Random inspection report
Care homes for older people
Name: Address: Red Gables 59 Killerton Road Bude Cornwall EX23 8EU one star adequate service 23/09/2009 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 8 0 3 2 0 1 0 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 10 0 4 1 2 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 10 What we found:
This random inspection was carried out by Regulatory Inspector Gail Richardson over a 5 hour period. The purpose of the inspection was to look at the requirements made at the previous key inspection on the 23rd September 2009 and random inspection on the 4th December 2009. We also looked at the actions taken by the home to address concerns raised with them in the interim period. At the time of this visit there were 23 people living at the home, two of whom were currently in hospital. During the morning there were on duty, the manager designate, 3 care assistants, one cook, one kitchen assistant, one cleaner and one maintenance man. The Responsible Individual also attended the home for a period of the inspection. As part of the inspection we, the Commission, were took a tour of the building, spoke with four staff members and three people using the service. We looked at care records relating to two people and we looked at staff rotas, staff training records and staff recruitment files for 3 staff members. What the care home does well:
People using the service who spoke with us told us that they were happy at the home and happy with the service provided. They were very complimentary about the standard and variety of meals available. The manager designate has addressed all concerns raised with the service in a robust manner. Extra training needs identified and ongoing supervision mean that staff practices have developed and improved to support people using the service. The management of substances hazardous to health has improved. Staff are now aware of the risks of leaving these substances unattended and the risks of accidental ingestion. The management of the laundry with relation to previous practices of soaking clothing in the sink has been addressed. The laundry also now has a key pad access system to the laundry to ensure the safe storage of cleaning solutions. The manager designate demonstrated that the service includes the input and support from visiting health professionals to ensure that peoples needs can be met. There was evidence that the district nurse service and dementia liaison staff visit the home and their opinions are sought to support both people using the service and staff. Care plans are now completed for each person using the service. These are detailed and support a person centered approach to care. They provide a clear audit trail of how decisions are made which affect peoples care.Two files seen, needed to be updated to reflect that changes in care had been implemented. This update must be included to ensure that staff are clear of what care they are required to give. The home now has a fax machine in place to enable medication changes to be faxed through as a written record of verification. This provides a clear audit trail to support staff information. Care Homes for Older People Page 4 of 10 All prescribed creams, except for one, are now clearly named and dated to establish who they are prescribed for and when they were opened. This prevents any confusion and enables the shelf life of stock to be managed appropriately. We looked at the management of accidents. we saw that a system is in place whereby if falls take place they are included as part of each individuals monthly review. The reason for the fall is investigated and an action plan put in place as part of a risk assessment and plan of care. This plan then continues to be reviewed. What they could do better:
Staff training is ongoing. However, there are periods of time when staff on duty do not have a designated person who has undertaken the medication training to establish competence in this area. This means that the on-call manager designate or deputy manager would need to be called in to administer medications. This may cause delays in medication being available to people using the service. This may also pose a risk to staff members who have the responsibility of holding the keys for medication they are not trained to administer. Further training is taking place to ensure that at any time a suitable trained member of staff is available to administer medication. CQC request that we are advised when this situation has been suitably addressed. One person using the service told us that some staff are sometimes a little sharp with them. They told us that this was because the staff are very busy and get tired. Staff also confirmed that they were busy. We looked at the staff calculations in relation to the assessed level of dependency and found that the home exceeds the hours indicated as needed by the dependency tool. However, the dependency assessment had not been undertaken since January 2010. Other contributing factors must also be considered, such as, new staff starting work, sudden increases in short term dependency, geographical layout of the home. These factors must be considered at the time of staffing and not at a later point. The registered person must ensure that the dependency level is assessed regularly to ensure that the staffing level is appropriate for the current time and not used as a reflective measure. The upper floor shower room and ground floor bathroom continue to need maintenance to ensure that they are suitable for people using the service. The upper floor shower is difficult for people using the service to access due to the raised edge around it. The ground floor bathroom also requires further attention as the sealant is black and stained. A further bathroom is under development to provide a suitable bathroom for people using the service. We were told by people at the home that the delivery of hot water is sometimes a problem, in that, the water is not hot enough. We discussed this with the responsible individual who says that hot water leaves the tank at the correct temperature but may sometimes be cool if the tanks are used up. The delivery of hot water must be reviewed to ensure that suitably heated water is available when needed. We observed that several wardrobes were not secured to the wall and may pose a risk of tip/tilt injury to people using the service. We recommend that these be risk assessed and appropriate action taken to remove any such risk. As part of reviewing the previously made requirements we reviewed the recruitment files
Care Homes for Older People Page 5 of 10 for three staff members. We have identified at both the previous key inspection and subsequent random inspection that recruitment procedures were not robust and may place people using the service at risk. We have been advised by the Registered Provider and Quality Manager that this requirement had been addressed. On review of these files it was found that this requirement had not been addressed within the stated timescale and continues to not be addressed in a robust manner by the company. We found that there were unexplained gaps in employment history which identified that references had not been requested from the most recent employer. Reasons for leaving had not been investigated. Criminal Record Bureau checks used as portable had not been investigated or replaced by Ladybrook Care. Not all staff have two references in place. One person had not received any references. These people had been employed and working at the home unsupervised. The registered person has agreed to audit all recruitment files and provide CQC with assurance that all recruitment checks identified have been put in place and appropriate actions taken in the interim. The agreed date for this to be completed was within 5 days. This area will be reassessed at this time. 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 10 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. Care Homes for Older People Page 7 of 10 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 9 13 The registered person must 23/04/2010 ensure that there is a suitably trained staff member on duty who has the skills and competence to administer medication. Appropriate on call arrangements must be in place until such a time that the home has a competent medication administration staff available in the home. This is required to ensure the safety and well being of people using the service. 2 27 12 The registered person must 24/03/2010 ensure that the level of dependency of people using the service is accurately and currently reflective of staff complement. The dependency and associated staffing level must be reviewed at the time and not undertaken reflectively. This is required to ensure that there are sufficient staff on shift at all times to meet Care Homes for Older People Page 8 of 10 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 the needs of people using the service. 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. The registered person is recommended to risk assess each radiator and ensure appropriate action is taken to make each one safe. The registered person is recommend to undertake an annual review of quality and act accordingly in response to any findings. The registered person is recommneded to undertake a risk assessment for all free standing units, for example, wardrobes. The registered person must take the appropriate action to ensure that there is no risk of tip/tilt injury to people using the service. 2 24 3 32 4 38 Care Homes for Older People Page 9 of 10 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 10 of 10 - 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!
