Random inspection report
Care homes for older people
Name: Address: Red Gables 59 Killerton Road Bude Cornwall EX23 8EU one star adequate service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Helen Tworkowski Date: 1 1 0 8 2 0 0 9 Information about the care home
Name of care home: Address: Red Gables 59 Killerton Road Bude Cornwall EX23 8EU 01288355250 Telephone number: Fax number: Email address: Provider web address: leedifford@btconnect.com Name of registered provider(s): Name of registered manager (if applicable) Mr Andrew James Renshaw Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ladybrook Care Homes Ltd care home 32 Number of places (if applicable): Under 65 Over 65 32 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who may be accommodated is 32. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category:- Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Red Gables is a large detached house, standing in its own grounds, near the centre of Bude. It provides accommodation for 32 elderly people on two floors. A shaft lift and staircase connect the two floors. The majority of the bedrooms have ensuite facilities. There are a number of communal areas, including a lounge, a conservatory, and a
Care Homes for Older People Page 2 of 14 Brief description of the care home dining room. There are seating areas outside the home, and a patio area. The home is within walking distance of the shops for anyone who is reasonably fit. The current fee scal is (Correct at time of report) £308.00 to £400.00. This does not include hairdressing, chiropody, dental work and opticians. Some toiletries must also be privately purchased. Care Homes for Older People Page 3 of 14 What we found:
This was an unannounced Random Inspection carried out on 11th August 09 between 10.20am and 3.20pm. The purpose of the visit was to follow up an immediate requirement that had been made at an earlier inspection, where we had concerns about the low level of staffing providing care. The Inspection was carried out by two inspectors. When we arrived at the home we found that there were only three of the 28 people who live at the home downstairs in the lounge or dining room. We were told that everyone else was in their rooms. We looked at the rota and the staff signing in sheet to find out how many staff had been on duty. We found that whilst the rota indicated that there had been five staff on duty on the morning of the 10th August 09, two of these people were not actually providing direct care. In the afternoon we found that whilst there appeared to be three or four staff on at various times, two of these individuals had started work in the last few days and were were therefore learning what was needed to be done. We were told by the Manager that they were in the process of recruiting new staff, and had also recently recruited a new cleaner and a new cook. We talked with the care staff on duty about the needs of the people in the home and about whether they believed they had sufficient time. We were told that there were six people who live in the home who needed two staff to help them transfer or to provide care. One of the staff told us that the staffing levels were fine, but problems had been caused at the weekend by someone not turning up for their shift. Other staff expressed real concern for the levels of staffing. We were told that whilst on the morning of the inspection, 11th August 09, there were three care staff providing direct care to people who live at Red Gables. We were told that this low level of staffing had meant that it was extremely difficult to provide care to the all of the people in the home. When we looked at the rota there were other senior staff on duty, however they had not been involved in providing care other than one person administering medication. One of the staff told us that the staffing levels in the home were atrocious, that the staff are exhausted. We were also told that since the current providers had taken over the dependency level of people who live in the home had increased. One of the staff told us how the residents felt that they were being neglected as staff were always rushing, but she said that staff had to rush to get through the work. Staff told us that they were expected to do activities with people, but they did not have the time. Some of the staff we spoke with raised concerns that they still lacked the equipment to be able to move people safely, and that some of the bedrooms made it extremely difficult to use the right equipment. We went and looked at some of the bedrooms to see what the problems were. We found that some of the rooms were not suited for the people who occupied the room. We saw that there was insufficient space to use hoists. We were told that one person had recently moved into a first floor room in the home. We were shown the way staff have to maneuver the wheelchair for this individual to go downstairs. This involved staff having to manhandle the wheelchair to get it round corners to get to the lift. We were also shown that there was insufficient space in the lift for the wheelchair, its occupant and a member of staff. This meant that the persons feet had to be jammed against the wall of the lift. When we asked representatives of Ladybrook Care Ltd about the lack of particular pieces of equipment we were told that they were in the building. We were also told that there were plans for one person to move rooms, so that they would
Care Homes for Older People Page 4 of 14 have more space. We also looked at some of the bathrooms. we saw that cleaning materials, including some containing bleach had been left there. There was a lack of paper towels to dry hands after washing, and there was only tablet soap, rather than the liquid soap that is less likely to spread infections. We also note during this visit there were no window restrictors on first floor windows. We asked to see a copy of any risk assessments relating to the windows but none were available. The weather on the day of the inspection was warm, and in spite of the conservatory doors being open and a fan being used, the room was very hot. No one who lives at the home was in the room, however we were concerned that this room could become to hot and could cause health problems for people at the home. We saw that there were some charts in the lounge which were to record the amount people drank. These charts had not been filled out since the 14 th July 09. We asked the Manager about these charts and she was unable to tell us whether they should have been completed or not. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 5 of 14 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 1 4 The Statement of Purpose must contain all the information that is required by regulation, including the number and sizes of rooms. A copy of this document must be provided to the Commission. The Commission must know what services and facilities a home provides, and any changes. 01/08/2009 2 3 14 Comprehensive pre 01/09/2009 admission assessments must be completed on each individual prior to moving to the home. This is to ensure that the service is able to meet the persons needs. 3 7 12 The arrangements, including 15/08/2009 space and equipment, for helping people to move or transfer must be reviewed. People must be safe from unnecessary injury caused by poor moving and handling practices. 4 7 15 People who live at Red Gables must have detailed care plans, based on 15/08/2009 Care Homes for Older People Page 6 of 14 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action comprehensive assessments. These documents must be developed and agreed with the individuals or their representatives. Staff need to know what help they are to provide. Written records help ensure that care is consistent. 5 7 13 Risk assessments must be comprehensive (covering falls, tissue viability, nutrition, self medication) and reviewed regularly. Risks should be managed positively to help keep people safe and to lead the life they choose. 6 8 15 Conditions such as diabetes must be identified in care plans, and their must be detailed accounts of how such conditions are to be managed. People need to know that their health care needs will be addressed. 7 9 13 Where people choose to self medicate, a risk assessment must be carried out to ensure that they recieve the right support and have the correct facilities People need to be supported to safely manage their own medication, where ever possible.
Care Homes for Older People Page 7 of 14 15/08/2009 15/08/2009 15/08/2009 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 8 9 19 Staff must be appropriately 15/09/2009 trained if they are to carry out invasive procedures. This training must be done by someone who is competent and is authorized in this area. Staff must be competent, so as to avoid harming people. 9 9 13 The controlled drugs cupboard must comply with current standards and be fitted with appropriate bolts to the wall. Medication must be kept safe. 15/08/2009 10 9 13 Medication must only be 15/08/2009 given to the person for whom it is prescribed. It is unsafe for care staff to give people medication that they are not prescribed and which does not belong to them. 11 12 6 People must be offered the opportunity to engage in a range of activities that meet their needs. Keeping active and involved helps maintain good physical and mental health. 15/09/2009 12 15 16 People who need a soft diet must be offered food that is well presented and appealing. 15/08/2009 Care Homes for Older People Page 8 of 14 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Pureeing a whole meal, means that the food is unappetizing. 13 15 13 Staff must be appropriately trained this should include dealing with choking and have a food hygiene certificate if preparing food. People need to be safe from unnecessary harm. 14 16 22 The Registered Provider must 15/08/2009 provide the Commission with a statement of the complaints made during the preceding 12 months (or from the time of registration), and the actions that were taken in response. The Commission needs to be confident that complaints have been properly managed. 15 16 17 The Registerd Provider must 15/08/2009 ensure that information relating to complaints is kept in the home and available for inspection. The Commission needs to be able to check at inspection that complaints are being properly managed. 16 18 12 The Registered Provider must 15/08/2009 ensure that all allegations of abuse are referred to the Safeguarding Process. People must be protected
Care Homes for Older People Page 9 of 14 01/09/2009 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action from abuse. 17 22 16 The Registered Provider must 15/08/2009 review the bedroom accommodation, to ensure that each person has sufficient space so that they can move or be assisted safely. Insufficient space can lead to people being moved incorrectly or equipment not being used. 18 27 18 The staffing levels must be 15/08/2009 reviewed to ensure that staff have sufficient time to carryout their duties. Lack of staff can lead to a poor quality of service for people in Red Gables. 19 29 19 Appropriate recruitment 15/08/2009 checks must be made to ensure that suitable staff are recruited. This must including two references and a POVA check prior to starting work. Staff must be suited to working with vulnerable people. 20 31 12 The home must be properly managed, ensuring that where issues have been identified, that action is taken to put things right. The Manager has a central role in improving the service.
Care Homes for Older People Page 10 of 14 15/08/2009 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 21 35 13 Any money held on behalf of 15/08/2009 people who live at Red Gables, must be kept safe, appropriately managed and properly accounted for. This includes keeping receipts and not loaning money. The people who live at Red Gables need to know that their money is kept safe and available to them. 22 38 13 Risk Assessments, including a fire risk assessment and legionella risk assessment must be completed and any checks or actions implemented. People must be protected from unnecessary risk of harm. 15/08/2009 Care Homes for Older People Page 11 of 14 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 1 22 13 Slide sheets and any other moving and handling equipment needed, must be both provided and in use. Lack of proper equipment can mean that both the people who live at Red Gables and the staff are put at risk of injury. This requiremetn was made on 11/8/09, with immediate effect. 11/08/2009 2 27 12 Sufficient staff must be 11/08/2009 provided at all times to meet the physical, emotional and psychological needs of the people who live at red Gables. Lack of staff means that peoples care needs are not being properly met due to insufficient time. This requirement was made on 11/8/09 with immediate effect. 3 38 13 Risk assessmsents must be completed and implemented in relation to risks posed by windows with unrestricted openings on the first floor. Falls from first floor windows could cause a death or serious injury. 13/08/2009 Care Homes for Older People Page 12 of 14 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 25 23 The temperature in the 20/09/2009 conservatory must be monitored to ensure that it is not too hot and would cause harm or discomfort. People who are immobile may not be able to leave the conservatory if it gets too hot. 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 Care Homes for Older People Page 13 of 14 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 14 of 14 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
