Inspection on 23/09/09 for Red Gables

This inspection was carried out on 23rd September 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 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 11/08/09

Red Gables 19/07/09

Red Gables 15/06/09

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 18/02/2010.

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: Gail Richardson     Date: 2 3 0 9 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 36 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 36 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) 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 36 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 36 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 was an unannounced inspection, which took place over seven hours on the 23rd September 2009 by Regulation Inspectors Gail Richardson and Mandy Norton. For the purpose of this inspection the term We will be used when referring to the Care Quality Commission. The last key inspection took place on the 15th July 2009 and due to concerns raised a further random inspection took place on the 19th July 2009. Following safeguarding alerts and concerns raised about the staffing levels and standard of care, the management of the home voluntarily temporarily suspended admissions whilst work was undertaken by the home to address the issues raised. Following improvements seen, admissions to the home were recommenced. A tour of the home took place and some of the bedrooms and all communal areas were Care Homes for Older People Page 6 of 36 seen. There were 23 people currently residing at the home with two of those people currently being in hospital. We spoke to nine of the people using the service and seven members of staff, the Manager Designate was available throughout the inspection. Some comments were also received from relatives of people using the service. Comments received from those surveys and, following discussion with people using the service, comments received are also included in this report. We looked at records relating to care including four care plans, three staff files, finances and health and safety records. The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: The registered person is recommended to review the Statement of Purpose/ Service User Guide to ensure that it contains all the information required. Any changes must have been agreed with the Commission. It is then recommended that all people receive an updated copy. Care plans, risk assessments and reviews currently being addressed also need to be continued to ensure each person has a detailed and updated care plan for staff to follow. Care Homes for Older People Page 8 of 36 Whilst medication systems appear to be improving the management of prescribed creams must be addressed to ensure safe practice is maintained. The continued development of safe systems of medication management is required. Further development is needed of activities provided to ensure that each persons social and recreational expectations are met. The home needs to look at how people decide their daily routines to ensure that people are aware of their options to come downstairs and partake in activities and social interaction. People need to be able to summon staff attention and access drinks when they need them. Systems need to be put in place to ensure that each person can get to a call bell and drink safely. Some aspects of health and safety need to be addressed. These include the correct storage of chemicals which may be hazardous to health. The safe management of laundry and subsequent risks of cross infection must also be addressed. The home needs to undertake an environmental risk assessment to find and address all areas of risk. This will also include bathrooms which are in need of refurbishment to ensure that they are safe to use. It should also include the risks of radiators which have a high surface temperature to ensure there is no risk of burns. Further staff training is needed to ensure that all staff have received mandatory training in all required areas. It is also required that all staff receive abuse awareness training to ensure that they are aware of situations of abuse and how to manage them appropriately. Staff recruited to the home must have received the appropriate checks prior to their employment. The registered person is recommended to undertake an annual review of quality and act accordingly in response to any findings. This will develop the service to specifically meet peoples choices, preferences and expectations. The policies and procedures at the home are recommended to be reviewed to be specific to the home. This will ensure that staff have the correct guidance that they need. 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 order line 0870 240 7535. Care Homes for Older People Page 9 of 36 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 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that people who are thinking about using the service, and/or their representatives, have the information they need to enable them to make an informed decision about moving to the home. The home has assessment procedures in place to ensure that it only offers a service to people whose needs can be met by the home. Evidence: The home has recently reviewed and updated the Statement of Purpose/Service User Guide. The document provides clear information for any prospective person using the service . Further detail is needed to ensure the range of room sizes is included. This is needed to ensure that people are aware of the difference in rooms and any associated difference in fee scale. The Homes Annual Quality Assurance Audit (AQAA)stated that The Service User guide Care Homes for Older People Page 11 of 36 Evidence: and Statement of Purpose has been reviewed and is being distributed to the residents and thier family or advocates. Only two people have received the updated version and further distribution is needed to ensure people are clear about the services available to them. Since the last key inspection changes have been made to the environment. It is required that all changes be included in the Statement of Purpose and that when updated this document is agreed with the Commission. This was discussed with the manager designate who has agreed to complete this action. We received four surveys from people using the service. One told us they had received sufficient information about the home and one did not receive the required information. People are able to test run the home and the manager designate explained that people can visit the home and spend time with other people using the service. People told us that they or their families had chosen the home. One person told us that their relative had chosen the home for them but they had selected the room themselves. We were unable to look at any recently admission assessment documents as nobody has recently been admitted. We will review this at the next key inspection. The manager designate told us that a new admissions assessment document is being used and that this would enable a wider scope of information to be documented. This is needed to ensure that the home can be sure that it can meet all areas of identified need prior to admission. The home is required to ensure that it can meet the needs of people considering and using the service. The home has had a significant change of staff in the recent months up to the inspection. Staff training has been increased and is required to continue to be provided to ensure that staff collectively and individually have the skills and experience to deliver the service and care the home offers to provide. Contracts were not available at this inspection and will be reviewed at the next inspection to ensure they contain clear terms and conditions of residency. Care Homes for Older People Page 12 of 36 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. Care plans are being updated to ensure all areas of assessed need have an appropriate plan of care to support both people using the service and staff. Further work is needed to complete this update. The homes procedures for the management and administration of peoples medication are being updated to ensure the safety of people using the service. People are treated with dignity and respect by the staff at the home and people value the staff members kindness. Evidence: During this inspection we examined four care plans in detail. The home is reviewing all care plans and updating them to a new documentation system, which is significantly more detailed and person centered. It is appreciated by the Commission that this process takes time to complete thoroughly. The care plans we examined included a copy of the previously used system, this is not Care Homes for Older People Page 13 of 36 Evidence: adequate to supply staff with the range of information and plans of care needed to ensure all needs were identified and met to a good standard. We looked at three other care plans of the new system. These were competed to varying levels and it was evident that these are a work in progress. The areas we looked at which had been completed , had been done to a good standard and were sufficiently detailed and person centered. Some areas however need to be improved. These included ensuring that night time care plans are in place for those people who are identified as getting up in the night. Further detail is also needed when people are mobilising to give specific details of moving and handling equipment to be used. The registered person must ensure that all risks identified have an assessment and plan of care to support that person to maintain independence safely. Furthermore staff should be encouraged to complete sections about monitoring and providing care given. There was some evidence that two family members had signed agreement with the updated care plan and this must continue to be reviewed. All people using the service should be encouraged to be involved in their care plan and sign their agreement. if this is not possible then the persons representative should then be involved in this role. Staff were seen to be updating each persons daily record with any care given that day. Care plans contained evidence that people have access to appropriate health care professionals. Each person is registered with a local GP. The home maintains detailed records relating to the persons contact with health care professionals. Care plans also contained information as to the individuals preferences with regard to preferred times for waking, retiring to bed, dietary preferences and bathing. People who had specific needs relating to wound care had the regular input of the visiting District Nurse and records of this were maintained at the home. Equipment to support Independence such as hoists and frames were seen where there was an assessed need. Since the last key inspection some people have changed rooms to enable staff to use moving and handling equipment with sufficient space to ensure the safety of all involved. People who spoke with us and surveys received confirm that people are happy with their care. One survey told us Most things are done well, Im quite happy another Care Homes for Older People Page 14 of 36 Evidence: said Im happy with what we have. However, one survey commented that the home could do better by More activities, cutting fingernails, more staff.They are busy. One person told us that it was difficult for some people seated in the lounge to access a call bell system or summon assistance or access a drink. The registered provider told us that a new call bell system implemented allowed for pendant call bells to be used. We were told that these would be put in communal rooms to alleviate this problem. It is recommended that staff be made aware of when people cannot access drinks and call bells to ensure people can summon assistance or get a drink when needed. Throughout the day we were able to observe staff interactions with the people living at the home. These were noted to be kind and respectful. People looked clean and well dressed. People told us that staff were always kind and people felt well cared for. They told us Its nice here, we are looked after very well, Its ideal really. Staff pop in, lifes pretty smooth here. and Staff talk to you like you are family- really excellent staff. The home employs both male and female staff and so any gender preference for carer could be accessed for people who express a preference. The medication systems appeared to be mostly managed to a good standard; some areas require further review to ensure that systems are safe. The home uses a pre packed blister pack system. People using the service have the option to self medicate should they want to and risk assessments are in place to ensure safe practice is maintained. These risk assessments are reviewed regularly to ensure people continue to be safe. It was noted that on one of these reviews the facility to self medicate was removed for the persons safety. The systems currently being used have recently changed and the staff member allocated to overview the medication systems appeared knowledgeable. It is observed that systems for procurement, administration and disposal are being developed to reflect best practice and will be reviewed again at the next key inspection. A new controlled drugs cupboard has now been fitted to meet the Royal Pharmaceutical Guidelines. Some improvements in practice are required. These include that staff request a confirmation by fax when variable medication doses are changed. This will provide a Care Homes for Older People Page 15 of 36 Evidence: safety check for people using the service and for the staff dispensing. Further advice must be sought from the doctor about checking of pulses when some medication is administered. It was observed that some prescribed creams did not have the correct label in place and in one case the label had been partially removed and the cream was being used for someone else. This practice was discussed at inspection and must be reviewed and discontinued. Furthermore there was no evidence to support when the prescribed creams had been opened. This is needed to ensure that they do not exceed their shelf life. It is recommended that all prescribed creams are clearly labeled, dated when opened and signed for when administered. All staff have received medication training appropriate to dispensing medication and a further plan is in place to provide staff with a further training program from the local dispensing pharmacist. Since the last key inspection further training has been sought in the specific areas identified. These include Blood Sugar monitoring and actions to be taken if someone chokes. Further training is planned from the District Nurse Service to assist staff to provide catheter care and some minor would care. Care Homes for Older People Page 16 of 36 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. Activities provided need further development to ensure that the home can meet each persons social and recreational interests. People are supported to exercise choice and control over their lives. Mealtimes are a pleasant and sociable dining experience Evidence: The homes Statement of Purpose/Service User Guide tells us that the home employs a full time Activities Organiser. The home does not currently employ an activities coordinator but is advertising the post . This means that staff are currently undertaking this role as well as their care duties. Staff told us that this was made possible by increased staff working in the home and continuity of this would be dependant on them having the time. Activities planned are advertised on a notice board in the home. The day before the inspection people had been offered the opportunity to play board games. We were told by staff that two people attended this activity. The day after inspection further activity was planned. Care Homes for Older People Page 17 of 36 Evidence: We observed that not many people came down to the lounge and the most people we saw in the lounge was five. We spoke with people using the service about this. Some people told us that they preferred their own company , some people told us that this was just the way it was. The manager designate is recommended to review how the decisions are made about people coming downstairs and ensure people are aware of their options. We looked at the social records in four care plans. The Manager Designate explained that these are new documents and continue to be developed. The Manager Designate is required to ensure that each person has a social history taken and this is used to develop activity which is person centered and reflects peoples choices and preferences. The activities undertaken should be recorded to included the level of participation and reviewed to develop activity provision for each person. The Statement of Purpose told us that there are clergymen of many denominations visiting the home. This was seen to be advertised and people told us that they have the option to attend. Visitors are welcomed at the home and there are no time constraints to visiting house. The homes Statement of Purpose told us that guests can stay for a meal with a small charge payable. The local library visits every 6 weeks to exchange books and newspapers are delivered to the home on request. People told us that they could get up and return to bed at a time of their choosing. They told us that they could move freely around the home and that they cold choose how they spent their day. One person told us I come down for lunch but prefer to come back and read in the afternoon. The home does not currently have anybody who needs an independent advocate. However the Manager Designate is prepared to investigate this further if needed. The home has a pleasant dining area which is easily accessible. People can eat breakfast in the dining room or their bedrooms as they choose. Coffee is served mid morning with a choice of homemade biscuits and cheese and crackers served. Lunch is the main meal of the day, a choice is available. Tea is a lighter meal and supper is also available. We observed lunch being served. This appeared to be well attended and a pleasant social experience. Wine was served and each table had vegetables and sauces served individually. One person told us The meals are very good , usually on time. The practice previously identified of storing cooked food for later serving Care Homes for Older People Page 18 of 36 Evidence: appears to have been discontinued. The cook was seen to be preparing the lunch within an appropriate timescale. We observed that some people chose to eat lunch served on a tray in their rooms. People told us that the meals had been A bit patchy and variable recently. However the home has employed a new cook and people told us that since then the meals had improved. The cook has been given the responsibility of setting the menu and is involving people using the service in the choices. One person told us Food is patchy, you get a choice, they offer the choice the day before Some people were seen to need help with eating and drinking and were supported in an appropriate manner by staff. Puree diets are now served individually to ensure that taste and texture is discernible. Care staff were seen to help serving lunch and we are advised that care staff also serve the evening meal. All staff have now completed the Basic Food Hygiene Certificate. We received three comments from staff who expressed this concern Employ a cook for tea time so the carers dont have to spend much time in the kitchen and not with the residents. Care Homes for Older People Page 19 of 36 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 told us that they are confident that any concerns and complaints would be acted upon appropriately. Further staff training is needed in abuse awareness to ensure the safety of people using the service. Evidence: The home displays its complaints procedure and has included it in the Statement of Purpose. People told us that they were confident that any concerns would be appropriately addressed by the Manager Designate. The four surveys received told us that three people know how to make a complaint and one did not. Staff surveys told us that they know how to make a complaint but one did comment that they felt the management of the home should Listen to staff when they have a genuine complaint and act on it. Another told us Give staff more support and pay attention to the verbal complaints reported by staff. The home has ongoing complaints and safeguarding issues which are currently being investigated. The home does not have any further complaints since the last key inspection. All people using the service are registered to vote in any future electoral process. The home has accessed the safeguarding policy for Cornwall and demonstrated an Care Homes for Older People Page 20 of 36 Evidence: increased insight into the processes involved. Staff training in abuse awareness has started. This is a cascaded training from the quality manager. Some staff told us that they had not yet received this training. It is required that all staff receives this training to ensure that people using the service are protected from the risk of abuse. Care Homes for Older People Page 21 of 36 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. The home provides a clean, homely and pleasant environment for people to live in. People are supported to furnish the room to their personal tastes. Some areas require some development to ensure the safety of people using the service. Evidence: The home is a converted building which comprises of 29 bedrooms over two floors accessible by stairs and shaft lift. There are 15 rooms with en suite facilities. The lounges and dining room are on the ground floor. There is a decked area outside and garden space. The home is a No Smoking home. There are bathrooms/ shower rooms available on each floor. The upper floor shower room is in need of refurbishment to ensure it is hygienic and appropriate for use. The ground floor bathroom was seen to be in need of refurbishment. The bathroom suite was damaged and there was a TV being stored there. This was removed at inspection. We have been advised that there are plans for the registered person to refurbish all bathrooms and this will be reviewed at the next key inspection. Several of the bathrooms were noted to have soap and communal toiletries. It is important that soap and toiletries are not shared as this can increase the risk of cross Care Homes for Older People Page 22 of 36 Evidence: infection. A selection of bedrooms and all communal areas were viewed during this inspection. It was apparent that people are encouraged to personalise their rooms and small pieces of personal furniture were evident. We saw two rooms which were shared. The standard of furnishings, fixtures and decor in bedrooms and en suites were generally of a good standard. The registered person must ensure that as rooms are changed for purpose the Commission is informed and changes agreed in the homes Statement of Purpose. The communal areas have been upgraded and identified areas such as the difficulty in maintaining a comfortable temperature in the conservatory have been addressed by the use of an air conditioning unit. New furniture has been purchased for the lounges and they appear pleasant and accommodating for small or larger groups. One staff member told us A lot of decorating of rooms has been done. Lounges and dining room are more homely. People told us that they liked their rooms. The previous key inspection highlighted that in some instances the size of the room made providing the care difficult. The home addressed this issue and have moved people to an appropriate size room to meet their needs. It was observed that some areas were under refurbishment to increase room size, make into suites or be developed to meet the needs of people using the service. One unused room on the upper floor had an unrestricted window which may pose a risk of falls to people using the service. This was restricted whilst the inspection was underway. It was observed that some rooms have radiators which have a high surface temperature. These may pose a risk of burns to people using the service. The registered person is recommended to risk assess each radiator and ensure appropriate action is taken to make each one safe. There is a range of bathrooms and toilet facilities with equipment for bathing either assisted or unassisted available to support people with personal hygiene. Hot water outlets are fitted with thermostats to ensure that they do not exceed the Health & Safety Executive recommended upper limits. Outlets checked at this inspection were within recommended limits. We were advised that records of these routine checks are maintained but were not available for us to see. Care Homes for Older People Page 23 of 36 Evidence: The home takes some steps to reduce the risk of the spread of infection. Liquid soap and paper towels are provided in some areas and staff have access to a good supply of disposable gloves and aprons. It was observed that not all areas have bins which were foot operated; this is recommended to reduce the risk of cross infection. The home employs one domestic staff each day and the home appeared to have a very good standard of hygiene and was fresh smelling. Four people using the service told us that the home is always clean. One survey told us The cleaning department is better, they have more staff on mornings now. The registered person is strongly recommended to undertake an environmental risk assessment. This will identify all areas of the home which may pose a risk to people using the service and enable a plan of action to be implemented to reduce that risk. Care Homes for Older People Page 24 of 36 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. The current staffing levels meet the needs of the people using the service. Further training is needed to ensure staff have all the skills needed to meet peoples ongoing and changing needs. Recruitment procedures require further development to protect people using the service from the risk of abuse. Evidence: We spoke with seven staff members during the inspection. We had identified at the previous inspection that a reduction in staffing available had made an impact on the care provided. The registered person has addressed this and increased the staff to ensure that peoples needs are met and that staff are supported to provide care in a timely way. One person told us that The home is now better, there are extra staff. Another told us new carers seem very good This person explained that they used the call bell staff came in a good timescale. On the day of inspection there were five people working in the home. All five were seen to be providing care. Staff told us that they had felt the benefit of the increased staff availability and that the increase had been consistently maintained. The home appeared calm and staff appeared to have the time to talk with people. Four staff surveys received commented that staff availability had improved. A further three staff surveys told us that mobility aids which were noted to not be available at the previous Care Homes for Older People Page 25 of 36 Evidence: inspection had now been made available. The home has implemented a means of relating peoples dependency to staffing levels. This enables changes in need to be identified and the need for changes in staff as a result. People using the service were all complimentary about the staff and told us that they felt their needs were being met. One survey received told us The care I receive is very good, improved since I have been here. A visitor to the home told us I can see massive improvements, senior staff are brilliant, Staff training has been implemented to support staff development and raise the standards of care and to support good practice. Whilst some training in moving and handling and basic food hygiene has been undertaken by most staff, some people still require updates in training. We appreciate that in the short term the training is being planned and that given an appropriate timescale the registered person has assured us that all staff will receive all mandatory training updates. We received three comments about training of which this is one example Outside training would be better, rather than in house training that is often not carried out. We will review this at the next key inspection. Specific training has been undertaken to address identified issues such as choking and monitoring of blood sugars. Further specific training is being sought to meet peoples needs. One staff survey told us that they felt supported and that There is always someone to put you right. Training has been provided to some staff in abuse awareness, further training is needed to ensure that all staff have a good knowledge of abuse awareness, the Deprivation of Liberty and Mental Capacity Act. This will enable staff to have Good insight and clear direction to the care they provide. Recruitment records were examined and found to contain most of the documented checks needed. However all staff must have two references in place prior to commencing employment. It was also discussed that when staff have received a Protection of Vulnerable Adults check (POVA) but prior to the Criminal Record Bureau Check (CRB) being received . It is essential that staff monitoring is planned and recorded to ensure the registered person can account for the staff members actions. Care Homes for Older People Page 26 of 36 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. The management of the home is currently stable and is providing support to enable the service to improve. The views of people need to be sought to ensure the service develops to meet peoples choices and preferences. Financial procedures have improved and are now safe. The home is developing safer working practices. Evidence: The management of th home has changed. The manager designate is Mr Stephen Difford who is also a director of Ladybrook care. This management change is a temporary measure whilst a new manager is recruited and trained. People using the service and staff told us that things had improved at the home. People found the manager designate to be supportive and approachable. One staff survey told us The present owners have havent been here long and are putting things right. Care Homes for Older People Page 27 of 36 Evidence: The Commission has requested that to enable a smooth transition of management that Mr Difford provide a sustained period of induction for any prospective new manager. The Commission feels this will support the staff and people using the service and maintain the improvements seen so far. Quality assurance surveys have not yet been sent to all relevant pepole. This is required to be undertaken to enable the management of the home to review the care provided and use the response to shape changes at5 the home. The home has not yet undertaken residents meetings but has plans to do this soon to enable people to voice their opinions. The financial procedures for peoples personal monies have been reviewed in a robust manner. The systems now in place are accurate and ensure that peoples individual monies are stored safely. Supervison of staff is ongoing and must be increased to ensure that all staff receive the opportunity to have one to one time with a senior member of staff no less than six times each year. This is recommended to identify staff training needs and support and develop good practice. Records were observed to be stored securely in line with the Data Protection Act. Some areas of health and safety require further development to ensure people remain safe. It was identified at inspection that some substances which are hazardous to health such as bleach and cleaning solutions were accessible around the home. We requested that these be secured and this was done immediately. It is required that all substances of this nature are stored securely and that staff are aware of the risks in there being left out. Some aspects of infection control require review. One staff member told us that some staff do not use the sanitary cycle on the washing machine for soiled clothes as It takes too long, so we soak them instead. We observed two bowls of soaking clothes in the sluice. We are not aware of the cleaning solutions being used. This is poor practice and may place people and staff at risk. We looked at the homes laundry management policy to see what this told staff to do. We identified that no such instructions were provided for staff. One staff survey told us Employ a laundry person to ensure the laundry is done properly. The policy must be clear for staff what is required of them to ensure good infection control procedures. Care Homes for Older People Page 28 of 36 Evidence: It was also noted that the meat slicer in the kitchen does not have the appropriate guard fitted and may place people at risk. This must be reviewed and the appropriate action undertaken to ensure its safety. Policies and procedures provided for staff were observed in some cases to be generic and lacked detail for them to be relevant at Red Gables. These need to be reviewed to ensure staff are clear of the actions they are to to take. Care Homes for Older People Page 29 of 36 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, Care Homes 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 15 People who live at Red 15/08/2009 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. Care Homes for Older People Page 30 of 36 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 4 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. 15/08/2009 5 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 6 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. Care Homes for Older People Page 31 of 36 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 18 12 The registered person must ensure that all staff receive updated training in abuse awareness. This is required to ensure that people are protected from the risk of harm and abuse. 27/11/2009 2 19 11 The registered person must ensure that as rooms are changed for purpose the Commission is informed and changes agreed in the homes Statement of Purpose. This will ensure that the Commission is aware and has agreed all the necessary changes to the fabric of the home. 27/11/2009 3 21 12 The registered person must ensure that all bathrooms and washing facilities are safe and in good repair. 27/11/2009 Care Homes for Older People Page 32 of 36 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 Ay repairs/ refurbishments need must be undertaken to ensure the safety of people using the service. 4 38 12 The registered person is required to ensure that staff are aware of the safe systems to manage soiled laundry. This will involve using the equipment provided and not the practice of soaking soiled items. 5 38 12 The registered person must ensure that all staff area aware of the laundry management of the home and that safe practices are followed. This will ensure that safe systems are in place for soiled laundry. 6 38 12 The registered person must ensure that all substances hazardous to health are stored securely. This is to protect people using the service from the risk of accidental ingestion 27/11/2009 27/11/2009 27/11/2009 Care Homes for Older People Page 33 of 36 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The registered person is recommended to ensure that all people using the service currently and all prospective people have a copy of the updated Statement of Purpose/ Service User Guide to provide them with information about the home. It is recommended that staff be made aware of when people cannot access drinks and call bells to ensure people can summon assistance or get a drink when needed. It is recommended that when prescribed medication doses are changed that fax verification is recieved by the home to enable an audit trail of any changes made. It is recommended that all prescribed creams are clearly labeled, dated when opened and signed for when administered. The manager designate s recommended to review how the decisions are made about people coming downstairs and ensure people are aware of their options. The registered person is strongly recommended to undertake an environmental risk assessment. This will identify all areas of the home which may pose a risk to people using the service and enable a plan of action to be implemented to reduce that risk. The registered person is strongly recommended to undertake an environmental risk assessment. This will identify all areas of the home which may pose a risk to people using the service and enable a plan of action to be implemented to reduce that risk. The registered person is recommended to risk assess each radiator and ensure appropriate action is taken to make each one safe. It was observed that not all areas have bins which were foot operated; this is recommended to reduce the risk of cross infection. Staff who have received a Protection of Vulnerable Adults check (POVA) but prior to the Criminal Record Bureau Check (CRB) being received . It is essential that staff monitoring is planned and recorded to ensure the registered person can account for the staff members actions. 2 8 3 9 4 9 5 15 6 19 7 19 8 25 9 26 10 29 Care Homes for Older People Page 34 of 36 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 11 33 The registered person is recommend to undertake an annual review of quality and act accordingly in response to any findings. The reggistered person is recommended to ensure that staff recieve supervision no less than six times each year to promote staff training and promote good practice. The registered person is recommended to ensure that the meat slicer used has the appropriate guard available and is suitable for its purpose. The registered person s recommended to update all generic policies to ensure they accurately reflect the policy of Red Gables. 12 36 13 38 14 38 Care Homes for Older People Page 35 of 36 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. 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