Care Home: The Haven Colchester

What the care home does well The recruitment process ensured that people living at The Haven were protected by the safe recruitment of professional and friendly staff. Relatives told us they were happy with the service and care provided for people living at the home. What has improved since the last inspection? Since the previous visit to the home some improvements have been made in the care planning documents to make them more user friendly and working documents for staff to use. Evidence was available to confirm that all pre employment recruitment checks had been undertaken before people started to work at the home. This is to ensure that people were looked after by staff that were appropriate to work with vulnerable people. Some requirements and recommendations resulting from the previous inspection visit had not been progressed under the previous ownership of the care home however there had already been some improvements under the new leadership and many more were planned for the immediate future. These included staff training and improving the environment to make it more appropriate for people living with dementia. What the care home could do better: The management team need to continue with their efforts to improve standards in the home. Whilst residents and relatives are generally happy, there is much work to do in order to bring the service up to the required standards. Work is needed on care planning and management for residents. Some shortfalls in the administration of medication need to be addressed along with the significant gaps in the staff training provision. This will help to keep people safe and healthy. The premises need to be improved to provide an enabling environment for people living with dementia and to make The Haven a more pleasant and more homely place to live. Key inspection report Care homes for older people Name: Address: The Haven Colchester 84 Harwich Road Colchester Essex CO4 3BS     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Greaves     Date: 2 2 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: The Haven Colchester 84 Harwich Road Colchester Essex CO4 3BS 01206867143 01206793166 the.haven@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Comfort Care Services (Colchester) Limited care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 29 persons) Date of last inspection Brief description of the care home The Haven is registered to care for 29 older people with dementia. The home offers long term or respite care. The Haven is a purpose built detached property in a residential area of Colchester. The accommodation is mainly on the ground floor, providing good access for people with physical disabilities. There are two lounges serving different parts of the building and a communal dining room. With one exception, bedrooms offer en-suite facilities. Three bedrooms are located on the first floor and are accessed by a stair lift. There is a small garden and a parking area to the front of the property and an enclosed garden at the back. Care Homes for Older People Page 4 of 31 Over 65 29 0 Brief description of the care home Fees range from £434.00 per week, items considered to be extra to the fees include private chiropody, hairdressing, toiletries and manicures. This was the information provided at the time of key inspection, people considering moving to this home may wish to obtain more up to date information from the care home. Inspection reports are available from the home and our website at www.cqc.org.uk Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key site visit that took place over 7 hours. At this visit we considered how well the home meets the needs of the people living there and how staff and management support people. This service had a change of owner two weeks prior to this site visit. There have been a number of improvements planned, some of these have been referred to throughout this report. The new owners demonstrated a sound understanding of what improvements were necessary to enhance the quality of life for the people living in this home and had plans in place to bring about improvements with immediate effect. A tour of the premises was undertaken, care records, staff records, medication records and other documents were assessed. Time was spent talking to, observing and interacting with people living at the home, visitors and staff. Care Homes for Older People Page 6 of 31 Prior to the site visit the owner of the home had completed and sent us the homes Annual Quality Assurance Assessment (AQAA). This is a self assessment document required by law and tells us how the service feels they are meeting the needs of the people living at the home and how they can evidence this. Before the site visit a selection of surveys with addressed return labels had been sent to the home for distribution to residents, relatives and staff. Views expressed by visitors to the home during the site visit and in surveys responses have been incorporated into this report. Feedback on findings was provided to the owner and manager throughout the inspection and the opportunity for discussion and clarification was given. We would like to thank everyone at The Haven for the help and co-operation throughout this inspection process. The previous key inspection of this service took place on 30th June 2008. Care Homes for Older People Page 7 of 31 What the care home does well: 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. Care Homes for Older People Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into The Haven may not have accurate written information to help them to make decisions. Assessments undertaken will however give people confidence that the home will be suitable for them. Evidence: A Statement of Purpose and Service User Guide were available to provide people with detailed information about the home to enable them to make an informed decision about whether the home will meet their needs. This information about the home has been reviewed by the new owners and clearly sets out the objectives and philosophy of care, detailing the specialist services provided, the quality of the accommodation, qualifications and experience of the staff and how to make a complaint. The Service User Guide stated We encourage and welcome prospective residents and their families (Or any representative on their behalf) to visit The Haven to assess the service we provide. All residents initially enter the home on a minimum 4 week trial Care Homes for Older People Page 10 of 31 Evidence: basis before a final decision is made on permanent residence. We noted the Service User Guide stated that all rooms are tastefully decorated. The new owner shared their plans with us for the re-decoration of the entire home and some of these were already underway however, the information in the Guide was misleading at the time of this visit (See environment section of this report for more detail). The AQAA stated in the section entitled our plans for improvement in the next 12 months We will be refurbishing our home to make it even more comfortable for our residents. Before people moved into The Haven the manager, or senior member of staff, visited them either in their own home or in hospital to undertake an assessment of their needs to ensure the staff and facilities provided could meet those needs. We looked at the file of a person recently admitted to the home. The areas of need covered in this assessment included: communication, breathing, nutrition, circulation, mobility and hygiene. There were numbered options to select to determine each persons dependency rating, we noted there were additional notes added to the form providing more detail. Training records showed us that staff had not received all the training necessary to give them the skills they needed to meet peoples assessed needs. this had been identified by the new owners and courses in Dementia Care and managing challenging behaviours had already been booked for July 2009. There were significant gaps in the staff basic core training provision, please see the staffing section of this report for more detail. Relatives told us via surveys about the experience of choosing the home:I was very impressed with the way in which the manager conversed with me. The booklet was very impressive. Care Homes for Older People Page 11 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive instinctive care from caring staff however this is not based on sound care planning. Daily practice does not protect peoples privacy or promote their dignity.The medication practices in the home do not protect peoples safety and welfare. Evidence: The manager reported that care plans had been further developed since the previous inspection visit, this had been achieved with the support of outside professionals. The new owners were in the process of changing care plan documentation to be in line with other homes within the organisation. There were 29 people living at The Haven at this visit, 6 of the care plans had been transferred over to the new format at this time. We looked at the care records for 3 people living at the home. The amount of detailed information and quality of information varied between the care plans sampled. One file did not contain a photograph of the resident. The care plans covered areas of need such as mobility, washing, bathing, hair, teeth, dressing and jewelery. There was no detail included about social interaction, stimulation or how to encourage people to Care Homes for Older People Page 12 of 31 Evidence: enjoy their daily lives. The people living at The Haven were living with severe dementia needs, there were no care plans in place to identify peoples individual support needs or strategies for staff to employ to increase peoples well being. Care plans contained a checklist for daily appearance: This was a tick list for staff to complete to be sure they had attended to peoples dentures, hair, nails, shave, feet, shoes etc. These did not contain any detail about the nature or level of support provided, the new owners reported these had been discontinued now in favour of more detailed recording. There was a bath chart for staff to complete to show the temperature of each persons bath, what elements of personal care had been delivered such as hair washing, nails and any comment about marks on the skin or pressure areas. One example recorded was a skin tear to a persons right arm. One care plan we looked at identified that a person was prone to become resistant and agitated when assisted with personal hygiene and will show aggression toward staff attending. This information had been taken from the comprehensive mental health needs nursing assessment, there were no strategies documented for staff to employ to reduce the individuals stress and anxiety at these times. Care plans included a record of health professional visits including GP, District Nurse and continence adviser. The outcomes of these visits were documented on the record sheet however did not feed into the care plans and there were no amendments made to the care plans for staff to ensure peoples changing needs were met. The files we looked at contained risk assessments for areas such as falls and nutrition. The risk to individuals was identified however there were no recorded plans to instruct staff how to remove or reduce the level of risk. The risk assessments we saw were not dated so it was not possible to assess when this element of care and support was due for review. One persons risk assessment identified that there was a tendency to lean forward in the chair placing them at risk of falling. The Care Programme Approach documents in the care plan stated Due to Dementia and agitated behaviour this person requires monitoring. There were no instructions included in the care plan for staff to follow to ensure this person was safe, to reduce the persons agitation or to ensure the person was not isolated. We visited this person in their room on three separate occasions during the day. The room was isolated in an area where staff would not be passing regularly, the person was sat in an armchair with the door of the room closed. This showed us there was limited understanding about the persons needs or how to support them and reduce the identified risks to their health, safety and well being. Care Homes for Older People Page 13 of 31 Evidence: In discussion with staff and the manager it was apparent there was little understanding about what a risk assessment should achieve. The new owners reported that risk assessment training was scheduled to take place the week following this inspection site visit. The quality of daily recording varied. One persons daily records showed us they had spent a happy afternoon with good mobility, good diet and fluid intake. Others we saw included comments such as Personal hygiene given and assisted to bed. This just tells of the processes undertaken not the elements of care and support provided for that individual. Some records were even briefer including Full assistance given with PH and assisted with PH this afternoon. This shortfall in recording was identified at the previous inspection of this service in 2008. Care plans included a social activities diary. This record showed us that one person was asleep in the lounge all day and every day therefore not involved in activities or stimulation of any sort. This information was not fed into the care plan and there was no evidence that efforts had been made to find out why the person slept all day and if there were any strategies in place to enrich this persons life. Care plans included a relatives contact sheet which showed us that the staff and management kept in touch with relatives regarding the health and welfare of people living at the home. One person living at The Haven had a grade 3 pressure sore that had developed whilst they were living at the home. The District Nursing notes showed us that this was being dealt with appropriately under instruction. Visiting professionals we spoke with as part of this inspection process told us care can be reactive rather than proactive and I have no problem with the care, the organisational side of things lets the service down. Relatives told us: Care is absolutely brilliant, couldnt ask for better. During the afternoon we noted peoples care plans lying on the dining table in the back lounge, there were no care staff in the vicinity. This meant that peoples personal and private information was accessible for any visitor to the home to access. Staff returned to the lounge some 15 minutes later. One staff member asked a colleague where the person who had been working on the care plans had gone. The response was called across the lounge full of residents She has gone to toilet (persons name). These practices demonstrated a lack of staff awareness about promoting and Care Homes for Older People Page 14 of 31 Evidence: protecting peoples dignity and privacy. The AQAA told us that the new owners have strict policies and procedures on privacy and dignity and staff are informed on induction about these. The manager reported that she audited medications weekly to ensure that all had been administered and signed for. We observed a staff member giving out the morning medication. There were no medicine pots available, staff were having to use plastic cups to hand out peoples medication. The medication trolley contained a bottle labeled refused medication where any tablets were put that residents had refused to take for any reason. There was a considerable number of miscellaneous tablets in here. It was not possible to assess whos was what, staff told us the refused medication should have been returned to the pharmacy weekly but agreed that, due to the number of tablets in the bottle, they obviously hadnt been. The home admits people under respite care, one respite resident had been admitted during the week before this site visit. The pharmacy had not supplied the home with any spare Medication Administration Records sheets (MARs), staff had made do by amending a previous sheet for the person. The tablets brought into the home by the individual had not been booked in. Therefore there was no audit trail showing the amount of medication brought into the home and so not possible to confirm the person had been given all their medication as prescribed. The MARs sheets had gaps in recording, therefore not possible to confirm if people had taken their medications and if so, who had administered it. MARs sheets included photos of residents to avoid mistakes in identity. One person in the home was prescribed a controlled drug. The new owners had identified the home did not have a controlled medications cabinet, one was securely fitted to the inside of the medications cupboard on the day of this visit. Staff training records did not confirm that staff responsible for the administration of medication in the home had attended training to provide them with the skills and knowledge to do this task safely. Subsequent to the inspection site visit the owner informed us that this training was booked for July. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will be offered opportunity for activity but may find mealtimes are not currently an enjoyable experience. Evidence: The AQAA stated: We provide meaningful activities and inform our residents about the forthcoming events in the home etc. The Service User Guide stated: We have a qualified activities organiser to provide and organise activities suitable for dementia suffering residents. This statement was aspirational, the person was not yet in post nor had they achieved their qualification. The new owners had arranged for a person from the existing staff team to take up the post of permanent activities co-ordinator and to undertake a formal qualification in this area. There was no schedule of arranged activities. Staff told us we have to go with the flow as far as what the residents want to do. records showed us that outside entertainment was brought into the home such as a monthly visit by a singer. People were supported to celebrate their birthdays and a Church service took place on the first Sunday each month. Care Homes for Older People Page 16 of 31 Evidence: We observed 10 residents in the back lounge on the morning of this visit. They were listening to music and joining in with games facilitated by staff. We saw good, kind and sensitive staff interaction. One resident was singing and others laughing whilst they played hoop la. The new owners told us that a monthly news letter was being developed for the residents and their relatives and a resident/relatives committee was being formed to keep relatives informed of the changes within the home and to include them. We saw 14 people in the dining room having their breakfast, and 7 people in the back lounge having their breakfast, some sitting at the table and some in their chairs. The dining room was not large enough to accommodate all the people living in the home. The new owners told us of their plans to create a further dining area in the large main lounge as there was space there that was not being utilised. We saw 14 people in the dining room having their lunch, the food was taken to the dining room on a hot trolley and dished up individually by the cook. We saw staff ask people what they wanted to eat from the two choices available. Today there was a beef casserole or shepherds pie. We noted that portions were of a good size, the cook had good knowledge about individuals likes, dislikes and portion sizes. We saw one resident emptying her food from her plate onto the corner of her cardigan that she had laid on the table. The carer approached her from behind and put a bib around her neck saying lets put this on you to protect your clothes. The person was startled by this approach. We noted that 5 people in the dining room needed assistance to eat their food and staff told us of a further 4 people that remained in their rooms or in bed that required assistance. Staff told us: Difficult to supervise all residents at once and provide appropriate encouragement. The manager and provider were aware of this high demand at mealtimes and reported they were in the process of reviewing practice to improve the experience for people. One suggestion was that they staggered mealtimes into two sittings and that the new addition to the staff team, the activity co-ordinator, would be another pair of hands to lend assistance. The provider pointed out that this would improve the dining experience for all concerned because there would be less tension in the dining room and people would then be able to enjoy their food more. Some residents were sitting at the table in the back lounge to eat their lunch, we noted this was a quieter and calmer environment. We visited the kitchen after the lunch service and we saw 2 platters of sandwiches made up in preparation for the afternoon tea. These were covered and labeled Care Homes for Older People Page 17 of 31 Evidence: however were not in the fridge. It was a warm day and the kitchen was warm after lunch. Chicken liver pate sandwiches left in this environment for the afternoon may be unsafe to give to frail elderly residents at afternoon tea. There were three small under the counter domestic fridges in the kitchen. One of these was not working, the staff told us that this had been the case for some time. When the provider was made aware he instructed for the sandwiches to be disposed of and fresh ones made at tea time. He then proceeded to order two new fridges for the kitchen for delivery as soon as possible. Copies of the menus provided for the residents showed us that there were daily choices offered of main meals, desserts and afternoon tea. Relatives told us via surveys that The meals are nicely cooked and presented. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that any complaints or concerns will be dealt with appropriately. Evidence: The service had a complaints procedure in place that clearly set out the timescales and actions that would be taken by the management of the home in the event that anyone should be dissatisfied with the quality of the service provision. Given the varied abilities of the people living at The Haven, some with visual impairment and all living with dementia, making this information available different formats should be considered in order to maximise peoples awareness. Records showed us that one complaint had been received since the previous inspection visit, evidence was available to show us that this had been dealt with appropriately. The issue had been refered to the ECC Adult Safeguarding Team for investigation, records showed us that the management of the home had been compliant throughout the investigation. Staff training records showed us that 12 of the 24 staff employed to work at The Haven had attended training in the Safeguarding of Vulnerable Adults. Staff recruitment checks showed us that Criminal Record Bureau disclosures and 2 references were received for people starting to work at the home. Care Homes for Older People Page 19 of 31 Evidence: The previous inspection of this service had identified a need for staff to receive training to give them the skills and knowledge to understand and manage episodes of challenging behaviour. Training records showed us that 7 staff had attended this training in the past year and the remaining staff members were booked to attend this training in July 2009. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will benefit from the current and planned refurbishments which will provide a more enabling and pleasant place to live. Evidence: The Haven is a purpose built care home situated close to Colchester town centre and all local amenities. The courtyard garden, in the centre of the property had a summerhouse for people to use in good weather. The AQAA stated Our home is well maintained, tastefully decorated with modern facilities and equipment. This statement does not reflect what we found on the day of this visit however, the new owners told us it was meant to reflect what the home would be like in a few weeks time. They had bought the home two weeks prior to this visit and the programme of redecoration and refurbishment was already underway. The communal lounge area was being decorated on the day of our visit, new carpets were to be fitted in all communal areas by the end of the month, new dining furniture was due to be delivered this day. The new owners shared their plans to redecorate and refurnish each persons bedroom as they became vacant. The communal hallways were all painted the same colour, this made it confusing for people living with dementia to find their way around the building. All residents doors were painted the same colour with just a number on them maing it very hard for Care Homes for Older People Page 21 of 31 Evidence: people to find their own personal rooms. The provider discussed plans to introduce name plates, photographs and memory boxes to help people identify their personal rooms. The redecoration plans involved the use different colours and pictures throughout the home so that people would be able to orientate themselves and feel safer in their environment. The home had a dedicated hairdressing room, this was functional and people would benefit from this room being made less institutional to provide more of a pampering feel to reflect a trip to the hairdressers. All bedrooms were single, some contained personal possessions to brighten up the environment however some we saw were bland and institutional looking. For example, one room we saw at this visit had paint peeling off the walls in the en suite bathroom, bland magnolia walls in the bedroom and bathroom with dark washable flooring throughout, this did not reflect a homely environment. Staff told us this room was one of the Local Authority funded rooms. The new extension contained larger, brighter and better furnished rooms, staff told us these were for privately funded residents. The communal bathrooms we saw were all functional but soulless, spartan with plain magnolia walls. We saw signage in shower room telling staff to Weigh residents on bath day. If care staff refer to the care plans and are using them as working documents they will take their instruction from there and do not need to refer to clinical and institutional signage around the building that detracts from the environment. A spacious bathroom in the extension was cluttered with wheelchairs and sit on scales. There was a bin, with no lid on, containing soiled incontinence pads and a plastic drawer unit containing disposable gloves and aprons. These were trailing out of the drawers contributing to the room looking untidy, soulless and institutional. Staff training records showed us that one staff member had received training in Infection Control in August 2008. The owners had identified this shortfall in the training provisions and a training course had been arranged for the staff team. There was a slight malodour throughout the home, we acknowledged that new carpets, furninshings and staff training in infection control procedures should serve to eradicate this. Completed surveys returned to us included comments such as Sometimes smells of urine and Sometimes room a bit smelly and needing a clean. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by sufficient numbers of caring staff however they may not have received all the training they need to meet peoples needs safely. Evidence: We looked at copies of the duty rota. These showed us that residents received 24 hour care, with 3 care staff and one senior carer on duty daily and 3 staff covered the night shifts. In addition the new owners had recruited a dedicated activities co-ordinator. Completed surveys received from relatives included: Staff very helpful to every suggestion made and During busy times staff not always available. Staff files were not on the premises at the beginning of this visit as the new providers had taken them away to undertake a complete audit to satisfy themselves that all the necessary documents were present. They were returned to the building, the management indicated they were aware there were some minor shortfalls in the documentation but confirmed they would rectify this with immediate effect. We looked at recruitment records for two people recently employed to work at the home to confirm that all the necessary checks had been made to promote and protect the safety and welfare of the people living at The Haven. Both files included written application forms, proof of identity, satisfactory Criminal Record Bureau checks and references. Staff told us via completed surveys: I had to wait before I could start Care Homes for Older People Page 23 of 31 Evidence: work until my CRB was cleared. We noted that staff were not wearing name badges. The provider told us these were on order so that relatives would be able to identify who they were speaking to. Staff training records provided for us at this inspection visit showed us there were significant shortfalls in the basic core training staff needed in order to provide them with the skills and knowledge necessary to safely care for this vulnerable client group. For example, 7 of the 24 people employed to work at the home had not attended Moving and Handling training, 14 had not attended Fire awareness training, 12 had not attended Safeguarding Vulnerable Adults training, 23 had not attended infection control training or Health and Safety training. The new providers had been pro-active in addressing these shortfalls and records showed us that training courses in Dementia, managing challenging behaviours and COSHH training been booked for July 2009. The management reported that we are in process of booking Medications, Food Hygiene, Infection Control, Nutrition and Bereavement Courses over the coming months. Comments received in staff surveys included: At the start of every shift we always have handover, The home provides and safe and secure environment for all the residents. All staff who work there have the opportunity to do a lot of courses which will help them perform well at work, We are given ongoing training to keep us up to date on changes of needs of people living at the home. The management team give us lots of support in our job and have an open door policy for staff to see them if a member of staff needs to see them and In staff absences it is sometimes strain on staff as they get called in and then become tired themselves. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home where management are working to implement changes and improvements to benefit them. Peoples health, safety and welfare were not fully protected. Evidence: The ownership of the home had changed two weeks prior to this inspection site visit. The new owners had experience of running care services that provided good and excellent outcomes for people, they shared their immediate plans to enhance and improve the lives of the people living at The Haven. The owners had made themselves aware of the shortfalls we identified during this inspection process and were able to show us they were being pro-active in taking expedient steps to address these areas. The provider told us that the Quality Assurance processes that were used within other homes in the group would be utilised for The Haven, a copy of the questionnaire was Care Homes for Older People Page 25 of 31 Evidence: given to us. This showed that peoples views and opinions would be sought about areas such as catering and food, personal care and support, daily living, premises and management. The owner told us that responses from these surveys would be collated and a summary would be made in order to create an action plan to address any identified shortfalls in the service provision. There was a matrix available to show us that staff received supervision every 2 months and good records were maintained to show that these sessions were effective. This ensured that staff members received support they need to carry out their role. We saw the most recent Gas and Electrical safety certificates and confirmed, during our tour of the building, that hoists and fire extinguishers had been regularly checked and serviced. We found that one of the fridges in the kitchen was out of order and this meant that sandwiches prepared in advance for the residents tea were left in a warm kitchen throughout the heat of the day during lunch preparation when the kitchen was very warm. This is not safe practice and could put the health and welfare of residents at risk. When the owner was made aware of this new fridges were ordered immediately and the prepared food was disposed of. Shortfalls in the staff training provision (see staffing section of this report) means that the health, safety and welfare of people living at the home may not be adequately protected at this time, however the new management have been pro-active in organising training for the staff team. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 (2) Mdication must be properly 30/06/2008 administered and clear records kept. This will ensure that people receive the correct levels of medication. This is a repeat requirement from key inspection 26/07/07 Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans need to include 22/08/2009 detail of each persons specific needs and what support is required to ensure their needs are met. This is so that staff have clear guidance on how individuals need to be cared for. 2 9 13 Medications in the home must be administered and recorded properly and staff must be provided with training in the administration of medication. This is so that peoples health, safety and well being are promoted 22/07/2009 3 10 12 People living at the home must be afforded respect and dignity in all aspects of their daily life. 22/07/2009 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is so that people feel valued and maintain a sense of self worth 4 30 18 Staff must be trained and competent to undertake all the duties and responsibilities that they have. This is so that residents are cared for by a skilled and competent staff team. 5 38 12 The health, safety and 30/09/2009 welfare of people living at the home must be promoted and protected by staff receiving appropriate training and by improving daily working practices in the home. This so people can be assured their health, safety and well being are promoted and protected at all times. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 30/09/2009 1 1 Consideration should be given to providing information about the home and how to make a complaint in a format suitable for people with a visual and/or other sensory impairments. Daily records need to reflect how individuals have spent Page 29 of 31 2 7 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations their day and how their care and support have been provided for them. Entries such as assisted with PH do not describe the well being of people. Good daily records should provide a picture of what has worked for the individual that day, where there has been progress and achievements and identify any concerns about their health and welfare. 3 15 The management need to continue their review of the dining arrangements in order to make mealtimes a more pleasurable experience for the people living at The Haven. 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