Inspection on 22/04/08 for Red Brick House

This inspection was carried out on 22nd April 2008.

CSCI found this care home to be providing an Adequate 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 Brick House 20/10/08

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Red Brick House Victoria Terrace Prudhoe Northumberland NE42 5AE Lead Inspector Elaine Malloy Key Unannounced Inspection 09:45 22 April to 12th May 2008 nd 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 Red Brick House DS0000070973.V362298.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. Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Red Brick House Address Victoria Terrace Prudhoe Northumberland NE42 5AE 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) 01661 830677 01661 830681 www.southerncrosshealthcare.co.uk Southern Cross BC OpCo Ltd Miss Clare Dowling Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 50 The maximum number of service users who can be accommodated is: 50 2. Date of last inspection Brief Description of the Service: Red Brick House is a purpose built care home that provides nursing and personal care for up to 50 older people. This includes 14 NHS/GP beds for rehabilitation/short stay care. The home is in a residential area of Prudhoe in Northumberland and is close to the local shopping area and other amenities. It is a three-storey building with a passenger lift. Good size communal lounge and dining areas are available. There are 46 single bedrooms and 2 doubles. 31 bedrooms have en-suite facilities. Separate bathrooms, shower and toilets are provided. The home has a garden and conservatory, and car parking space at the front of the building. A guide to the home’s services and inspection reports are readily available at the home. Weekly fees up to end March 2008 ranged from £415.34 to £582.00. The home was awaiting the fee levels from April 2008 to be clarified by the provider company. Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Red Brick House is an established care home that was registered with a new provider company in November 2007. The inspection was carried out by: • Looking at information received about the service since November 2007. • Getting the provider’s view of the service and how well they care for people. • An inspector visiting the home on 22nd and 25th April 2008. • Talking to the management and staff about the service. • Looking at records about the people who use the service and how well their needs are met. • Looking at a range of other records that must be kept. • Checking that staff have the knowledge, skills and training to meet the needs of the people they support. • Getting the views of people who use the service, their relatives, and staff by talking to them and from surveys they completed. • Observing lunch being served on two visits to the home. What the service does well: New people have their needs assessed before they come to live or stay at the home. Assessments are regularly updated to identify each person’s current needs. The home has a dedicated rehabilitation unit that aims to enable people, wherever possible, to return to their own homes. Some residents and relatives were complimentary about the service. They said, “The care home has a warm atmosphere and staff are friendly”, “Staff do their best but are busy”, and “The nurses and carers are genuinely nice caring people”. The staff team and medical professionals support people to meet their health care needs, and a good level of aids and equipment is provided. There are appropriate medication procedures and trained staff administers medication. People are encouraged to keep contact with family and friends, who advocate on their behalf where necessary. Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 6 Procedures are in place to prevent abuse and staff will be getting further training about safeguarding adults from abuse. Staffing levels are appropriate to meet the needs of the number of people living at the home, and more staff are being recruited. What has improved since the last inspection? What they could do better: Many residents and relatives who gave feedback about the service feel standards at the home have deteriorated. All complaints need to be properly logged and addressed by management so people can be confident their concerns are dealt with effectively. Resident care is to be planned and recorded in a more person-centred way to show how staff will support individuals to meet their needs. Residents are to be given more opportunities for stimulation and meeting their social needs by providing daily activities. The quality of food must be improved to make sure residents receive appetising meals. A schedule of work to improve the building needs to be introduced so that residents live in a comfortable setting that is being properly maintained. Full recruitment details must be kept to demonstrate that staff are properly vetted and prevent risk of harm to people living at the home. A staff training programme needs to be organised to make sure residents are supported by skilled workers. This is to include more staff achieving care qualifications that are nationally approved. A plan is to be developed that sets out methods to monitor and assure the quality of the service, and listen and act on residents/relatives views. The provider, or their representative must make sure they visit the home every month and report their findings on the standards of the service. Fire safety needs to improve by giving staff regular instruction on what to do in the event of a fire, and doors not being wedged open. Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 7 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. Red Brick House DS0000070973.V362298.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 Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Thorough assessments of needs are carried out before admission to make sure people’s care can be properly planned. People using the rehabilitation service are well supported by using a multi-agency approach to become more independent, and where possible return home. EVIDENCE: The manager confirmed that a new Statement of Purpose and Service User Guide have been introduced since the home changed ownership. This information about the service is made available to existing and prospective residents and their relatives. Miss Dowling said she also informs people that they can access inspection reports, either in the home or through the Commission for Social Care Inspection website. Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 10 The majority of residents who completed surveys said they received enough information before being admitted so they could decide if it was the right place for them. One person said, “Just got a leaflet off hospital then had a look around”. A sample of new resident care records showed the manager had conducted assessments of individuals needs before anyone is admitted to the home. Assessments from other health and social care professionals are also obtained. The manager agreed to follow up on getting the care manager assessment for a resident who was recently admitted. On admission a checklist is used to verify the new resident has been introduced to their ‘key worker’, other staff and residents, and that a full range of assessments are carried out. These identify the person’s current needs and establish where care plans are required. People who stay at the home in NHS/GP beds are provided with intermediate care. The manager receives referrals by telephone and through attending Multi-Disciplinary Team meetings at Hexham General Hospital. There is dedicated accommodation on the first floor of the home and a good level of equipment is provided. Health care professionals from the Community Rehabilitation Team support people during their stay. This includes Occupational Therapy, Physiotherapy and Speech and Language therapy. In the past six months there have been 38 admissions into the home’s NHS/GP beds and 39 discharges. 16 people returned to their own homes, 10 moved into nursing or residential care homes, and four people went into hospital. There were nine deaths. Red Brick House DS0000070973.V362298.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. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People using the service do not receive care that is planned according to their individual health and personal care needs. EVIDENCE: A wide range of assessment tools is used to identify individuals’ health and personal care needs, and these are updated monthly. A sample of resident care plans was examined. These were based on needs and risks identified from assessments. The plans addressed physical and mental health, moving and handling, mobility, hygiene, nutrition and hydration, skin and pressure area care, continence, social needs, and personal safety. The home currently uses ‘core care plans’ with standardised interventions for how staff will assist residents. These rarely had any additional detail recorded Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 12 to make them person-centred to the individual’s needs and requirements. One example of this was care plans for a person with mental frailty. The plans did not show the approaches that work well with the person when they are confused and anxious. A summary list of care plans is signed by the resident/relative to verify they have been agreed. Care plans are evaluated at least monthly to demonstrate how well plans are working. Staff maintain an ongoing record of day and night reports on each person. The manager said that staff were awaiting training/instruction on the provider company care documentation before this is introduced. Staff who completed surveys said they are ‘always’ or ‘sometimes’ given up to date information about the needs of the people they support or care for. They said that the ways they pass information about residents between staff ‘always’ or ‘usually’ works well. Residents who completed surveys said they ‘usually’ or ‘sometimes’ receive the care and support they need. Comments included, “I stay in my room and buzz when I require anything, I don’t always get things though”, and, “I haven’t had a shower since I came in”. The majority said staff are ‘usually’ available when they need them. One person said, “When I buzz they always come, sometimes don’t do what I ask, but they make me happy”. Some people said staff listen and act on what they say whilst others feel they don’t. One lady indicated staff always say to wait ‘five minutes’. A gentleman told the inspector that he had bathed for the first time in two weeks, as he usually has a shower but this is out of order. The majority of relatives/friends who completed surveys said the home ‘usually’ or ‘sometimes’ meets the needs of their family member/friend, and gives the support/care they expected. Comments included, “Day to day care is adequate, but any special requests seem to cause problems”, “The carers are clearly over stretched”, and, “Certainly her social needs are not met. Personal hygiene needs are not always met due to either the lift to the only shower being out of order, or more often the shower itself”. One person said there could be problems with getting staff to accompany a resident to hospital appointments. Each person’s physical and mental health needs, and risks associated with supporting individuals are assessed and care planned. This includes moving and handling, risk of falls, oral hygiene, nutrition, continence, pressure relief and pain control. Monitoring records are kept of weights, and where applicable food and fluid intake. The home is designed and equipped to make it suitable for people with physical disabilities. There are wide corridors, handrails, a passenger lift and assisted bathing and shower facilities. The manager said that any aids individuals require are put in place before they are admitted, and further aids are obtained, as people’s needs change. Hoists and other moving and handling Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 13 equipment, and specialist beds/mattresses are provided. One resident told the inspector that they were awaiting delivery of a new wheelchair and has a pressure-relieving mattress to keep them comfortable. Residents use five local GP practices. Arrangements are in place for a podiatrist, dentist and optician to visit. Staff work closely with the Community Rehabilitation Team for people staying in the NHS/GP beds. The home has accessed input for individuals from a tissue viability advisor, continence advisory service, and psychiatry services. Staff have been working with a Clinical Psychologist who is visiting one resident, and has provided training sessions. This resident has an individualised care plan for behaviour/lifestyle that is supported by behaviour charts. All contact with health professionals is recorded separately in care records. Most residents who completed surveys said they ‘always’ or ‘usually’ receive the medical support they need. One person said they never do. Two people commented that never see their doctor. A relative said she was happy with the nursing care and that her husband sees his GP and has good medical care. The home has a medication policy and procedures to guide staff practice. A local chemist currently supplies medication to the home. The manager reported that the supplier would be changed in the near future. Nursing staff only administer prescribed medication and the manager has provided in-house training and completed competency assessments. Current administration records and the controlled drugs register had a photograph on their record for identification purposes. Records were appropriately completed and codes used to identify any reason why medication was not given. The manager agreed to make sure directions for application of creams and ointments are stated clearly. An extensive monthly medication audit is conducted. The manager said that occasionally people who are staying in NHS/GP beds wish to self-administer their medication as part of the rehabilitation process. A risk assessment is carried out and lockable storage facilities are provided. The home has policies and procedures on the values of privacy, dignity and choice, confidentiality, equal opportunities and diversity. Staff have received training in ‘customer care’ to give them understanding of the different needs people may have. Personal care and medical examination/treatment is carried out in private. Residents who spoke with the inspector said staff respect their privacy and dignity. The home provides mainly single bedroom accommodation. There are two double bedrooms and both have en-suite facilities and are fitted with curtain screening for privacy. People living at the home are asked how they wish to be addressed and whether they prefer male or female staff to support them with Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 14 personal care. These preferences are recorded. A questionnaire is completed on admission to get information on each person’s preferred routines. Telephone points are provided in all bedrooms and a minority of residents have had telephones installed. There is no pay telephone for residents’ use. The manager said residents could make and receive calls in the small offices on the units. Post is given directly to residents and staff provide support in reading/dealing with letters, appointments etc if this is needed. Systems are in place to make sure residents wear their own clothing. Inventories are completed and clothing has name labels. The home employs dedicated laundry staff and each resident has an individual laundry basket. Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Although adequate systems are in place to encourage lifestyle choices, these are not consistently followed and therefore, impact on the choice and quality of food and activities available to people. EVIDENCE: Residents’ social interests and preferred routines are assessed to some extent, and care planned. Most residents who completed surveys said there are ‘usually’ activities arranged by the home that they can take part in. Two ladies commented that they get bored. A relative commented, “The people who are not alert seem not to have their mental needs met as there is very little stimulation”. A care worker had recently taken up the Activities Co-ordinator post on a part time basis. The position will become full time when care worker vacancies are filled. A weekly activities programme is in place however it is not consistently Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 16 followed. Social activities are only usually provided when the Activities Coordinator is on duty. A file is kept with a ‘recreational activities’ chart for each resident. These were introduced 2-3 months ago and the vast majority were blank, therefore there was no ongoing evidence of activities provision. The inspector suggested allocating staff responsibilities each day for providing activities and keeping records up to date. The manager said there is a ‘comfort fund’ for activities and outings. This is supplemented by staff fund-raising efforts. New activities resources and materials have been ordered and audio books are being obtained for residents with visual impairment. The Activities Co-ordinator will be attending a course on chair aerobics to enable her to do these exercises with residents. A ‘pat dog’ comes to the home most weeks. The home aims to organise visiting entertainment on a monthly basis and the company mini-bus with driver is available monthly. Recent destinations for trips included Heighley Gate Garden Centre, the Sea Life Centre at Tynemouth and Corbridge. The Activities Co-ordinator and other staff also accompany residents to go out locally. A relative told the inspector that she has accompanied her husband on trips in the past. She said activities seem to be improving and the Activities Co-ordinator is trying out games and films. The home has an open visiting policy and visitors are welcomed at any time. Visits can take place in resident bedrooms or in communal areas. Visitors are shown the small kitchen area to help themselves to drinks, and can stay for meals if they wish. The majority of relatives/friends who completed surveys said they ‘usually’ get enough information about the service to help them make decisions. Most said they are ‘always’ kept up to date with important issues affecting their family member/friend. One person said changes to routines are not always explained, and described an incident involving their friend that they were not informed about. There are some links with local schools and pupils visit, for example at Christmas to put on concerts or perform in a choir. Local clergy visit individual residents. Residents are encouraged to maintain contact with the local community and use its’ facilities. New residents, wherever possible choose their bedroom and the manager discusses and agrees the extent of personal possessions they will bring in from home. The manager was also looking towards making the short stay bedrooms more homely. No residents at present manage their personal finances. Relatives assist them to do so, or people can maintain the services of their solicitor. Family and friends support residents and advocate on their behalf if needed. This was demonstrated during the inspection. People told the inspector there Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 17 was greater attendance at the recent residents and relatives meeting where a number of concerns were expressed. These included deterioration in the standards of care, delays in repairs being carried out, complaints about food and concern about future management arrangements. Relatives are invited to individual care reviews so they can be kept informed of any changes to the resident’s planned care. The manager said residents and relatives can access their personal care record and are involved in agreeing to care plans. Relatives/friends who completed surveys said the service ‘usually’ or ‘sometimes’ supports people to live the life they choose. One person said, “I feel my mother would benefit from a few outings”. Another indicated that her friend prefers to stay in her room but this can mean her personal needs are slow in being attended to. Most feel the service ‘usually’ meets the needs of different people. One person said, “My friends deafness caused problems at first but staff seem to have improved their communication with her”. The home usually has two cooks, however one post is vacant and the manager reported some problems with recruitment. Agency cooks are providing cover. There is a 4-week menu that offers a good range of meals. Breakfast consists of cereals, toast and cooked breakfast is available. There is a choice of main meal and dessert at lunch and assorted sandwiches are an alternative to the lighter meal at tea, with cake/scones/buns. The inspector was told suppers are usually sandwiches etc that have been left over from tea. Varied snack suppers need to be forward planned and stated on the menus. Residents have their nutritional needs assessed and weights are monitored. Special diets are catered for, for example soft, low fat and diabetic diets. One lady told the inspector that her husband is given homemade fruit smoothies and milkshakes as he has appetite loss. A new catering system, ‘Nutmeg’, is being introduced in the near future following staff training. However, during mealtimes menus were not displayed. Preference sheets were not consistently completed on a daily basis to show residents had been asked which meal they wanted. The sheets also provide information to catering staff on the required quantity of each meal and if residents have requested alternatives. Tables were nicely set with coloured cloths, tablemats, coasters and condiments. Hot and cold drinks were served during the meal. Staff served food from a hot trolley. Choice of meal was offered. Independent eating is encouraged, with use of feeding and drinking aids if needed. Staff were observed helping with cutting up food and assisting residents with eating. Residents confirmed they are offered choice of meals. The majority of residents who completed surveys said they ‘sometimes’ like the meals. Comments included, “I don’t eat the meals, they’re always cold and don’t even taste like food. Bread is stale, milk is off and the fruit is horrible”, “I would like a change Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 18 every week”, and, “Sometimes nice, the eggs are awful”. Two residents said the food had deteriorated in recent months. A relative said, “We are always concerned about the poor/cold food and lack of imagination or variety. We often have to buy our own food because there is nothing mum likes or the quality is of the cheapest”. A relative told the inspector she had taken a meal in the home recently and that it was “almost cold”. A resident said, “I need more help with eating”, and a relative said, “My mother needs help with feeding and this is not always available”. Complaints discussed at the recent residents and relatives meeting concerned the standard of food, temperature, presentation, hot drinks not being served in the evening, and a shortage of crockery and glasses. Some people told the inspector there are times when the meal is almost cold, and one person indicated staff are not aware of foods that individuals dislike. The manager said crockery has since been purchased and she has instructed staff to make sure evening drinks are provided. She was reviewing suppliers and looking towards ordering new hot trolleys. Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 19 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. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Although an adequate complaints procedure is available, this is not consistently followed. This means that people don’t have confidence that their complaints will always be addressed. EVIDENCE: The home’s complaints policy is displayed and a copy is provided to residents in the Service User Guide. The majority of residents and relatives who completed surveys and spoke to the inspector said they know how to make a complaint. One relative said, “But only found out in the last week when a number of us made enquiries of the manager”. Other comments from relatives were, “Normally after talking to the carers or manager, concerns are sorted out quickly. Unfortunately things seem to slip back within a few weeks”, “Have to find manager or nurse rather than them finding me to report on progress or action after concern raised”, and, “Staff/managers say they will look into things that sometimes you hear no more about”. Each of the staff who completed surveys indicated they know what to do if a resident or relative/advocate has concerns about the service. Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 20 Complaints records were examined. There were three complaints since the home was registered in November 2007. Senior management of the company dealt with two of these. The information was incomplete in that one did not have the complaint letter and both lacked details of investigation and responses. The third complaint was investigated internally and appropriately recorded. Complaints made at the residents and relatives meeting had not been formally logged in the complaint file. A monthly audit of complaints is completed and sent to the provider company. There is a range of policies and procedures on recognising and preventing abuse, and ‘whistle blowing’ (informing on bad practice). Staff have been provided with in-house training on protecting vulnerable adults. The manager said the provider company would be organising further training. In the period since registration the home has notified the Commission for Social Care Inspection (CSCI) of two allegations of potential abuse. One allegation has lead to an internal investigation resulting in disciplinary action being taken against a staff member. The police investigated the other allegation and decided there should be no further action. In both instances the home responded promptly to protect residents and notify the relevant authorities. Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 21 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. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Although the home is generally clean and comfortable, there are no plans to improve the environment, and people using the service are being affected by delays in repairs. EVIDENCE: In the past year corridors in the home have been redecorated and had new carpets fitted, a new television was purchased, foot operated bins were introduced and window restrictors were replaced. There is no current programme for redecoration and renewal within the building. This was an outstanding requirement from previous inspections when Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 22 a different company owned the home. The manager stated she was not aware of any plans to improve the environment. She said she has informed the company that priority is redecoration of bedrooms. A lack of storage space still needs to be resolved. An unused bathroom is being used for storage purposes. Residents and relatives said they are unhappy at how long it takes for some repairs to be carried out. Examples given included the passenger lift being out of order for approximately two weeks, and the only shower in the home was currently not working. Residents who prefer a shower to a bath, or are unable to use a bath have complained. The manager said she has explained that the shower was reported for repair a week ago. The inspector toured parts of the building. Communal lounge and dining areas were clean and comfortable. Resident bedrooms were, in the main, nicely personalised. There were problems with over heating in a gentleman’s bedroom. The radiator could not be turned off, as there was no individual thermostat control. He said he had to have the windows and door open to let air in to cool the room. A contractor arrived during the inspection to fix the problem. Most of the residents who completed surveys said the home is ‘usually’ or ‘sometimes’ fresh and clean. One person said it sometimes smells and could not understand why domestic staff mop and spray carpets. The home has a dedicated housekeeping team. There are policies and procedures on hygiene and control of infection. The building has suitable hand-washing facilities and staff are provided with supplies of disposable aprons, gloves and alcohol cleansing gel. The laundry is well organised and washing machines have sluicing cycles. Arrangements are in place to dispose of clinical waste. Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 23 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. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There are appropriate staffing levels for the number of residents but more training is needed so that all staff have the necessary skills to better support people. EVIDENCE: The home has staffing levels of two first level nurses and eight carers between 7.00am and 3.00pm, two nurses and seven carers between 3.00pm and 9.00pm, and two nurses and four carers at night. The manager’s hours are in addition to these levels though she covers shifts when needed. Miss Dowling said that despite staff vacancies, levels have been maintained through existing staff working extra hours and minimal use of agency staff. There are good weekly catering, domestic, and laundry hours. Full time administrative support is provided. A handyman is employed for 30 hours weekly. Resident comments on staff included, “They are smashing, I can’t praise them enough”, “I’m looked after well”, and, “Staff do their best but are busy”. One relative described the staff as being a good team and said the manager’s support has been ‘phenomenal’. Other relatives and friends comments Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 24 included, “The care home has a warm atmosphere and staff are friendly”, “The nurses and carers are genuinely nice caring people”, and, “The staff from the Philippines are particularly caring, cheerful and hardworking, as are the cleaners”. Staff who spoke with the inspector showed caring attitudes and commitment to their roles. One carer said they work extra hours and was aware that recruitment was taking place to fill staff vacancies. Staff who completed surveys said there is ‘usually’ or ‘sometimes’ enough staff to meet the individual needs of all residents. One person said, “We are always short staffed, always rushing around trying and making sure everythings done”. Another said, “Recently, since the takeover, a lot of staff have left, leaving the kitchen team and domestic team short staffed. Care shifts are always staffed to the legal limits”. Nine of the 25 carers have achieved National Vocational Qualifications (NVQ) in care. More staff need to complete this training to meet the standard of at least 50 of carers with NVQ qualifications or equivalent. Some domestic staff have undertaken NVQ training in housekeeping. In the past six months seven staff have left employment and two were dismissed. There are currently vacancies for one nurse, two carers, a cook, and a domestic. Two new carers have been recruited and will start when their Criminal Records Bureau checks have been received. Staff who completed surveys said their employer had completed all necessary checks before they started work. A sample of recruitment files for staff employed in recent months showed that staff are employed subject to Criminal Records Bureau checks. Proof of identification was on file. A recent photograph for each employee is to be introduced. Application forms were completed, but it was difficult to ascertain full employment history, as sometimes dates of previous employment were not stated. A medical questionnaire is completed though there is no declaration statement of the person being physically and mentally fit to do the work. Interview assessments are carried out and recorded. In the main references were obtained from suitable sources, however one person’s references did not match with their previous employment details. Individual staff training details were due to be updated on new company documentation. An overview of training for all staff showed that some staff had not completed training on moving and handling, fire safety, food hygiene, and first aid. Other staff had not undertaken update training in these safe working practices for 3-4 years. There was no current planned training programme in place. The manager indicated that she was not clear about the arrangements for accessing training via the provider company. Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 25 New staff undertake induction training to Common Induction Standards. The manager said in the last six months there had been training on the following topics: fire safety, food hygiene, C.O.S.H.H (control of substances hazardous to health), challenging behaviours, speech and language therapy, diabetes, continence, and constipation. Staff confirmed they had received suitable induction training. One person said their workload had increased with new tasks and they had not been given induction to these. Most said they had been provided with training relevant to their role. Two staff said they are keen to do more training. Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 26 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. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Management systems are not sufficiently developed to fully support the delivery of a service run in the best interests of people living at the home or, that promotes their health and safety. EVIDENCE: Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 27 Miss Dowling, the home’s manager told the inspector that she submitted her resignation almost three months ago. She was due to leave employment the following week and had informed residents, relatives and staff. The provider company had not notified the Commission for Social Care Inspection about the Registered Manager leaving. This was discussed with the home’s Operations Manager, who is new into post, following the visit. She confirmed that another company manager would be managing the home temporarily on a full time basis. Arrangements were made for the new manager to have a ‘handover’ period with Miss Dowling in her last week. The company has advertised the manager’s position but did not appoint, therefore further recruitment was taking place. A new deputy manager had recently been recruited internally and was being inducted into the role. Staff who completed surveys and spoke to the inspector said their manager ‘often’ or ‘regularly’ meets with them to give support and discuss how they are working. One staff member expressed concern at what the future management arrangements would be once Miss Dowling leaves. The provider company has introduced an extensive range of audits and resident and relative meetings continue. There is no current annual quality development plan and surveys for residents/relatives to give feedback have not been carried out recently. Visits and reports on the conduct of the service by the provider or their representative, have not been consistently carried out on a monthly basis, as required. Only two reports were on file for the last six months, dated December 2007 and January 2008. During the inspection a number of residents and relatives gave feedback of a negative nature about aspects of the service. Comments about how the service should improve included, “We expect higher standards than we are getting for our money in caring, attitude, catering and the state of the building”, “There have been complaints about the food and its’ presentation. As this is a major part of residents lives I feel that improvement of this should be a priority”, “We have noticed a deterioration in the level of care, food, funding etc. The manager is leaving, the deputy manager is only newly appointed. There is an absence of future direction among all staff and relatives/friends”, and, “Better and stronger management of staff in care home. Less restrictions on manager. Quicker responses to breakdown of lift and shower. Better training for cook. Better recruitment. Give more stimulation to residents. Show more care”. Residents and relatives have asked for a meeting with representatives from the provider company to discuss their concerns, and this was in the process of being organised. Staff who completed surveys gave comments on what they feel the service does well. They said, “We do our best to look after residents”, and, “The service does well in rendering the care needed by every resident, meeting the different needs within the whole aspect of care”. Comments about how the Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 28 service could improve were, “Have more staff. Carers that arent lazy! Better food. Cleaner surroundings. Friendlier staff. More training”, and, “Service could do better by having additional training for the staff, additional knowledge in rendering care”. Resident personal finance records showed individual account sheets are kept and checks of balances and cash are carried out at least monthly. Transactions showed evidence of personal spending and cash being repaid to residents. Receipts are obtained for purchases. The manager and administrator hold keys to the cash box and an emergency fund can be accessed out of office hours. The system for safekeeping resident personal finances will be changing in July 2008. This will entail cash being pooled in the home and a central bank account facility. The administrator has attended a workshop and said she was told each resident would accrue individual interest on his or her money, where this is applicable. There is a health and safety policy and a wide range of associated procedures. Risks assessments are conducted for safe working practices and other environmental/task oriented risks, for example risks to workers carrying out duties during pregnancy. Residents have an assessment of risks according to individual vulnerabilities. Where necessary care plans to manage or minimise risks are drawn up. As previously stated not all staff have completed or received update training on safe working practices. The inspector observed a member of staff assisting a person in a wheelchair from the lounge, without the footrests being used. This is a potentially hazardous practice and was brought to the attention of the manager. Fire safety records showed that staff were not being provided with fire instructions at the required frequency of six monthly for day staff and three monthly for night staff. Following the inspection the manager confirmed that the majority of staff had been given in-house instruction and the remaining staff would receive this as they returned to duty. Checks and tests of fire alarms, emergency lighting and fire fighting equipment were being carried out at the correct intervals. The main door to the kitchen, and doors to store rooms were being chocked open by wedges. Accident reports are appropriately recorded and some analysis of accidents is carried out to establish any patterns. Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 30 N/A 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 OP7 Regulation 15 Requirement Care plans must be personalised to demonstrate how individuals’ health, personal and social care needs will be met. A daily programme of activities must be provided to offer residents regular social stimulation. (a) Action must be taken to improve the quality of meals to provide residents with an appealing diet. (b) Varied suppers must be provided to ensure residents are offered a snack meal in the evening. Full details of all complaints received must be kept to demonstrate the nature of complaint, investigation and action taken. A programme of redecoration, renewal and maintenance, with timescales, must be introduced to demonstrate how the building will be improved and maintained. The recruitment process must include: (a) A recent photograph for each DS0000070973.V362298.R01.S.doc Timescale for action 22/10/08 2. OP12 16(2)(n) 22/05/08 3. OP15 16(2)(i) 22/04/08 4. OP16 22 22/04/08 5. OP19 23(2)(b) (c)(d) 22/07/08 6. OP29 19, Schedule 2 22/04/08 Red Brick House Version 5.2 Page 31 7. OP30 18(1)(c) 8. OP33 24 9. OP33 26 10. OP38 23(4) employee. (b) Full employment history. (c) A fitness declaration statement. (d) References obtained from suitable sources, including last employer. (a) A training and development programme must be organised that ensures staff fulfil the aims of the home and meet the needs of residents. (b) The programme must incorporate safe working practices training and updates to ensure resident and staff welfare. An annual development plan must be introduced that sets out how the quality of the service will be monitored and assured. The Registered Person, or their representative must visit the home at least monthly and prepare reports on the conduct of the service. (a) Staff must be provided with fire instructions at the required frequency of six monthly for day staff and three monthly for night staff. (b) Doors must not be wedged open to ensure safety in the event of a fire. (c) Footrests must be used on wheelchairs to make sure residents are moved safely. 22/07/08 22/07/08 22/04/08 22/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000070973.V362298.R01.S.doc Version 5.2 Page 32 Red Brick House 1. 2. 3. 4. Standard OP12 OP15 OP19 OP28 Provision of social activities should be suitably recorded to show individual participation. Menus should be displayed for resident information. Preference sheets should be completed daily to show residents are offered choice of meals. Arrangements should be made to ensure that repairs within the building are carried out promptly. At least 50 of care staff should be trained to National Vocational Qualification Level 2 or equivalent. Red Brick House DS0000070973.V362298.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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