Inspection on 20/07/09 for Red House Residential Home

This is the latest available inspection report for this service, carried out on 20th July 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Red House Residential Home 31/07/07

Red House Residential Home 07/08/06

Red House Residential Home 06/03/06

Red House Residential Home 07/07/05

Red House Residential Home 17/02/05

Red House Residential Home 02/10/04

Red House Residential Home 24/03/04

Red House Residential Home 05/11/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Red House Residential Home Meadow Lane Sudbury Suffolk CO10 2TD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Small     Date: 2 0 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 33 Information about the care home Name of care home: Address: Red House Residential Home Meadow Lane Sudbury Suffolk CO10 2TD 01787372948 01787377528 regmanager@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Red House Welfare and Housing Society care home 34 Number of places (if applicable): Under 65 Over 65 34 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 The Red House is registered as a care home for 34 older people. The Red House Welfare and Housing Society was founded after the Second World War by a group of local religious, civic and business people on a non-profit making basis, to provide communal accommodation to meet the needs of older people. The home was opened in 1950 and has been extended over the years. The original house is 18th century and set in its own gardens enclosed by an unusual crinklecrankle brick wall. The grounds are very well maintained and provide a pleasant and substantial area for residents to take short walks. The home is sited very close to the centre of Sudbury and there is a range of local facilities within walking distance for the more able. Bedroom sizes vary although all are designed for single occupancy. Within the home Care Homes for Older People Page 4 of 33 Brief description of the care home there are four small flats, two of which have been made by converting the former accommodation known as Matrons flat. Communal space is located on the ground floor and consists of two spacious lounges and a pleasant dining room. There is a shaft lift to carry residents to the first floor. During the key inspection the manager told us that the fees for accommodation in the home range between £460.00 and £565.00 per week depending on the accommodation occupied. Fees do not include hairdressing, chiropody, telephone accounts, newspapers and specialised toiletries. The service does provide some basic toiletries if required. Care Homes for Older People Page 5 of 33 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: two star good 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: The unannounced inspection took place Monday 20th July 2009 from 09:20 to 17:20. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. The manager was present during the inspection and the requested information was provided promptly and in an open manner. During the inspection health and safety records, staff training records and the recruitment records for three staff were viewed. The care records of four people that live at the home were tracked, which included care plans and medication records. Further records viewed are detailed in the main body of this report. Observation of Care Homes for Older People Page 6 of 33 work practice was undertaken and six staff members, three visitors and five people who lived at the home were spoken with. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home and it was returned to us in the required timescales. Staff and service user surveys were sent to the home. Two staff and five service user surveys were returned to us before the inspection. What the care home does well: What has improved since the last inspection? What they could do better: The Suffolk safeguarding guidelines needed to be obtained for staff reference and to ensure that they are fully aware of how to make safeguarding alerts appropriately and in line with the local authority guidelines. It was recommended that the manager be provided with supervision meetings, which would support them in their work role. It is recommended that the manager attend training course on the Mental Capacity Act and Deprivation of liberty and incorporate Care Homes for Older People Page 8 of 33 them into the running of the home. It is recommended that environmental risk assessments be completed, which identified the actions that the manager has taken to minimise the risks for people who use the environment. 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 set out 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 9 of 33 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 10 of 33 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 who use this service can expect to be provided with the information that they need to enable them to decide if they want to move in, to be provided with the opportunity to visit the home before they move in and to have their needs assessed and met. The home does not provide an intermediate care service. Evidence: People were provided with information about the home, which detailed the service that they could expect and which enabled them to make decisions about if they wished to move into the home in the homes brochure, Statement of Purpose and Service Users Guide. The Statement of Purpose and Service User Guide were displayed, along with the previous key inspection report in the entrance hall to the home for the people that lived at the home and visitors reference. The service user survey asked if they were provided with enough information about the home before they moved in, three answered yes, one answered no and one did not answer. Care Homes for Older People Page 11 of 33 Evidence: The Statement of Purpose was viewed and detailed the service that was provided at the home. Information provided in the document included details about the environment, room sizes, aims, quality, facilities and services, the name and address of the provider, the name and the qualifications of the current manager, structure of the organisation, a summary of the complaints procedure and the previous contact details of CQC (Care Quality Commission). The manager told us that they had recently received details of the new contact address of CQC and that they would ensure that the details were included in the Statement of Purpose and Service Users Guide, should people wish to contact us. The Service Users Guide was viewed which included the information about the service that was provided at the home and other information such as the description of the home and environment, aims of the service, assessment and criteria of people living at the home, staffing, staff qualifications, a summary of the complaints procedure and the contact details of CQC which also needed to be updated to show the current address. The manager told us that they were in the process of redistributing the Service Users Guide to people that lived in the home and their relatives to ensure that they were made aware of the updated information. The AQAA stated we give possible clients as much information about Red House as we can over the phone, we send out our brochures laying out what Red House does as a home. We invite the enquirer and their relative to visit Red House to have a look around, tour the house when it suits them. We spoke with a person who had recently moved in to the home and their relative and they confirmed that they were provided with the opportunity to visit the home to decide if they wished to move in. Another person who lived at the home confirmed that they had visited the home before they moved in. A requirement made at the last key inspection was that the needs assessments must be show the specific needs of people and how they should be met. At this key inspection it was noted that needs assessments had been improved. The needs assessments were viewed for four people who had moved into the home since the last key inspection. They detailed peoples individual needs, their preferences, mobility, manual handling needs, their physical and mental well being and what actions needed to be made to meet their needs. Examples included that a mobility aid had been purchased before the person moved into the home to ensure that they were safeguarded by appropriate manual handling procedures and an appointment had been made with a district nurse with the view to obtain a mobility aid for a person to use to improve their mobility and to support their independence. Care Homes for Older People Page 12 of 33 Evidence: An admission assessment had been undertaken when people moved into the home, which further explored their needs and preferences. Care plans were in place which showed how their needs were to be met. The care plans are further discussed in the second section of this report. The AQAA stated clients are assessed by two members of staff, usually the manager and a senior carer. We go through the initial client assessment by putting an individual at their ease by being friendly, kind and caring taking all the relevant information needed so that we can determine if Red House can meet the needs of the individual before admittance. Once accepted there is a trial period of a month on either side to confirm the needs of the client is being met. People that were spoken with confirmed that their assessed needs were met at the home. A person and their relative that were spoken with told us that the manager and another staff member had visited them to ask about their needs and preferences before they moved into the home. Care Homes for Older People Page 13 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to have their health care and social needs set out in a care plan, to have their needs met, to be treated with respect and to be protected by the homes medication procedures. Evidence: Since the last key inspection peoples care plans had been improved to show how peoples assessed needs were met. The care records of four people that lived at the home were viewed and each held a needs assessment, admission assessment and care plan which showed how their needs were met. The manager was spoken with and agreed that they would further improve the care plans to reflect peoples preferences and individuality. They told us that peoples key workers undertook monthly updates with people and these would be included in the care plans. Staff that were spoken with had a clear understanding of the individual needs of people and told us about some of their preferences with regards to their daily routines that were not included in their care plans, such as what they usually preferred for supper and bedtime drinks and how a person preferred dress. Care Homes for Older People Page 14 of 33 Evidence: Daily records that were viewed showed the support that people had been provided with on a daily basis and also included details of their well being and choices. At the previous inspection it was noted that a communication book was viewed in which peoples personal information was recorded, which did not ensure that their confidentiality was maintained. At this inspection the communication book was no longer used for recording peoples individual information and all information was stored in their personal records. The AQAA stated care staff are very aware of clients changing needs on a daily basis and report any changes to the senior or myself (manager) for immediate action. People that lived at the home that were spoken with told us that they felt that their needs were met. A relative of a person was spoken with and they confirmed that their relatives needs were met.. The service user survey asked if they were provided with the care and support that they needed. One answered always, three answered usually and one answered sometimes. Staff that were spoken with told us that they care plans had improved and that the management of the home clearly explained how peoples needs were to be met. Two staff surveys said that they were always provided with up to date information about the people that they cared for and that the ways that they passed over information about the people who used the service always worked well. The care plans that were viewed included risk assessments such as manual handling, fire safety, physical frailty and mobility, which identified how the assessed risks were to be minimised. Details of peoples medical history were included and how their health care needs were met were identified, such as routine support provided by a district nurse, chiropodist and their dietary requirements. Outcomes of medical appointments were recorded, such as with the doctor, district nurse and optician. The service user survey asked if they were provided with the medical help that they needed. One answered always, two answered usually, one answered sometimes and one did not answer. A person that lived at the home who was spoken with told us that the doctor was called promptly if they wished to see one and they explained about their various conditions and the support that they were provided with to ensure that their health needs were met. A person told us that the staff at the home had assisted them to get their eyesight and hearing sorted, this was confirmed by their relative who told us that the appropriate appointments had been made which ensured that the persons sensory needs were met. Care Homes for Older People Page 15 of 33 Evidence: The AQAA stated we maintain individuals health and ensure that they have access to health professional on arrival and when required all through their stay at Red House. Peoples assessments that were viewed clearly showed their wishes at the time of death, which included who was to be informed and their choices of service. The medication procedure was viewed and it clearly showed how medication was to be handled, stored and administered appropriately to ensure that people were safeguarded. Staff training records showed that those who were responsible for the administration of medication had been trained to do so. A staff member was spoken with and when asked if they had been provided with medication training answered yes seven times. Medication audits were undertaken twice weekly, which included stock checks of medication and issues were addressed promptly. The medication was stored in MDS (monitored dosage system) blister packs in a secured cupboard in the office. The MDS packs were moved to a secure medication trolley for administration. There was an appropriate secured controlled medication cabinet, which was attached to the wall and provided a double locking facility. The MAR charts of four people were viewed and it was noted that all medication was accounted for. Part of the lunchtime medication round was viewed and it was noted that the medication trolley was secured when left, that the medication was provided to people directly from the MDS blister packs into clean pots and that the MAR (Medication Administration Records) charts were recorded when people took their medication, or the appropriate codes were used when people had refused their medication. The AQAA stated individuals are supported to make their own decisions and risk assessments are in place regarding self medication of their tablets if they require to do this. The medication system regarding ordering, recording, handling and disposing works very well at Red House. A stock take of all medication is carried out throughout the building so a clear picture is found if anyone not taking their medication properly and therefore being a risk to themselves, thus more support is given to allow these individuals to remain independent. During the inspection we observed that the staff that worked at the home treated people and their visitors with respect. Staff were observed to speak to people in a respectful manner and they always used peoples preferred forms of address, which were identified in their care plans. People that lived at the home told us that the staff were always respectful. They also told us that their privacy was respected and that Care Homes for Older People Page 16 of 33 Evidence: staff always knocked on their bedroom doors before entering, which was confirmed by observations of staff doing so during the inspection. People were clean and smart, which showed that their dignity was maintained. Staff that were spoken with had a clear understanding of their responsibilities regarding ensuring that peoples privacy and dignity was respected in their daily living. The AQAA stated we promote independence, choice, privacy and dignity. Care Homes for Older People Page 17 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be provided with the opportunity to participate in activities which are of interest to them, to be supported to maintain their chosen contacts and to be provided with a balanced and healthy diet. Evidence: Since the last key inspection an activities co-ordinator had been employed at the home and the activities that were available for people to participate in if they chose to had improved. The planned activities were provided to people three full days each week. The activities records and the July activity plan that was viewed showed that activities included bingo, quizzes, games, manicures, flower arranging, gardening, growing vegetables, making cakes and seasonal activities such as sewing hearts for Valentines day and making baskets for Easter. People that were spoken with told us that there was a good range of activities which they could participate in if they chose to. The service user survey asked if there were activities that they could take part in, two answered always, one answered usually and one answered sometimes. The AQAA stated we hold bingo twice weekly and people who are unable to participate due to memory are supported to play with the aid of a carer. We have regular keep fit Care Homes for Older People Page 18 of 33 Evidence: exercise for anyone who wishes to attend. Regular worship of different denominations are held every Sunday at Red House and others who want to are supported to attend a service in the community. The AQAA told us that people discussed their preferences in residents meetings with regards to outings that they wished to participate in. However, it stated that the Committee made the decisions of the outings that people were provided with. The manager told us that they had spoken with the committee about how they could further improve the activities provided at the home by listening to peoples choices, such as trips to the zoo and to the coast for fish and chips. The day before the inspection there had been a garden party at the home, which included food and visiting entertainers. A person that lived at the home told us that the garden party was very good. They told us that people had to shelter from the rain in the marquis. Throughout the inspection we heard people talking to each other and staff about how they had enjoyed the party. The activities co-ordinator showed us a large canvas on which were paintings of flowers and butterflies, they told us that people had each painted and initialed a part of the art work and that it would be displayed in the home when it was completed. There was a large notice board in the entrance hall of the home, which displayed a time line of history, such as when the second world war started and finished and the birth years of people that lived at the home and the happenings in the world for that year. People that lived at the home told us that they enjoyed looking at the time line and helping to add information to it, such as their memories and items of history. Throughout the inspection people were observed to stop and look at the time line and discuss it with each other and visitors to the home. The committee meeting minutes that were viewed showed that they had asked that the time line be moved to another place in the home to allow for fresh flowers to be placed in the fire place. The activities co-ordinator was spoken with and they told us about how they ensured that all people were included in activities, such as if they chose not to take part in group activities they would be supported to do something individually, such as shopping or chatting. They told us that a record player had recently been purchased on which people played vinyl records, which they enjoyed. During the inspection one of the two social visitors was observed to be playing chess with a person who lived at the home. They told us that they had played several times that day and it was noted that the person was keen for us to leave them to their next game. Another social visitor supported a person to a hospital visit, they told us that they often escorted people to medical appointments and that they came into the home each Tuesday to chat with people. People were observed to play bingo and enjoy afternoon tea in the large dining room on the afternoon of the inspection, a person went out for lunch with their relative, a person went for a walk to the local shops and people were observed to Care Homes for Older People Page 19 of 33 Evidence: enjoy visits from their relatives. A person that lived at the home told us that they maintained contact with their relatives, through visits, telephone calls and letters. Another person told us that their friends visited them at the home and that they were always made welcome and offered drinks. A relative of a person who visited the home during the inspection told us that they were always made welcome when they visited their relative. Peoples care plans that were viewed showed the contacts that people chose to maintain, such as with their friends and family. During the inspection we observed people making choices throughout the day, such as what they wanted to do and what drinks and food they wanted. People told us that they chose what they wanted to do each day and that the staff listened to their choices. The daily records of people were viewed and they showed how people had made choices in their daily living. People told us that the homes menu always provided two choices for each meal, including a vegetarian option and that if they wanted to eat something else then this would be provided. The menu was viewed and it was noted that there was a varied and balanced diet provided at the home. There was a large white board in the dining room, which showed the meals for the day. During the inspection lunch was a choice of nut roast or toad in the hole, fresh vegetables and potatoes. People were observed to eat their meal, which smelled and looked appetising, in the large and attractively furnished dining room. Staff were observed to be attentive to peoples needs during their meals and it was noted that there was little left on the plates when people had finished eating. The AQAA stated meal times are led by the residents who eat at their pace and not to the pace of staff. Anyone who does not want to attend the dining room is free to have their meals in their room if this is their desire. People told us that the food was good at the home and always freshly made. The cook was spoken with and told us that they always used fresh produce and that they ensured that there was always a choice of freshly made soup available on the menu for the evening meal. The service user survey asked if they liked the meals at the home, one answered always, two answered usually, one answered sometimes and one did not answer. Care Homes for Older People Page 20 of 33 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 who use this service can expect to be protected from abuse to to have their complaints listened to and acted upon. Evidence: The manager told us that since the last key inspection all the staff team had been provided with safeguarding training and a safeguarding procedure was in place. The AQAA stated we have put all staff on a safeguarding course and the policy for staff on safeguarding of vulnerable adults has also been updated. Staff training records were viewed and they showed that there had been two training dates provided since the last key inspection and all staff had attended the training. Staff that were spoken with told us that they were aware of their responsibilities in ensuring that people were safeguarded. The homes safeguarding procedure was viewed and it detailed the actions that should be taken if there were concerns about a persons safety. However, the Suffolk safeguarding guidelines were not present in the home for reference. The manager was spoken with and they agreed that they would ensure that they would be obtained and present in the home as soon as possible. We had been made aware of a safeguarding issue which had occurred in the home, for which no safeguarding alert had been made. We alerted the Suffolk safeguarding team, who had fully investigated the issue, which included a strategy meeting, which was attended by CQC, social care, the homes manager, two members of the Care Homes for Older People Page 21 of 33 Evidence: committee and the police. During the meeting the representatives of the home were advised that a recent notice that had been displayed in the home which advised staff that they were not to report concerns to us, social care or the police, was inappropriate. The manager advised that the notice was a result of malicious allegations. The members of the committee and the manager were advised of their responsibilities regarding safeguarding during the meeting. The manager was spoken with during the inspection and they explained that the issue had been investigated in the home, however, they had not made an alert. They told us that they were now aware of their responsibilities with regards to safeguarding and would ensure that all future concerns would be reported appropriately. The homes complaints book was viewed and it was noted that all concerns were clearly recorded and investigated. The AQAA stated we have had three written complaints from residents in the last 12 months which were all dealt with promptly and effectively. There were several thank you cards and letters that were viewed, which had been sent to the home thanking them for the support that was provided to people. The AQAA stated we have a very good complaints procedure and they are dealt with sensitively and confidentially. The complaints procedure was viewed and detailed what people could expect when making a complaint, the procedure was also summarised in the Service Users Guide and Statement of Purpose. The manager was spoken with and we told them that three service user surveys had said that they knew how to make a complaint and two said that they did not. The manager told us that from the results of recent quality assurance satisfaction surveys they were aware that seven of nineteen relatives had said that they knew how to make a complaint and as a result of this they were in the process of distributing the Service Users Guide to the people that lived at the home and their relatives to ensure that they knew what to do if they had concerns about the home. The satisfaction questionnaires were viewed and it was noted that thirteen service user questionnaires had been returned and they all had said that they knew who to speak to if they were not happy. People that lived at the home who were spoken with told us that they knew what to do if they had concerns about the service that they were provided with. Two staff surveys said that they knew what actions to take if a person wished to raise a concern about the service that they were provided with. Care Homes for Older People Page 22 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be provided with a clean, hygienic and comfortable home to live in. Evidence: A tour of the building was undertaken and it was noted that the home was clean, attractively furnished and well maintained. The maintenance book was viewed and it was noted that areas for improvement were identified and addressed promptly. The manager explained how they had improved the domestic arrangements in the home and that a staff member was responsible for undertaking domestic checks of the home. During the inspection it was noted that there were no unpleasant odours in the home. The service user survey asked if the home was fresh and clean, one answered always and four answered usually. People that were spoken with told us that the home was maintained to a good standard and that they were happy with the environment that they lived in. The communal areas in the home included two lounges and a large dining room, all of which were clean and attractively decorated and furnished. There was a large garden, which was beautifully maintained, which people could walk or sit in and in which there had been a garden party the day prior to the inspection. Since the last key inspection people had used the garden for activities, which included growing flowers and Care Homes for Older People Page 23 of 33 Evidence: vegetables and drying lavender in the greenhouse. The manager told us that since the last key inspection there had been several bedrooms that had been redecorated and new furnishings such as matching bedding and curtains had been purchased. Peoples bedrooms that were viewed were clean, tidy and personalised with items of their memorabilia, which reflected their individuality. Peoples care plans that were viewed included a personal inventory list, which showed that people had bought in items of their personal furniture for their bedrooms, such as an armchair, chest of drawers and a small table set, which showed that they were supported to ensure that their bedrooms reflected their choices. The AQAA stated that their plans for improvement for the next twelve months were would like to have memory boards installed in residents rooms, particularly those who have short term memory loss so they can recognise their own things, pictures, belongings and photographs of loved one and also pets, thus making them feel more at home and secure. Since the last key inspection a bathroom on the ground floor had been refurbished, which included a new supported bath, which was suitable for supporting people with their bathing. There was sufficient supported bathing facilities, bathrooms and toilets in the home for peoples use and it was noted that each bathroom and toilet provided hand wash liquid and disposable paper towels, which minimised the risk of cross infection. There were grab rails provided in bathrooms and there was raised toilet seats, which ensured that they were accessible to the people that lived at the home. The home provided aids and adaptations which ensured that people were provided with the facilities that they required to ensure that they could move around the environment safely, which included a lift, chair lift and grab rails in corridors. During the inspection the lift and chair lifts were in the process of being serviced by an engineer. There were two hoists, both of which had stickers on them, which identified that they had been recently serviced. The assessment of a person that lived at the home which was viewed showed that the appropriate manual handling equipment had been purchased before they had moved into the home, which showed that their manual handling needs were met. The laundry was viewed and it was noted that it was clean and well maintained. The manager told us that a new washing machine had recently been purchased, there were two washing machines to ensure that peoples laundry was undertaken promptly. A laundry assistant was spoken with and they clearly explained the methods for minimising cross infection in the laundry and they told us that they had been provided with infection control training. They showed us the stock of laundry bags, gloves and Care Homes for Older People Page 24 of 33 Evidence: aprons and hand washing facilities in the laundry, which were available for their use. During the inspection staff were observed to use good infection control procedures, which included washing their hands and wearing protective clothing when working with food and laundry and when supporting people with personal care. Since the last key inspection the infection control procedures had been updated and they included issues such as MRSA and HIV and Aids. The manager showed us a notice which was posted on the entrance door to the home, which requested that people do not enter the home if they had flu like symptoms. The manager said that the action had been taken to address the issue of swine flu and that they had sought guidance regarding the notice from an environmental health organisation. Care Homes for Older People Page 25 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be supported by staff who are trained and competent to meet their needs and to be protected by the homes recruitment procedures. Evidence: The manager told us that the home was fully staffed and that they had not used agency staff. The AQAA stated it is our plan to continue to employ our own staffing team and to fill vacancies as they arise quickly and efficiently, therefore avoiding the need to employ agency staff giving continuity of care to our residents.... The Manager told us that a minimum of four staff members worked on the morning and afternoon shifts and two waking night staff during the night. Observations of the staff numbers at the time of the inspection and the staff rota, which was viewed, confirmed this. The staff rota showed the staffing arrangements in the home for each shift and included when staff were not at work, for times such as sickness, leave, days off and training. During the inspection staff were observed to be attentive to the needs of people that lived at the home and they were observed to interact with people in a respectful and professional manner. People that were spoken with were complimentary about the staff that worked at the home. The service user survey asked if the staff were available when they needed them, one answered always, three answered usually and Care Homes for Older People Page 26 of 33 Evidence: one answered sometimes. The home had met the target of 50 staff to have achieved a minimum of NVQ (National Vocational Qualification) level 2 in health and social care as identified in the National Minimum Standards relating to older people. The AQAA stated that there were twenty one care workers who worked at the home and fifteen had achieved an NVQ level 2 or above. The training records of five staff members were viewed and it was noted that they were provided with the training that they needed that supported them to meet peoples needs. The training included safeguarding, manual handling, fire safety, health and safety, infection control, food hygiene and medication. Two staff surveys said that they were provided with training which was relevant to their role, provided them with enough information about health care and medication, helped them to understand and meet peoples needs and which kept them up to date with new ways of working. Staff that were spoken with told us that they were provided with training which supported them in their role. A requirement made at the last key inspection was that newly employed staff were to be provided with an appropriate induction. The manager told us that they had been provided with support from the local authority quality and monitoring team and that they were to provide them of details of formal Common Induction Standards training. However, it was noted that newly employed staff were provided with training such as safeguarding and manual handling and they were supported to work through the Common Induction Standards workbook. The manager told us that new staff shadowed more experienced staff when they started working at the home. Two staff surveys said that their induction covered everything they needed to know to do the job when they started working. The recruitment records of three staff members were viewed and it was noted that the appropriate checks had been undertaken which ensured that people were safeguarded. The checks included details of their work history, two written references, POVAfirst (protection of vulnerable adults) checks, CRB (Criminal Records Bureau) checks and identification. Two staff surveys said that the appropriate checks, such as references and CRB checks were undertaken before they started working at the home. Care Homes for Older People Page 27 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to live in a home which is run in their best interests and to have their health, safety and wellbeing promoted and protected. Evidence: There was no registered manager at the home since July 2007. A manager had been appointed, who no longer worked at the home and their registration application was incomplete. The homes current manager was in post since June 2009 and they told us that they would be making a registered manager application. They had achieved NVQ qualifications in health and social care levels 2, 3 and 4 and they were working on their Leadership and Management Award (LMA). The managers training records were viewed and showed that they consistently updated their knowledge and had recently attended training courses on safeguarding, manual handling, palliative care, COSHH (Control of Substances Hazardous to Health), health and safety, fire safety and they had completed a distance learning course on dementia. Care Homes for Older People Page 28 of 33 Evidence: The manager was spoken with and agreed that they would look into attending training courses on Deprivation of Liberty and Mental Capacity Act which will advise them of how to incorporate them into the running of the home. The manager had a good understanding of their role and responsibilities in managing the home and they were receptive to the inspection process. The manager was asked if they had been provided with regular supervision meetings which supported them in their work role. They told us that they had not yet been provided with a formal supervision but they had advised the committee that they were required and they were awaiting for the meetings to be arranged. The requirements that had been made at the previous inspection had been met and the manager had updated the homes polices and procedures, which were viewed. There were policies and procedures in place regarding safeguarding and equal opportunities and the manager told us that they were in the process of ensuring that all the procedures were complete and up to date. Staff that were spoken with were complimentary about the management style of the manager. The running of the home was monitored by the providers in monthly house meetings, for which the manager prepared monthly reports, which updated the committee of all aspects of the running of the home. The Regulation 26 visit reports were viewed and it was noted that they were not being undertaken on the required monthly basis. The manager told us that they had noted the lack of the visits from since February 2009 and they had raised the issue in the meetings with the committee and that the visits had recommenced. The meeting minutes were viewed and confirmed this. The Regulation 26 visit reports were viewed and it was noted that people that lived at the home were provided with the opportunity to express their views about the service that they were provided with. The satisfaction surveys were viewed, which had been completed by people that lived at the home and visitors, following with a recent quality assurance activity. The manager told us that they had identified an issue regarding the complaints procedure that they had addressed, which is further discussed in the complaints and protection section of this report. This showed that actions were taken to ensure that the views and comments made by people were acted upon. At the last key inspection it was noted that peoples finances were not available to them at all times. The manager told us that since the last key inspection they had changed the procedures for ensuring that peoples finances were safeguarded. Peoples spending in the home was invoiced to the person or their relative/representative, which minimised the need for storing peoples money in the home. Care Homes for Older People Page 29 of 33 Evidence: The manager told us that since the last key inspection they improved the fire safety in the home, which included ensuring that the fire safety equipment was in working order and that they had joined a fire safety scheme with a telecoms provider. The fire safety records were viewed and it was noted that there was a fire risk assessment in place and fire safety checks were regularly undertaken which minimised the risks to people in case of a fire. Water temperature checks were undertaken which ensured that people were safeguarded from scalding and portable electrical equipment was checked, which ensured that they were safe to use in the home. The manager explained the actions that had been taken which ensured that the health and safety in the home was monitored, however, it was noted that they had not completed risk assessments for the assessed risks and the actions that they had taken to ensure that the risks were minimised. The manager agreed that they would ensure that risk assessments were completed for risks in areas in the environment. Care Homes for Older People Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 31 of 33 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 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 1 7 It is recommended that the care plans be further improved to show the how peoples individual preferences and needs are met. It is recommended that a copy of the Suffolk local authority safeguarding guidelines be obtained for reference to ensure that the staff at the home are aware of the local guidelines regarding safeguarding. It is recommended that the manager be provided with formal supervision meetings, which are documented, to ensure that they are supported in their work role. It is recommended that the manager attend training courses relating to Mental Capacity Act and Deprivation of Liberty and to incorporate their learning into the daily running of the home It is recommended that risk assessments be completed which identifies how risks are to be minimised in the environment. 2 18 3 31 4 31 5 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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. 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