Random inspection report
Care homes for older people
Name: Address: Red Gables 59 Killerton Road Bude Cornwall EX23 8EU one star adequate service 15/06/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Gail Richardson Date: 0 4 1 2 2 0 0 9 Information about the care home
Name of care home: Address: Red Gables 59 Killerton Road Bude Cornwall EX23 8EU 01288355250 Telephone number: Fax number: Email address: Provider web address: leedifford@btconnect.com Name of registered provider(s): Name of registered manager (if applicable) Ladybrook Care Homes Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 32 Number of places (if applicable): Under 65 Over 65 32 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who may be accommodated is 32. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category:- Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Red Gables is a large detached house, standing in its own grounds, near the centre of Bude. It provides accommodation for 32 elderly people on two floors. A shaft lift and staircase connect the two floors. The majority of the bedrooms have ensuite facilities. There are a number of communal areas, including a lounge, a conservatory, and a
Care Homes for Older People Page 2 of 11 1 9 0 7 2 0 0 9 Brief description of the care home dining room. There are seating areas outside the home, and a patio area. The home is within walking distance of the shops for anyone who is reasonably fit. The current fee scal is (Correct at time of report) £308.00 to £400.00. This does not include hairdressing, chiropody, dental work and opticians. Some toiletries must also be privately purchased. Care Homes for Older People Page 3 of 11 What we found:
This was a random unannounced inspection, which took place over 3.5 hours on the 30th November 2009 by Regulation Inspector Gail Richardson The purpose of the inspection was to ensure that peoples needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that the requirements made at the key inspection had been met within the timescale stated. We spoke to four people using the service, and five members of staff, the Manager Designate was available throughout the inspection. We looked at care records for four people, three recruitment files and further documentation relating to the management of activities. We found that six requirements had been met and a further requirement has been made, further requirements are under review. Three good practice recommendations have been met. What the care home does well:
The Statement of Purpose/ Service User Guide has now been updated to reflect the range of room sizes available and total amount of rooms. Pre admission assessments were seen to have been completed to a good standard. The documents used have been improved to incorporate a more detailed assessment. This is important for the home to establish that they can meet peoples needs prior to admission. Risk assessments are now in place for each person to identify the level of risk and actions to be taken to manage the risk positively to keep people safe whilst leading the life they choose. The service has reviewed how people using the service can attract the attention of staff and access drinks in the communal areas. people using the service told us that staff are more frequently available and that they can use the call bell. The Manager Designate told us that pendant alarms have been purchased for the use of people in the conservatory and around the home to enable staff to be alerted at any time. The kitchen staff have undertaken to prepare drinks and staff have received further instruction about ensuring they leave each person with a drink. Activity provision is being developed to ensure that each person is offered a form of recreational pastime each day. An overall view was seen and 14 out of the last 30 days record activity provided. There is a notice board in the corridor which advertises these activities. The Manager Designate told us about a breakfast club which had been introduced to encourage people to dine together each morning to develop friendships and promote interaction. Numbers of people attending was increasing and 12 people had attended at the weekend. There are records of peoples participation or choice not to be involved located in each persons care plan. People are being encouraged and supported to come to the communal lounges more regularly and people were seen at inspection to be having their hair dressed and chatting between themselves.
Care Homes for Older People Page 4 of 11 The management of the service have undertaken a residents meeting, a relatives meeting and a staff meeting. These have been recorded and all areas identified addressed. This has been undertaken to audit the views and opinions of all concerned to monitor the quality of the service provided. This is good practice and we will continue to monitor this development at future inspections. The Manager Designate has started to implement staff supervisions with a view to this taking place for each staff member every 6 weeks. This is recommended to promote the ethos of the home and is an opportunity for staff to discuss any issues and training needs. This will be reviewed at the next key inspection. The meat slice in the kitchen, which was noted to not have a guard in place has been removed from the home. What they could do better:
The registered provider must also ensure that all rooms which have a change off purpose such as bedrooms changed to double rooms or dining room changes, are agreed with the Commission and an updated Statement of Purpose provided. When this document is updated it is recommended that it is supplied to all people using the service and people who may view the home with a view to possible admission. This is needed to enable people to have accurate and up to date information about the service. There are 22 people currently using the service. The home has competed 14 of the 22 care plans. An agreed timescale of a further 3 weeks was agreed for the completion of the records. The Commission must be informed of the completion of these records. The care plans which have been completed are detailed and person centered. They have been completed to a very good standard which enables staff to have clear instructions about the care people need and their choices and preferences. The 8 which have not yet been completed have in place risk assessments and auditing tools for nutrition and moving and handling. For those 8 people staff must rely on the information supplied at handover to note any changes or updates in care needs. This may place people at risk and addressing this must be a priority. Staff complete a daily record for each person and have a record of personal care provided. We reviewed the recommendations made with reference to the management of medications. It became apparent that the use of fax messages to confirm medication changes had not been taken place as the home does not have a fax machine. The Manager Designate confirmed that the local chemist has agreed to supply the home with a fax machine. We will review this at the next inspection. We reviewed the management of prescribed creams. We observed that one person had four creams which were not named and dated. This is needed to ensure that the correct cream is being supplied and used in the correct manner. This must be addressed and will be reviewed at the next inspection. The management of the service has recruited 7 new staff. We sampled 3 staff recruitment records. Only one file was seen to be complete. The remaining two had incomplete employment histories with gaps which had not been explored or the reasons recorded. Both records only had one reference when it is required that two be obtained.
Care Homes for Older People Page 5 of 11 This lack of appropriate checks may place people using the service at risk and must be addressed as a priority. Two files did not have a photograph and all three did not contain a start date. Because of this we could not establish that a Criminal Record Bureau Check and Protection of Vulnerable Adults Check had been received prior to the people starting work at the home. Records showed that all staff had undertaken an induction program and we are advised that this includes staff training in abuse awareness. The Manager Designate told us that all staff were undertaking this training, some had completed the training and records of this were seen. We looked at the bathrooms we had viewed previously. We noted that one bathroom which was in need or repair/ refurbishment is currently underway. We requested that a notice be put on the door to confirm that it was not in use to avoid any accidents. Another bathroom was noted to have hot water in excess of 50 degrees. This was adjusted at inspection to be within acceptable limits. It is concerning that the temperature had been turned up without the Manager Designate being advised. This may cause a high risk of burns. Staff training must be undertaken to ensure that this does not happen again. We noted that one shower room had cleaning solution and an opened dressing in the cupboard. Another bathroom had communal toiletries and sponge. Further staff training is needed to ensure that staff are aware of the risks of cross infection from sharing toiletries and equipment. We viewed the laundry. It was observed that substances hazardous to health such as bleach and Milton solution were accessible. This was addressed at inspection. However, this was also noted at the previous inspection and staff must be aware of the risks of accidental ingestion. At the previous inspection we noted laundry systems in place which may cause cross infection. Staff are now using alginate bags to transport and wash soiled laundry. We were advised that soaking in sinks of soiled items no longer takes place. We noted that two signs in the laundry said. Laundry must be streamed before they are put in to soak. This advice may be confusing for staff and does not correspond with the laundry policy of the home. The Manager Designate is recommended to review these notices and ensure that staff are clear about the management of laundry at the home. The Responsible Individual has confirmed that he will forward to the Commission the updated environmental risk assessment to include risk assessments for radiators which do not have low surface temperatures. He will also forward confirmation that the homes policies and procedures have been updated to reflect accurately the actions required by the service. The Manager Designate confirmed that foot operated bins have been ordered for all areas where clinical and incontinence products are used. This will reduce the risk of cross infection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 19 11 The registered person must 27/11/2009 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. 2 21 12 The registered person must ensure that all bathrooms and washing facilities are safe and in good repair. Ay repairs/ refurbishments need must be undertaken to ensure the safety of people using the service. 27/11/2009 3 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. 4 38 12 The registered person must ensure that all staff area 27/11/2009 Care Homes for Older People Page 7 of 11 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 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. Care Homes for Older People Page 8 of 11 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, 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 37 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 11/12/2009 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 all prescribed creams are clearly labeled, dated when opened and signed for when administered. 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. The registered person is strongly recommended to undertake an environmental risk assessment. This will
Page 9 of 11 2 9 3 9 4 19 Care Homes for Older People 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 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. 5 24 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. 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 s recommended to update all generic policies to ensure they accurately reflect the policy of Red Gables. 6 26 7 32 8 35 9 38 Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 11 of 11 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
