Care Home: The Haven Nursing Home

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What the care home does well Care files examined were well organised and documented in depth detailed information about each person. This should mean that staff have access to information about the needs of people living in the home and the actions they need to take to meet those needs. Care plans were person centred and should allow staff to deliver individual personal care based on the needs and wishes of people living in the home. Each of the care files examined contained information gathered during a preadmission assessment. The assessments identified the health, personal and social care needs of each individual. The home has a maintenance man who is responsible for repairs in the home. During the inspection visit he had taken off the radiator covers so that he could clean the covers and the radiators. This is good practice and supports the good standards of cleanliness seen in the home. The manager was very attentive towards the residents and she showed during the inspection that she is keen to make improvements for the benefit of the residents. The manager has completed the Registered Manager Award and recently completed a diploma in dementia care, this will support providing guidance for staff on providing residents with appropriate care that can be monitored and reviewed. What has improved since the last inspection? Communal toileting has ceased in the home and residents are shown respect by supporting them to tend to their personal needs in privacy and with dignity. The location of the clinical room has moved to provide a more suitable room that has an air conditioning system fitted. The room is better ventilated and offers more space for staff to work more comfortably and safely. A new extension has just been completed to the home. The extension has been completed to a high standard and has helped to improve the quality of living arrangements for people living in the home. CARE HOMES FOR OLDER PEOPLE The Haven Nursing Home New Road Ash Green Coventry CV7 9AS Lead Inspector Yvette Delaney Key Unannounced Inspection 7th July 2008 10:00 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 Nursing Home DS0000042690.V367896.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 Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Haven Nursing Home Address New Road Ash Green Coventry CV7 9AS 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) 02476 368100 02476 644008 Regal Healthcare Homes (Coventry) Ltd Mrs Valerie Lewis Care Home 61 Category(ies) of Dementia - over 65 years of age (61), Old age, registration, with number not falling within any other category (61) of places The Haven Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd May 2007 Brief Description of the Service: Regal Health Care Homes Ltd owns this home. The Haven Nursing Home provides nursing care for up to 61 elderly people this includes providing care to people with dementia. The home is located on the outskirts of Bedworth, with the City of Coventry close by. The Haven was originally a school; this was converted and extended to provide single storey accommodation for elderly residents. The extension to the home has been completed. The new extension consists of twelve en suite bedrooms. There are no plans to increase the number of residents occupied in the home this will remain at sixty- one. The new extension will support the reduction of shared bedrooms, leaving three shared bedrooms in the original building. There are now fifty-five single bedrooms. Communal facilities include a large lounge diner, a smaller lounge diner with an attached conservatory, quiet room and a small sitting room at the front entrance to the home. The current scale of charges for living in this home is set at £466, which are the rates set by Warwickshire Social Services. Other additional charges include the hairdresser varies between £6 and £17, Chiropodist £20 and aromatherapy £7.50. The Haven Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this home is 2 stars; this means that the home overall provides good outcomes for the people who use the service. This was the first key unannounced inspection of this year, which examines all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. This key inspection visit showed that ongoing improvements in a number of key areas are continuing in the home. It was evident that the manager and other staff had made good progress in ensuring that The Haven Nursing Home is meeting the Care Home Regulations and National Minimum Standards of practice. The manager completed and returned an Annual Quality Assurance Assessment (AQAA) questionnaire, containing helpful information about the home, in time for the inspection. This report uses information and evidence gathered during the key inspection process, which includes a visit to the home. Information examined and seen includes a Statement of Purpose and Service User Guide written by the home, inspection activity details, a number of resident case files, other records and files maintained in the home and information from other agencies and the general public. Questionnaires were also sent out by us to find out the views of residents, their relatives, carers and advocates on services provided by the home. The number of questionnaires returned from people living in the home and their relatives, advocates or carer was poor. Some of the issues expressed in the questionnaires have been included in the body of this report. Four people who were staying at home were ‘case tracked’. This involves establishing an individuals experience of living in the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files and focusing on the outcomes for the resident. Tracking peoples care helps us to understand the day-to-day life of people who use the service. What the service does well: Care files examined were well organised and documented in depth detailed information about each person. This should mean that staff have access to The Haven Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 6 information about the needs of people living in the home and the actions they need to take to meet those needs. Care plans were person centred and should allow staff to deliver individual personal care based on the needs and wishes of people living in the home. Each of the care files examined contained information gathered during a preadmission assessment. The assessments identified the health, personal and social care needs of each individual. The home has a maintenance man who is responsible for repairs in the home. During the inspection visit he had taken off the radiator covers so that he could clean the covers and the radiators. This is good practice and supports the good standards of cleanliness seen in the home. The manager was very attentive towards the residents and she showed during the inspection that she is keen to make improvements for the benefit of the residents. The manager has completed the Registered Manager Award and recently completed a diploma in dementia care, this will support providing guidance for staff on providing residents with appropriate care that can be monitored and reviewed. What has improved since the last inspection? What they could do better: Ensuring consistent and robust recruitment procedures are followed at all times. This must include requesting appropriate references for potential new staff before they start working in the home. This will ensure that people living in the home are safeguarded from the risk of abuse. The Haven Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 7 Consistent and safe moving and handling practices must be used at all times. The hoist must not be used as a form of transport. This puts the resident at risk of slipping from the hoist sling while being transported in this way. 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 Nursing Home DS0000042690.V367896.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 Nursing Home DS0000042690.V367896.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): 3, Standard 6 does not apply as the home does not provide intermediate care. Quality in this outcome area is good. People receive a comprehensive assessment of their care needs to ensure that they can be met before offered a place in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Haven Nursing Home provides nursing care for up to 61 male and female residents who have been diagnosed with dementia. We examined the case files of four people identified for case tracking to assess the pre-admission assessment process. The manager said that pre-admission assessments are carried out by her or her deputy. We were told that the manager or her deputy visit people who are considering moving into the home to undertake an assessment of their needs and abilities. Each of the files examined contained information gathered during a preadmission assessment. The files identified the health, personal and social care needs of the individual. Files also contained pre-admission information The Haven Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 10 provided by professional health and social care agencies incorporated into the form of care plans. For one relative speaking in their questionnaire they said that finding a home for their relative was not a happy experience. The person indicated that they were put under pressure from the hospital to find a home for their relative. They said that “…wife was described as a ‘bed blocker.’ The only information they were given was a list of the names of homes to visit. The list gave an address, telephone number and the name of the manager. …Although the initial experience in finding a home was a negative one the person told us that: “Luckily the home is an excellent one, there are no regrets in choosing it.” Information gathered about the needs and abilities of people assessed as suitable to move into the home is used to develop their individual care plans to meet these needs. There are opportunities for prospective residents or their representatives to visit the home before moving in. One resident told us, ‘My relatives visited the home before I moved in. It was lively and there was lots going on. They knew I’d be happy here because I enjoy being with other people and socialising.’ The Haven Nursing Home DS0000042690.V367896.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 and 10 Quality in this outcome area is good. Care plans provide staff with clear guidance on all aspects of resident’s needs. There is scope to improve the way medicines are administered to residents to ensure current practice maintain the safety of residents. People are treated with respect and their dignity maintained which helps to increase their self-esteem and quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living in the home looked well cared for. Residents had been supported by staff to dress and attend to their personal hygiene needs. As result people were well presented and wore clothes that were suited to the time of year. It was evident from our observation that the personal care needs of people living in the home are met. The care files of four people identified for case tracking were examined. Care files were standardised, well organised and documented in depth detailed The Haven Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 12 information about each person. This should mean that staff have access to information about the needs of people living in the home and the actions they need to take to meet those needs. Care plans were person centred and should allow staff to deliver individual personal care based on the needs and wishes of people living in the home. Care plans were available all of the identified needs of each person and supplied staff with the information needed to make sure these needs were met safely and appropriately. For example, one person with a urethral urinary catheter inserted had a care plan describing the specific care required with evidence that the catheter had been changed every 3 months, as planned. The home uses risk assessment tools to identify whether residents are at risk of developing pressure sores, poor nutrition or have an increased risk of falls. When the outcome of the assessment identifies an increased risk, action is always taken to minimise the risk. For example, one person admitted to the home was assessed as having a high risk of compromised tissue viability. A care plan to minimise the risk had been developed and we observed that pressure relieving equipment, such as a specialist mattress, was in use for this person. This puts this person at risk of deterioration in their health and well being. Communal toileting and ceased in the home and residents are taken to the toilet based on their individual needs and assessments. A review of this practice shows that the staff have considered the dignity and privacy of residents. Each person’s care file contained a record of contact with or visits by Health Care Professionals. These confirmed that people living in the home have access to Health Care professionals such as the GP, Dietician, Optician, Chiropodist and Tissue Viability Nurse Specialist. We examined the systems for the management of medicines in the home. A monitored dosage (‘blister packed’) system is used. Medication is safely stored in locked trolleys, which are kept in a locked clinical room. The location of the clinical room has changed, an air conditioning system has been fitted the room is better ventilated and offers more space for staff to work more comfortably. The clinical rooms were tidy and organised. Daily clinical room temperature recordings are maintained a thermometer in the clinical room showed a temperature of 22°C. Monitoring the temperature of the room ensures that medicines are stored below 25°C to maintain their stability. A medicines fridge is available in the treatment room with daily recordings of the temperature, which were within recommended limits. The facility for storing controlled drugs (CD) is satisfactory. There is one CD cupboard to store CDs. The contents of the controlled drug cabinet were The Haven Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 13 audited against the controlled drug register and the quantities were correct. Nursing staff had undertaken daily audits of the contents of the CD cupboard. Maintaining accurate records helps to ensure that medicines are maintained to comply with legislation and protect people from the risk of potential medicine administration errors. An audit of the medication prescribed for people involved in case tracking demonstrated that medicines had been accurately administered as prescribed and medicine administration records were accurately maintained. Appropriate systems for the safe disposal of medicines are in place. Unused medicines are checked and returned to the pharmacy. We observed poor practice in the administration of medicines during a medicine administration ‘round’. A nurse was observed to check the MAR sheet before dispensing medicines from the trolley but then give the medicine to one of the carers to give the residents. The nurse did not watch the carer going to the resident and giving them the medicines. Further concerns became evident when the carer went to give the medicine to a resident who was not in the lounge where the medicines were being given out. The nurse then signs the Medication Administration Record (MAR) chart. The MAR chart is signed by the nurse to confirm that the resident has taken the medicines prescribed for them. This practice is open to error and the nurse can not be sure that the resident has taken the medicines as they did not observe the residents taking their medicines. The manager showed a commitment to reviewing this practice and made changes at the time of the inspection. Staff had a sensitive, kind and caring attitude towards the people living in the home. Personal care was provided in private, residents were spoken to respectfully by staff and addressed by their preferred names. Speaking in their questionnaires staff said “We provide the highest quality nursing care to service users based on a person centred approach, which promotes individuality, independence and respecting the dignity of the service users.” The Haven Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 14 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 and 15 Quality in this outcome area is good. The lifestyle people experience in the home considers their preferences. Residents are supported to maintain their independence and interests that enhances their quality of life. Residents benefit from a nutritious and varied diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each of the residents’ files examined contained a biography recording the person’s life history, their enduring interests and relationships. This should assist staff to deliver ‘person centred’ care. A record of group and individual activities is maintained in the home. Photographs showing events that residents haven take part in are displayed in the corridor leading off the reception area of the home. Residents spoken with that there are usually activities taking place in the home. An activities co-ordinator is employed in the home. Activity sessions were not seen to take place on the day of the inspection visit. Art and craft sessions have been introduced into the home. The manager told us that they do have a planned programme of activities, this can be subject to change so that they are led by residents as to the activities they prefer on a daily basis. One resident told us, that they would like to see more activities and visits outside The Haven Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 15 the home. Staff speaking in their questionnaires also said that more social activities were needed. The manager is aware that there are concerns about activities in the home. Information in the AQAA told us that the outcome of information in the questionnaires they send to service users expressed the need for more suitable activities to take place in the home. We were told that these concerns relate more to residents who have advanced dementia. The home proposes to introduce more one to one therapies such as hand massage using essential oils and reading the newspaper with residents, The home has an open visiting policy. People are encouraged to maintain links with their family and friends. Residents told us that visitors are made welcome and the visitor’s record demonstrated that people can visit when they want to. A family member was visiting their relative on the day of the inspection and made plans to take them out for the day. We observed the lunch time meal service in the dining room/lounge on the lower level, which was served at 12.30 pm. The lunch time meal is a snack meal. Food served was mainly sandwiches and soup. Residents were supported to sit around the table dining tables were not attractively laid, for example no table cloths or condiments. The mealtime was a social occasion for some of the residents who are able to have a conversation. Meals were delivered to people who chose to sit in their chairs in the lounge area or eat in their room. The four care files examined contained thorough nutrition assessments. Residents are offered a choice of hot cooked meals in the evenings. Residents and relatives made positive comments about the food provided in the home. One person told us, ‘the food is good… I can choose something different if I want to.’ Photographs of different meals are being taken to provide residents with pictures, which will help them to choose a meal of their choice. This practice would support people with dementia to make a visual choice on what they would like to eat. This practice is still in the early stages and has not been fully developed. Residents who needed assistance with eating their meals were given appropriate assistance. One senior care staff was very observant of what was happening in the dining area. She sat next to a resident called them by their name and used an encouraging voice when talking with the resident to encourage them to eat. The resident was smiling and looked comfortable relating to the member of staff. When that person had finished eating the carer went to support another resident. The Haven Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 16 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 and 18 Quality in this outcome area is good. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place for staff to respond to suspicion allegations of abuse to make sure people living in the home are protected from the risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a formal complaints policy which is accessible to people living in the home and their families. People are encouraged to raise their concerns with the manager or senior staff on duty. Residents told us that they would initially raise concerns with their relatives or representatives who would speak to the manager on their behalf, but they said they felt they could go to the manager or deputy and they would be listened to. The complaints procedure is displayed in the reception area of the home. Copies are also available in the Service User Guide. Residents and relatives spoken with said that they were aware of how to complain and whom to complain to. Comments made include: “Staff are very approachable and will listen and act on any complaints or worries we have.” The Haven Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 17 “Any query I have is dealt with immediately.” The manager told us in the completed AQAA we received that there have been no complaints received by the home since the last inspection. The complaints register contained no additional complaints or concerns. We have received one complaint from an anonymous complainant. Issues raised relate to staffing levels in the home, health and safety practices, infection control and standards of care. These issues raised are addressed throughout this report. The policy and procedure detailing the action to be taken by staff to ensure the protection of vulnerable adults were examined. The information guides staff on the procedures to follow if they saw or suspected evidence of abuse. Staff were able to confirm that they had attended training related to the protection of vulnerable adults. Two members of staff were able to explain the action they would take if they saw abuse. Both answered appropriately. Training records examined indicates that protection of vulnerable adults training had been received by staff. Training records showed the topics covered and the date and year the training was attended. Residents spoken with told us that they feel safe here living in the home. One relative said ‘I feel I can relax more with my husband in this home.’ The Haven Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 18 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 and 26 Quality in this outcome area is good. The standard of the environment presents a homely and safe place for elderly people to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new extension has just been completed to the home. The extension has been completed to a high standard and has helped to improve the quality of living arrangements in the home. The extension of the home was not planned to increase the number of people accommodated in the home but to give existing and potential residents the opportunity to have their own bedroom. Haven Nursing home is a single story building the home offering accommodation for up to 61 male and female residents. There is two main communal dining/lounge rooms. The public areas in the home were clean, bright and airy. Residents were observed making use of all the communal spaces, although people who prefer to remain in their own rooms are able to do so. The Haven Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 19 Some of the specialist chairs and other furnishing looked worn. The manager told us that plans are to improve and refurbish other areas of the home now that the extension has been completed. The décor and furnishings in the home was also discussed with the provider who was able to discuss his plans for decoration, refurbishment and continued maintenance to continue in the rest of the home. The home has a maintenance man who is responsible for repairs in the home. During the inspection visit he had taken off the radiator covers so that he could clean the covers and the radiators. This is good practice and supports the good standards of cleanliness seen in the home. There are now three lounges/dining areas. One of the lounges is divided into small areas to encourage small group living. This encourages residents to socialise in smaller and feel calm and relaxed in the company of other people. Several bedrooms, including the bedrooms of people involved in the case tracking process, were viewed. Some of the rooms were homely comfortable, cosy and well decorated with en suite facilities. All the rooms were personalised with people’s own belongings. Equipment is available to assist residents and staff in the delivery of personal care, which includes assisted baths, moving and handling equipment including hoists. Pressure relieving equipment such as cushions and various types of mattress are available for people who have an identified need for them. The home has systems in place for the management of dirty laundry. The laundry is fully equipped and organised. Each resident has their own laundry storage box to hold their named clothing following the laundering process. Discussions with residents confirmed that a good laundry service was provided. Systems are in place to manage the control of infection. Protective clothing such as plastic gloves and aprons were available and arrangements are in place for the disposal of waste. The home has a cat, which was seen to relate well to the residents and sat in the lounge with them. Concerns had been raised that the cat was being fed in the kitchen. The manager told us that the cat is now fed outside and the problem of bringing mice into the home is being controlled. The home has a contract with a pest control service. The Haven Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 20 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 and 30 Quality in this outcome area is good. Staffing levels are sufficient to ensure that the needs of people living in the home are met. Residents benefit from being cared for by competent staff and are protected by robust recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of four weeks duty rotas showed that consistent staffing levels are maintained in the home. It was evident from the outcomes achieved for residents that there is sufficient staff on duty to meet their needs. Staff spoken to confirmed that the staffing arrangements enabled them to meet the needs of residents. One staff member told us, ‘…maintain the quality of care to all service users, all treated with dignity and respect to the highest standard.’ One resident told us, ‘The staff do everything I need; they really look after me.’ Training records show that fifteen out of 22 care staff permanently employed in the home have a qualification in care at NVQ (National Vocational Qualification) level two or above. Information in the AQAA told us that a further four care staff are currently working towards the award. This means that 68 of care staff in the home are qualified at NVQ level two or above which exceeds the National Minimum Standard for 50 of care staff to have The Haven Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 21 this qualification. Once all care staff have completed the course, the home will have 86 of care staff employed with an NVQ in care that should mean that people are cared for by competent staff. The personnel files of five recently recruited staff were examined. The files showed that they contained evidence that satisfactory pre-employment checks such as Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (PoVA) had been carried out. Two references were obtained for all staff. However steps were not always taken to ensure that references were being requested from the most suitable person. Ensuring consistent and robust recruitment procedures are followed before staff start working in the home safeguard people living in the home from the risk of abuse. One recently employed care assistant confirmed that pre employment checks were made before they started working in the home. They told us they had an induction period when they were not in the ‘working numbers’ but ‘shadowed’ an experienced care assistant. Another staff member told us “…I am happy with my job role, all staff are approachable.” Training records examined identify any gaps in learning. Records examined demonstrate that all staff receive mandatory training in moving and handling, infection control, abuse awareness, fire safety and food hygiene. This should mean that staff are updated in safe working practice. Staff told us that they “…access courses to extend on our existing knowledge of the physical and mental health needs of service users in our care.” “Staff are always kept updated with relevant training.” “I am currently studying palliative care and always attend moving and handling and fire lectures to keep updated.” Other training attended by staff include nutrition and health, enteral feeding workshop and infection control. The Haven Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 22 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, 33, 35 and 38 Quality in this outcome area is good. The home is managed by a competent person to ensure the service is run in the best interests of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager was present on both days of the inspection. The manager is knowledgeable about people in the home. The manager was seen to be very attentive towards the residents. She has the necessary experience to run the home. The manager has completed the Registered Manager Award and recently completed a diploma in a dementia care. The manager is responsible for the care practices in the home and the overall day-to-day management of the care home. The manager and staff showed during the inspection that they are keen to make improvements and since the last The Haven Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 23 inspection have taken actions to address all of the issues identified in the last report. There are clear lines of accountability within the home with the deputy manager reporting to the manager. The home has good support from an administrator who helps in the day to day running of the home. Staff spoken with said that the management team are always approachable. The manager told us in the AQAA for the home that questionnaires are sent out to residents. The home’s Quality Assurance file contained evidence that management reviews the service provided in the home and identifies areas for improvement. Action plans are developed for making improvements and are reviewed to monitor progress against the objectives set. The personal monies of people living in the home are kept securely in separate bags and accurate records of income and expenditure are kept. An audit of one resident’s personal monies was found to be correct. Information sent to us in the AQAA tells us that equipment is serviced or tested as recommended by the manufacturer or other regulatory body. Evidence was sampled at random to confirm this. For example, hoists indicate they were checked in December 2007. Gas appliances were checked in August 2007. A fire risk assessment and checking of fire equipment was made in March 2008. The fire alarm is tested weekly. Health and safety concerns identified at the last inspection visit related to the storage of chemicals in the home and moving and handling techniques performed by staff have been addressed. Chemicals products are being stored safely and staff have received COSHH (Control of Substances Hazardous to Health) training. This training covers the safe storage, risk assessments and safe handling of chemicals such as cleaning products used in the home. The manager told us that staff have also received training from external trainers on safe moving and handling practices to be used when transferring and moving people in their care. Moving and handling practices were seen to have improved. However there was one occasion when staff used the hoist as a form of transport while taking the resident from the seating area of the lounge to the dining area. This is not safe practice as the resident is at risk of slipping from the hoist sling while being transported in this way. The Haven Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 24 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 The Haven Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement The practice of care staff administering medication to residents when dispensed by a nurse must be reviewed. Nurses must be sure that individual people living in the home have taken the medication they have dispensed. This is because nurses should not be signing the MAR chart unless they are sure that resident’s have taken their medication. In addition accurate and meaningful audits cannot take place to demonstrate that medications have been administered as prescribed and the safety of residents maintained. Suitable information must be secured to determine the fitness of potential employees before they start working at the care home. This must include: Obtaining two suitable written references. This will support safeguarding vulnerable people choosing to live in the home. DS0000042690.V367896.R01.S.doc Timescale for action 07/08/08 2 OP29 19, Sch.2 30/08/08 The Haven Nursing Home Version 5.2 Page 26 3 OP38 13(5) Hoists must not be used as a 07/08/08 mode of transport when moving a resident from one area to the home to another. This will ensure the safety of people using the service. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations Residents and relatives should be consulted about the programme of activities that takes into account individual and group needs. Records of social and therapeutic activities should include the residents’ views on the activity or observation of the person’s wellbeing. This will ensure mental and physical stimulation, which meets their individual needs. The Haven Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Nursing Home DS0000042690.V367896.R01.S.doc Version 5.2 Page 28 - 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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