Inspection on 15/06/09 for Red Gables

This inspection was carried out on 15th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 22 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Red Gables 17/03/10

Red Gables 08/03/10

Red Gables 04/12/09

Red Gables 23/09/09

Red Gables 11/08/09

Red Gables 19/07/09

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

Key inspection report Care homes for older people Name: Address: Red Gables 59 Killerton Road Bude Cornwall EX23 8EU     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Helen Tworkowski     Date: 1 5 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 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: Name of registered provider(s): leedifford@btconnect.com Ladybrook Care Homes Ltd Name of registered manager (if applicable) Mr Andrew James Renshaw Type of registration: Number of places registered: care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 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 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. Care Homes for Older People Page 4 of 34 Over 65 32 0 Brief description of the care home 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 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This Key Inspection included a site visit. This visit took place between 8.00 am and 5.50pm on 15th June 09, and was carried out by one inspector on behalf of the Commission. As part of this inspection we sent surveys to the Manager for distribution to 30 people who live at the home and 28 of the care staff. At the time this report is being completed no surveys have been received by the Inspector. In addition we requested that an Annual Quality Assurance Assessment (AQAA) be completed, this has not been returned. The Manager, Mr Andrew Renshaw, was on leave at the time of this Inspection. Mr Stephen Difford, Responsible Individual, and two other representatives of the Company were present during the inspection. As part of this inspection we looked around the care home and tracked the care received by four people. We looked at records of care, Care Homes for Older People Page 6 of 34 at the medication system and daily recording. We talked with four of the people who live in the home and with five of the care staff. We were shown around the home by one of the staff and looked at some of the bedrooms and all of the communal areas. In addition we looked at the recruitment, induction and training of staff. We also considered how issues relating to complaints were managed and how people were kept safe from abuse. We looked at how money is managed on behalf of people in the home and at the way safety is managed. We spoke with a District Nurse who has regular contact with the home, and she told us her views. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Care Homes for Older People Page 8 of 34 order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who move to this home cannot be confident that their needs will be known about before they move, and therefore that their needs will be met following a move. People who are thinking about moving to the home are not always given the written information they are entitled, to help inform a decision about a move. Information about the home, in the form of Statement of Purpose, is incomplete. Evidence: We asked one person who had recently moved to the home about whether he/she had been given information about Red Gables. He/she said that whilst he/she had visited the home and had talked to the Manager, he/she had not been given any written information. People who are considering using the home must be given information about the services the home provides, in the form of Service User Guide. The Service User Guide should contain useful information about the home, including how to make a complaint and a copy of a sample contract. Care Homes for Older People Page 11 of 34 Evidence: We looked at whether a pre admission assessment had been carried out for two people who had moved to the home in recent months.We found that for one person the pre-admission assessment had been started but had never been completed. For another individual the information that had been provided by Social Services as part of their assessment, but had not been fully taken into account in the plan of care. It is important that such pre admission assessments are completed and are thorough as they help ensure that the person can be confident that their needs will be met. We asked to see a copy of the Statement of Purpose and Service User Guide, these documents should provide information about the service to people who live at the home, are thinking about moving, or who have contact with the home. When we looked at the combined Statement of Purpose and Service User Guide we noted that it did not contain all of the elements that are required, specifically a list of rooms and room sizes. The Commission must be informed of and agree any changes to this document. We found that changes had been made to the building in that the dining room and lounge had been swapped, and that there were further plans to make changes to the office and other storage areas. The Commission must be advised of these changes and must agree any amendments to the Statement of Purpose. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Registered Provider is in the process of updating care plans and developing risk assessments, however the documents that are currently in the home are insufficient to ensure that staff know what peoples needs are and how they should be met. Medication is not well managed. Evidence: We talked with four of the people who live at Red Gables about the care and help that they receive. Comments included The staff are very good and Its quite nice. People felt that they generally got the care and help needed. We looked at the information in Care Plans. These are documents that are based on an assessment, that should inform staff of what a persons needs are and how they are to be assisted. We were told by representatives of the Company that a new system of documents is being introduced, and care plans are being re-written. We looked at the existing care plans for six people. We found that the care plans, where they existed were not comprehensive, not always up to date and there was little evidence that individuals being consulted. One person confirmed that they had not been consulted about their care plan. From the information on file it was apparent that one individual had mental Care Homes for Older People Page 13 of 34 Evidence: health needs, however there was no information in the care plan to indicate what these were. Other individuals had conditions such as diabetes, however there was no diabetic care plan that would provide staff with the information that they needed to help individuals monitor their health. Some files had risk assessments relating to moving and handling but these were not always up to date. Information in daily notes indicated that one person was prone to pressure sores, however there were no assessments in relation to this problem. We talked with staff about the care that they provide, and was told by staff that following a reduction in the number of staff, they are frequently rushed and do not have time for people. One of the other difficulties identified was caring for an individual who needed a considerable amount of equipment to be used in the provision of care. We were told by staff that they are not able to do their job properly, because of the lack of space, and because of particular pieces of equipment such as slide sheets. This meant that the individual was lifted incorrectly, which is unsafe for the person and for the staff. We spoke with a District Nurse who has contact with the care home. She said that she believes that people receive a good standard of care. She said that they were called when needed and advice given was followed. The District Nurse also commented that all the interactions she had seen between staff and the people at Red Gables were very positive. This confirmed what we observed during the visit and comments made by people in the home. Staff knocked on doors before entering and spoke to people with respect. We looked at the medication and observed a senior member of staff administering medication, and this was done in an appropriate manner. We noted that some medication (movicol) that had been prescribed and supplied for one individual was being given to other people who had been prescribed the same medication. Medication must only be given to the person it is prescribed for, it is their property not the homes. It is also important in helping ensure that people get the correct medication, and that it is possible to audit the amounts of medication held. When we looked at the way medication was stored we found that the controlled drugs cabinet did not comply with current standards. We noted that some individuals were given the opportunity to self medicate. It is important that people have the opportunity to maintain their independence and receive the support they need. Therefore the Commission requires that risk assessments are completed in relation to people self medicating. When we looked for such a risk assessment, none were available. We asked the individual concerned if he/she had somewhere safe to lock their medication, such as a tin or bedside cabinet. No such facility had been provided by the home. We talked to staff Care Homes for Older People Page 14 of 34 Evidence: about the training they had received to enable them to assist with testing blood for sugar in relation to diabetes. We were told that the Registered Manager had trained staff. Such training must be provided by medical professional delegating the task, usually the district or diabetic nurse, and must be recorded. Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Red Gables are offered few activities, information about what is provided in the home is inaccurate. The food is generally enjoyed though consideration needs to be given to the needs of people who have difficulties swallowing. There are no rules at the home and people are free to make their own choices. Evidence: We talked to the people who live at Red Gables about the things that they do each day. We were told that there was little to do each day. One person told us that they do nothing and that sit in a chair all day and get stiff. We asked staff about activities and were told that staff do not have time to talk with people or do activities. We discussed this with the representative of the company and was told that they did provide activities. There is a bingo session every second week and residents have a film afternoon once a week, where a video or CD is put on the TV. We looked at the Service User Guide, a document that tells people about the home and saw that it states that there will be a full time Activities Coordinator. There was no Activities Coordinator. We asked people who live in the home if there are any rules, and we were told that Care Homes for Older People Page 16 of 34 Evidence: there were none. People could come and go as they please, and get up and go to bed when they wished. The homes usual cook was not working on the day of this inspection, and a cook from another home was working. The main meal was braised steak, mashed potatoes and vegetables. We were surprised to see that the vegetables and potatoes had been cooked and put in serving dishes at 10.50 a.m. for lunch at 12.30 p.m. We asked whether this was usual, and was told it was not. We asked about menus, the cook told us that the same meals were cooked each day in each of the homes owned by the Registered Provider. We asked the representatives of the company if this was the case and was told that the menu could be amended to reflect difference in homes and between individuals. We sat with one person who needed help to eat their meal. The food they were given had been pureed. If a soft diet has been prescribed then each element of the meal should be softened separately, rather than the whole meal pureed. This helps to ensure that the meal looks appetizing and so that each element can be tasted separately. We asked the people who live at Red Gables about the food and they were satisfied the meals. We asked one of the staff about one of the people who is prone to choking when they eat, whether they knew what to do if this happened. The member of staff told us that they did not know what they should do. We were told that the dining room had recently been swapped with the lounge. This was so that the dining room was closer to the kitchen. We were told that the residents were not happy with this change and one person had made a complaint about this on behalf of everyone. Details of this complaint were not available to be inspected. Concerns expressed about this change included that there was insufficient space, and that meals were very noisy, being disturbed by sounds from the kitchen. We noted that no one ate breakfast in the dining room and many of the residents also ate their tea in their rooms. Care Staff told us that they are now responsible for preparing tea, though not all of them had food hygiene certificates. Care Homes for Older People Page 17 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Red Gables feel confident to raise concerns. However, the proper process for Safeguarding people has not been followed when serious concerns have been raised. Records of complaints were not available for inspection in the home. This means that it is not possible to properly look at the way the home manages these issues. Evidence: We asked the people who live at Red Gables if they felt able to raise any concerns. They commented that they felt able to do this and that they would be listened to. We asked the representative of the company to see a record of complaints received. We were told that the information was not in the home, as is required by the regulations. From our discussions with staff and residents we were aware that at least two complaints had been made. We discussed one of these complaints with the representatives of the Registered Provider and the Responsible Individual, Mr Stephen Difford. It was apparent that one complaint concerned an injury to a person living at the home. The representatives of the Registered Provider, including the Responsible Individual, had carried out an investigation into this injury following a complaint by a relative. The representatives told us that they had taken the matter very seriously and had interviewed staff in their homes. However, it appeared that they had not considered whether this injury should have been reported to Social Services under safeguarding. It is important that such matters are reported before they are fully Care Homes for Older People Page 18 of 34 Evidence: investigated, so that the investigation can be coordinated by Social Services, who have responsibility in this area. We asked to see any paper work related to this matter and was told that it was not on site, and we were unable to see it. As has already been noted, we were also told that a complaint had been received in relation to the change of arrangements in the dining room. No documents or information was available on this issue for inspection. We were therefore unable to confirm whether the complaint had been appropriately managed. Care Homes for Older People Page 19 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Red Gables is generally well decorated with light and spacious communal areas. Whilst the home is clean and smells fresh, the arrangements for controlling infections should be reviewed. Evidence: As part of this inspection we looked around the home and saw some of the bedrooms and all of the communal areas. Work had just started on decorating the office when this inspection took place. Consequently things were not perhaps as well organized as they would have been. We were told that there were to be further changes in the way rooms are used. Such changes must be reflected in the Statement of Purpose, and the Commission must be given the opportunity to agree these. We found that the home was clean and generally in good order. We asked some of the people who live at the home about their rooms and they felt happy with them. As has already been noted earlier in the report, we considered that one of the bedrooms is very small for the occupants needs to be met safely and have required that this situation be reviewed. Staff told us that where there were double rooms they were shared by couples. We found that the dining rooms and lounges were well decorated, and furnished, though some of the chairs appeared very low for people who might have difficulties Care Homes for Older People Page 20 of 34 Evidence: with getting up out of low chairs. Some of the bathrooms we saw were in need of refurbishment- the flooring did not fit, taps were worn and difficult to use and the bath enamel damaged. We looked at the hoists and saw that they had been regularly maintained. We asked staff about using the bathrooms, and was told that the shower was very difficult to use, and they got very wet. We were also told that it was very difficult to maneuver hoists and wheelchairs in the ground floor bathroom, and the door had to be open during some of these transfers.We noted that one of the bathrooms lacked a pull cord to the call bell, and was told that this would be remedied. We looked at the laundry, this room had two tumble dryers and two washing machines, one of which was not working. The room is used to store some laundry and other items. We discussed with the Responsible Individual, Mr Difford, how the home would deal with an outbreak of an infectious disease. During this inspection we saw that staff were carrying soiled items around the corridor of the home. We also noted that not all wash hand basins had liquid soap and paper towels. The arrangements for controlling infections need to be reviewed and staff need to have appropriate training. Care Homes for Older People Page 21 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are in need of reviewing to ensure that following the recent reductions in staffing people get the care they need. The staff recruitment systems are not robust and this means that people who are not suited to the work, may be recruited. Evidence: We spoke with five staff during this inspection. Staff raised concerns that there had been a recent reduction in staffing. Previously there had been five staff on during the morning and four care staff on in the afternoon and evening. This had been reduced to four care staff on in the morning and three care staff on in the afternoon and evening. They said in addition to caring they were now expected to prepare the tea and carryout some cleaning duties. We asked staff what the impact of this was for residents at Red Gables. They told us that they do not have enought time to carry out their work and it is hectic. We were told that one person does not always get transfered properly using the right equipment because there is not the time. Also that there is not time to spend talking with residents and that daily notes are not always written up. We discussed this situation with the Responsible Individual, Mr Difford. He said that they had looked at the needs of people in the home and had based the staffing level on this assessment. Given the views of the staff, we believe that the staffing levels require reviewing to ensure that people are provide with an appropriate level of care and support. Care Homes for Older People Page 22 of 34 Evidence: We looked at the recruitment of staff since the new Registered Providers took over the home on 19th December 09. We found that one of the people who had been recruited without proper checks or references received. Another person did not have a check of the list of people who are prohibited from working with vulnerable people. We asked to see copies of an inductions, none were available. We looked at staff files to see if any supervision or one to one discussions with staff, had been provided. We found that most staff had not received any supervision, though there was some evidence that this had started to happen in recent months. We were told that there had been a recent training session in relation to moving and handling, and that staff had found this useful. As has already been noted elsewhere in the report skills deficits have been noted in relation to control of infection, food hygiene and in relation to dealing with incidents of choking. Care Homes for Older People Page 23 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Money held on behalf of the people who live at Red Gables is not well managed and some appears to be missing. Checks that should be done to help keep the house safe are not being carried out, and this could place people at risk. We therefore judge that the home whilst people feel satisfied with the care they receive, the home is only being adequately managed. Evidence: The Registered Manager, Mr Renshaw, was on annual leave at the time of this inspection. Mr Renshaw was employed by the previous owners of the home, and was the Registered Manager at the last inspection and continues in this role under the new Registered Providers. It was therefore of concern that many of the issues raised in the previous report, when the home was under Mr Renshaws management, are still outstanding at this inspection. We asked to see money kept on behalf of people living in the home. We looked at three lots of money, and found that money was missing for two people. We also found Care Homes for Older People Page 24 of 34 Evidence: that there was an IOU in one container, where money had been taken from one person and given to another. This money belongs to the individual and it is not for other people to lend. We looked at the accounts of money, most of the money spent was for items such as chiropody or hairdressing. There were no receipts, however the hairdresser had signed the account. How much money an individual has is private to them. Where there are financial transactions a receipt should be provided whenever possible. An immediate requirement had been made in relation to a similar concern at Red Gables when the home was last inspected under the previous owner. We asked to see the Fire Risk Assessment, a document that details the actions to be taken to avoid the risk of fire. The Responsible Individual told us that this had not been completed. We asked to see checks of the fire system, and was told that these had not been completed since March 09. We asked to see the Legionella Risk Assessment, and was told that the water had been tested. However, this is not a risk assessment. We asked about the quality assurance system, and was told that a meeting had been held with people who live at Red Gables and there relatives. They had been asked to complete questionnaires. We asked to see the results from this process, and was told that they were not available. Quality Assurance is more than asking people what they think, it must also involved analyzing the results and taking into account these views in planing future actions in the home. Care Homes for Older People Page 25 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 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. 01/09/2009 3 7 12 The arrangements, including 15/08/2009 space and equipment, for helping people to move or transfer must be reviewed. Care Homes for Older People Page 27 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 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. 15/08/2009 15/08/2009 15/08/2009 Care Homes for Older People Page 28 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action People need to know that their health care needs will be addressed. 7 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. 8 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. 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. 10 9 13 Medication must only be given to the person for whom it is prescribed. 15/08/2009 15/08/2009 15/08/2009 Care Homes for Older People Page 29 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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. 12 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. 13 15 16 People who need a soft diet must be offered food that is well presented and appealing. Pureeing a whole meal, means that the food is unappetizing. 14 16 17 The Registerd Provider must ensure that information relating to complaints is kept in the home and available for inspection. 15/08/2009 15/08/2009 01/09/2009 15/09/2009 Care Homes for Older People Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action The Commission needs to be able to check at inspection that complaints are being properly managed. 15 16 22 The Registered Provider 15/08/2009 must 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. 16 18 12 The Registered Provider 15/08/2009 must ensure that all allegations of abuse are referred to the Safeguarding Process. People must be protected from abuse. 17 22 16 The Registered Provider must review the bedroom accommodation, to ensure that each person has sufficient space so that they can move or be assisted safely. 15/08/2009 Care Homes for Older People Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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. 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 15/08/2009 Care Homes for Older People Page 32 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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. 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 15/08/2009 1 2 3 4 5 1 12 26 30 33 People who are thinking about moving to Red Gables should be offered a copy of the Service User Guide. People who live at the home should be consulted with about any changes to the arrangements at meal times. The arrangements for dealing with the control of infection should be reviewed and staff given appropriate training. Staff should receive training to ensure that are suitably skilled and competent in their role. The results of any surveys of views should be available and there should be evidence to show how these are taken into account in improving the service. Care Homes for Older People Page 33 of 34 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. 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