to those living there. There is evidence of regular contact through phone calls, visits or people being taken out by relatives or friends. During the inspections undertaken over the last few years there has always been good feedback about the quality of the food provided. This continues to be the case with home-cooked meals and people being involved in what is put on the menu. The daily routine also details what people would like for breakfast and where they would prefer it to be taken ie bedrooms or dining room although main meals are taken in the small dining area set off from the kitchen. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 17 When we visited over the two days one resident preferred to take a light tea in the privacy of their room whilst another enjoyed their tea in the lounge. We noted how people were asked about what they wanted with choices on offer. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People feel that they can raise concerns in a safe environment and when issues are raised they are listened and responded to. The adult protection procedures and practices protect vulnerable people living in the home. EVIDENCE: There is a complaints procedure in place and is on display in the hallway. Due to the change of contact within CSCI the address and telephone number needs to be changed. We noted that the procedure is written in fairly large print. There have been no formal complaints made in the last twelve months nor has the Commission received any concerns or complaints about the home. People spoken to and who provided feedback felt that the manager (who is also on duty for much of the time) takes on board issues or concerns raised and so there was rarely the need to make a formal complaint. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 19 A suggestion box is also located in the hallway although people have not made use of this yet. Residents meetings take place every three months along with informal chats. Both of these give an opportunity for people to become involved in how the home is run and how it can be improved. Adult protection procedures are also in place along with the Bromley InterAgency Guidelines for the Protection of Vulnerable Adults from abuse. Staff have undertaken a workbook which gives guidance on adult abuse, types and their role in ensuring people are protected. Certificates were noted on the staff files. We spoke to one member of staff who had a sound understanding of abuse and could tell us the meaning of “Whistle-blowing”. We spoke to people using the service and relatives who all said they felt safe and would say if they felt any concerns. It is also positive that leaflets on abuse are also available in the hallway to provide people with further information and guidance. No allegations of abuse have been made nor complaints received over the last twelve months. On checking individuals’ monies we found adequate records and receipts of expenditure with evidence of some people being in control of their monies and when they want to spend it eg signatures on record books. Recruitment practices are satisfactory and people are adequately protected from the employment of unsuitable staff. Further improvements could be made in some of the practices that would ensure practices are robust. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Haven provides a warm, homely and comfortable environment for people living there. However, access to areas of the home is difficult and potentially hazardous for some. EVIDENCE: The Haven is a well maintained and comfortable home with decoration and furnishings to a good standard. Individual rooms are personalised and very comfortable with mementoes and possessions to enable people to continue links with the past and what is familiar to them. We found them to be very comfortable, homely and well furnished. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 21 People spoken to and the comment cards received all stated that the home is comfortable clean and fresh and for many they chose the home due to its homeliness. The home appeared clean and fresh when we viewed it. We would however, expect the toilet seats to be replaced, as they look marked. We noted hand wash in the toilets and bathroom, although material hand towels are in use rather than paper hand towels. The Provider is reminded of then need to ensure good infection control procedures to minimise any risks to other people. We did note however, that a number of people have been in the home for a number of years and that most of them have mobility problems. There are a number of areas that present issues with access and potential trip hazards such as from the dining area to the kitchen, from the lounge to the conservatory and the area at the front of the house where there is a step and a doormat that present individuals with difficulties, including the inspector who had a slight trip over the doormat. People access the back garden by steep steps with handrails, although this is not sufficient for some of the people living there so the fitting of a ramp should be investigated. There must be safe access to all areas of the home for those living there and the manager/Provider is reminded of the need to comply with the Disability Discrimination Act The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 &30Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People in the home are cared for and supported by experienced, skilled and competent staff. Recruitment practices are adequate, although the induction processes require some improvement to ensure staff have the knowledge of the home and people in it to ensure consistent care. EVIDENCE: On arrival at the home on the first day we were greeted by one staff member, caring for two residents. The other four residents were out at a tea party with the manager. We viewed the staff rosters that showed evidence of one staff member at all times during the day and night with flexible staffing at times to meet needs of the residents eg appointments and activities. There has been some good progress with the training provided. The manager has also produced a training matrix to record staff training and what is required. Training is provided through a variety of sources, including the Bromley training consortium, outside providers and distance learning. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 23 All staff have or are going through adult protection, fire and infection control training on a distance learning course; medication; first aid, moving and handling and food hygiene training through the Bromley consortium. We noted that two new staff had been employed and viewed the staff files and training records to determine the robustness of the recruitment and training of new staff. We also spoke to one of the “new” members of staff. The files provided evidence of the checks that were completed prior to the person starting work in the home. There was evidence of the manager verifying the references and in both cases there was a Criminal records Bureau check, POVA1st, health declaration, proof of identification and application form. Neither had any record of interviews. Staff now have contracts in place for their employment in the home. We also noted that there was written evidence of induction, although not relating to the Common Induction Standards (CIS). The guidance states that induction should be completed within 12 weeks to take into consideration the need for certificated courses and that some individuals work part-time. The manager must consider this in the future when employing new staff. The manager is also reminded of the need to ensure there is a clear record of the initial orientation/induction that takes place. We spoke to one member of staff who told us that they had a five-day induction that covered a number of areas, including emergency procedures although were unable to locate the accident book and other information. On looking at the individual’s file there were certificates from the current employment and recent training provided at The Haven. We found evidence of some certificated training but no evidence of moving and handling training although they told us they have recently completed this at the main job. Copies of the certificates of training must be held by the home to enable the manager to determine the training needs to ensure they are safe and competent. The individual has not yet undertaken food safety training, although there is evidence that this is arranged for September. The person has been employed since November 2007 and involved in food preparation of some kind and therefore training should be provided in a more timely manner as detailed above. During discussion we found that they had a basic knowledge of infection control relating to food safety. We also discussed accident and emergency procedures and once again a basic knowledge was demonstrated. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 24 They were they fully aware of the correct fire muster point as detailed in the fire procedure on display in the hallway. We looked at the file containing training certificates and record of training maintained for each individual’s training undertaken. We found there to be training in core areas (except for the individual mentioned above). Where people have, or continue to work elsewhere, there were certificates relating to that employment eg fire, dementia, epilepsy etc. It is only in two cases (moving and handling and fire training for one person) that the certificates could not be found and therefore no evidence of their completion. The home meets the 50 of staff with NVQ 2 or above ensuring staff understand what good quality of care is. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager/Provider has been running the home for almost two years now and we have noted the progress and some improvements made such as more opportunities for activities. We also found that she updates her training, specifically core and mental health training to enable her to keep up with good practice in the care sector. It is clear from the feedback that there is an open and inclusive atmosphere at The Haven where people are valued and treated with respect and dignity. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 26 People spoken to were very happy in the home, happy with the support they receive and the way in which it is managed. We have said previously about the use of a suggestion box and residents’ meetings to involve people in decisions about their care and how they would like the home to operate. At the last key inspection we found that formal supervision of staff was required to be undertaken more regularly. There is evidence that this is now taking place and that staff practice, personal development and training is monitored to ensure people receive a good quality of care. The manager told us that new staff receive more regular supervision but she tries to formally supervise staff every two to three months. This is in addition to informal discussions and monitoring of practice and staff meetings that take place every few months. . The last key inspection required the manager to ensure full and detailed records were maintained in respect of individuals’ monies held. We found at the visit in February that these to have improved. Residents are encouraged to sign receipt of monies and are supported to maintain their independence in this area. It is good practice to detail the support required as part of their care plan. We found at this inspection that the records were generally well maintained with receipts and records of money spent. We strongly recommend that people are given receipts for the money they bring into the home on their relatives behalf. The manager continues to look to improvements to ensure residents are provided with a good, consistent quality of care. A review of the service has been undertaken, although it suggests there could be improvements it does not detail where these improvements are needed. The outcome of the survey is provided in the form of a bar chart. A report must be produced from this which details what they do well but also what improvements are needed. There have been few regulation 37 incidents received by us with three over the last twelve months. We viewed the accident forms and found that we had been informed of the incidents. The manager also assured us that where injuries had been sustained she was clear that appropriate treatment had been received within the home. We would remind her that, although she is a registered nurse, residential homes do not provide nursing care and therefore appropriate treatment should be sought from healthcare professionals. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 27 In the above cases no detriment was suffered by individuals but the manager should be aware of the boundaries and individuals receiving appropriate action. We checked a number of service agreements and records of examination of equipment and services and found them to be in date and in safe condition. On looking at the fire records we found records of weekly checks on the fire alarm system and a recent service of the system. Fire equipment is due for its annual service this month. A fire risk assessment has been completed detailing areas of the home and any risks. This document had not record of the date it was produced or date for review. We found records of fire training for all but one staff member and the manager was made aware of the need to update at least yearly. However, we found little evidence with the exception of one fire drill with a staff member and residents and discussions with staff and residents during meetings. There must be regular fire drills completed to ensure staff react appropriately in the event of a fire emergency. We have commented in the previous standards that staff are receiving core training with the couple of exceptions noted. The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 28 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X 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 2 2 X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 X 3 The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? 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 OP20 Regulation 23 Requirement There must be safe access to all parts of the home for the people living there including outside areas. Please provide the Commission with a plan of action. There must be a record of the induction given to new staff specifically on the home procedures and location of records. Staff must undertaken regular fire drills to enable them to react appropriately in the event of an emergency and keep people safe. As part of the recruitment practices the manager must ensure there is a record of the staff interview and copies of any certificates from previous employment. The manager must ensure that a report is completed on the outcome of surveys undertaken and include an action plan for improvement. Timescale for action 01/11/08 2 OP30 17 01/10/08 3 OP38 23 15/09/08 4 OP29 17 15/09/08 5 OP33 24 01/12/08 The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 30 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 2 Refer to Standard OP7 OP9 Good Practice Recommendations Care plans should include how staff can recognise signs of an individuals relapse in their mental health. Prescribed medication stored in boxes should have the date of opening recorded on it to enable accurate auditing. There should also be a record of creams carried forward each month. People who bring money into the home on behalf of their friend or family member should be provided with a receipt. New staff should be provided with induction in respect of the Common Induction Standards and the timescales detailed by the Skills Sector. 3 4 OP35 OP30 The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 31 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 The Haven DS0000066684.V369064.R01.S.doc Version 5.2 Page 32 - 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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