CARE HOMES FOR OLDER PEOPLE
Randell House Care Home Fernhill Road, Blackwater, Camberley Surrey Lead Inspector
Anita Tengnah Unannounced 29/6/05 10:00am 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 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. Randell House Care Home H54 S36975 Randell House V234101 290605.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Randell House Address Fernhill Road, Blackwater, Camberley, Surrey, GU17 9HR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0207 605 4200 The Royal United Kingdom Benificent Association. Mrs Janet May Young CRH 39 Category(ies) of DE(E)- Dementia over the age of 65 years: 39 registration, with number OP- Old Ag: 39 of places SI(E)- Sensory Impair over the age of 65 years: 39 Randell House Care Home H54 S36975 Randell House V234101 290605.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 28/9/2004 Brief Description of the Service: Randell House is a registered care home providing personal care to 39 service users in the older person category.The Royal United Kingdom Beneficent Association owns the service and has another service across the road from Randell House. Accommodation is provided on two floors with a passenger lift that allows access to all parts of the building. The home is situated in Blackwater on the outskirt of Camberley and has some local amenities close by. There are a variety of equipment and adaptations availalable to maintain and promote service users independence and the home is registered to provide service to people with visual impairment. The service also benefits from a well maintained garden and parts are accessible to wheelchair users. Randell House Care Home H54 S36975 Randell House V234101 290605.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced inspection took place over one day on the 29th of June 2005. As part of the inspection process a tour of the building was undertaken. The inspection took place over 5 hours. The inspector spoke to 9 service users, 7 staff, 2 visitors and the internal auditor who was visiting the home. The process included examining care records, observing social and meal activities and discussions with service users, staff and visitors. What the service does well: What has improved since the last inspection?
The care planning has improved and all care plans seen were reviewed and updated on a regular basis in order to reflect the changing needs of service users. The home has also developed a comprehensive system for recording information/ history of service users that are used for emergency transfer to hospital. These were found to be detailed and informative, a regular review of
Randell House Care Home H54 S36975 Randell House V234101 290605.doc Version 1.30 Page 6 this information is undertaken linked to assessments and care planning thus ensuring that these are valid and up to date. The provision of evening meals has also improved offering more choices for the main course and desserts. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Randell House Care Home H54 S36975 Randell House V234101 290605.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Randell House Care Home H54 S36975 Randell House V234101 290605.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,6 The home has a good process of assessment prior to admission to ensure that service users needs are met. The information that are available enable service users to make an informed choice. EVIDENCE: The manager assesses all service users prior to admission to the home. Family visit, as often service users are too frail to attend the home prior to admission. Information as per the statement of purpose is available to service users and also copy of the previous inspection as requested. The home does not provide intermediate care. Randell House Care Home H54 S36975 Randell House V234101 290605.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 The home has a good system of care planning and review to ensure that service users needs are met. The staff have good understanding of service users’ support needs. This is evident from the positive comments from the residents and practices observed. EVIDENCE: Arrangements were in place to meet the assessed needs of service users. Care plans were formulated and included risk assessments and manual handling assessments. The manager reported that some service users also attend the fall clinics and as part of the internal audit the incidence of falls are recorded and reviewed. Care plans seen were detailed; these were also reviewed and updated on a regular basis to reflect any changes in the needs of service users. Service users and relatives spoken to were complimentary with regards to the care that they were receiving. Service users stated that staff were very kind, they spoke proudly of their bedrooms and that they could receive visitors at any time. Comments from service users included “the girls are all very good.”
Randell House Care Home H54 S36975 Randell House V234101 290605.doc Version 1.30 Page 10 “ This is as good as home”. “ I have lots of memories around “ as stated by one service when referring to the pictures and photographs of families in her bedroom. Six service users spoken to state that they had autonomy and choice with regards to the activity of daily living. They chose when they went to bed and whether to remain in their rooms or join others in the conservatory for social activities. One relative that was visiting his father on the day of the inspection commented that staff are intuitive and helpful. The manager reported that the home has developed good relationship with the local surgery and district nurses and Community Psychiatric nurses visit regularly. The GP holds weekly surgery at the home and sees service users on request and others that the home refers to him as required. There were detailed and up to date records of visits from the GP and any changes in treatment were clearly recorded to inform practice. Regular assessments of service users needs are undertaken. The manager reported that one service user was awaiting transfer as she had been assessed as requiring nursing care. Randell House Care Home H54 S36975 Randell House V234101 290605.doc Version 1.30 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,15 The social activities are well managed reflecting autonomy, choice and fulfilment for service users. Meals at the service have improved and is well managed to the satisfaction of service users. EVIDENCE: The home retains the service of an activity coordinator. Six service users spoken to reported that they “have lots of fun” when referring to activities provided. The inspector observed two activity sessions through the day of her visit. These were interactive, competitive and with lots of banter that the service users appeared to enjoy. The home has a varied programme of social activities that included three boat trips, concert, horse racing at Kempton Park, lunch at Guildford Cathedral. Service users reported that they were also looking forward to the Summer Fair that was due to take place on Saturday and have been involved in the preparation for the event. One service user told the inspector that she had autonomy and chose to join in some of the activities and preferred to spend time in her room due to her deafness. The home has a planned menu. Nine service users were spoken to with regards to meals and they all commented that meals were very good and
Randell House Care Home H54 S36975 Randell House V234101 290605.doc Version 1.30 Page 12 choices are offered. Record of meal showed that there are 3 choices of main meal at lunchtime and 2 at teatime. Meals were nicely presented and appeared nutritious and well balanced. Most of the service users attended the communal dining room at lunchtime. Staff were available to offer support with meals in a sensitive manner. Service users reported that they had a menu provided where they chose their meals and retained a copy for their use. Service users reported that cooked breakfast was available on Fridays. However were unsure if they could have cooked breakfast on other days if they chose. This has also been identified in the internal audit and was discussed with the manager. A more flexible approach to cooked breakfast would ensure that autonomy and choices of service users are met. Randell House Care Home H54 S36975 Randell House V234101 290605.doc Version 1.30 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home has a satisfactory complaint and adult protection procedures in place that protects service users. EVIDENCE: The home has a complaint policy and procedure in place. Service users spoken to confirm that they would approach the manager or the person in charge if they had any concerns. A complaint log was maintained. The manager investigates all complaints. Record shows that there have been two complaints since the last inspection, these have all been resolved. There is a procedure in place that gave information to staff regarding reporting and recording all allegations of abuse. Training in adult protection was available. The manager is aware of the needs to report and refer all allegations of abuse to the appropriate authority for the protection of service users. Randell House Care Home H54 S36975 Randell House V234101 290605.doc Version 1.30 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,22,23,26 The standard of décor was good except for one area identified. The service provided service users with a warm and homely environment to live in. The lack of hand washing facilities in communal bathroom and toilet may be detrimental to service users welfare. EVIDENCE: A tour of the building was undertaken as part of the inspection process. The home was well maintained, warm, clean and homely. Service users rooms were all personalised and furnishing was clean and appropriate to service users needs. The home has adequate communal space and service users commented that they enjoyed the conservatory where a variety of daily activities take place. Equipment and adaptations were in place to maintain and promote service users independence. These included grab rails, hoists, ramps and assisted baths. Storage facility was available for wheelchairs and walking aids that allowed for clear passageways and maintain safety of service users.
Randell House Care Home H54 S36975 Randell House V234101 290605.doc Version 1.30 Page 15 The home has adequate washing and bathing facilities to meet the needs of service users. However it was noted that the communal bathroom and one toilet on the first floor did not have hand- washing facilities. This was discussed with the manager and was an infection control risk. The provider is required to ensure that hand washing facilities are put in place for the welfare of service users. The carpets and paintwork on door- frames were in poor state of repair. The provider must ensure that an action plan is in place to refurbish this area. The home has an in house laundry and all service users laundry were undertaken internally. The inspector found that the laundry floor was recently refurbished and was impermeable. The washing machines were fitted with sluice facilities; the floor was impermeable and hand -washing facility was prominently sighted. The inspector found that a quantity of service users personal clothing remained in the laundry. Staff reported that as these were unmarked and there were difficulties in identifying the service users that these belong to. This was discussed with the manager and a system for marking service users’ clothing should be in place. There was also poor storage practice of clean clothing that was found on the floor in the laundry cupboard. This may pose infection control risks, the manager stated that measures would be taken to address this problem. Randell House Care Home H54 S36975 Randell House V234101 290605.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The staff have good understanding of service users’ support needs. This was evident from positive and friendly relationships between staff and service users. EVIDENCE: The home has a rota for carers and a separate on duty rota for ancillary staff. The manager reported that staff undertake regular training to update their skills. Service users and staff spoken to confirmed that there are adequate staff to meet the service users’ needs. The home has 6 carers on the morning shift, 4 care staff for the afternoon shift, and 3 carers on night duty. Service users stated that they are well cared for and they don’t wait too long when they asked for help. Another service user commented “there is always someone around.” It was evident by practices observed and interactions that staff and service users have developed good relationships and are aware of service users needs. Randell House Care Home H54 S36975 Randell House V234101 290605.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,37,38 EVIDENCE: The manager has a good understanding of service users’ support needs. Service users and a relative spoken to stated that they would approach the manager if they had any issue. Regular staff meetings were held and minutes of these were maintained. One staff meeting for care staff took place on the day of the inspection. The provider undertakes monthly- unannounced visit to the home and reports are sent to the Commission. The home has an internal audit system in place where care delivery is reviewed and views of service users are sought. All records were maintained securely. Reports as per Regulation 37 are maintained at the home and copies are forwarded to the Commission.
Randell House Care Home H54 S36975 Randell House V234101 290605.doc Version 1.30 Page 18 Fire safety training was provided by Hampshire Fire Service bi -annually for all care staff. The manager and her deputy had recently attended a half -day update on fire prevention at the fire service head office and cascaded to care staff. There were a number of COSHH materials that were not maintained securely in the laundry room. This was discussed with the manager, as these may be detrimental to the welfare and safety of service users. the provider is required to ensure that all substances that are hazardous to health must be maintained safely at all times. Randell House Care Home H54 S36975 Randell House V234101 290605.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 2 x 2 x 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 3 x x x 3 2 Randell House Care Home H54 S36975 Randell House V234101 290605.doc Version 1.30 Page 20 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 19 Regulation 23(2) (b) Requirement The provider must put in place a refurbishment programme for the ground floor corridor carpet and paintwork. The provider is required to put in place hand washing facilities in the communal bathroom and the toilet on the first floor. The provider is required to ensure that all COSHH materials are kept safely at all times. Timescale for action 30/07/05 2. 21 23(2) (j) 30/07/05 3. 38 13(3) (4) 30/07/05 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 Good Practice Recommendations Randell House Care Home H54 S36975 Randell House V234101 290605.doc Version 1.30 Page 21 Commission for Social Care Inspection 4th Floor- Overline House Blechynden Terrace Southampton Hampshire National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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