CARE HOMES FOR OLDER PEOPLE
Red House St Annes Road Bridlington East Yorkshire YO15 2JB Lead Inspector
David Blackburn Unannounced Inspection 11th January 2006 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Red House Address St Annes Road Bridlington East Yorkshire YO15 2JB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01262 676836 01262 401183 Humberside Independent Care Association Limited Mrs Gail Burns Care Home 48 Category(ies) of Dementia - over 65 years of age (48), Old age, registration, with number not falling within any other category (48) of places Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To admit one service user under 65 years of age. Date of last inspection 3rd August 2005 Brief Description of the Service: Red House is a large single storey purpose built home situated in the seaside resort of Bridlington. It is located in a residential area of the town within walking distance of the seafront, shopping centre and local facilities and amenities. Public transport passes the door. There is a car park. Level access is available to all external doors. All bedrooms and services are located and operated on the one floor. The building comprises two units Bayle and Burlington. All bedroom accommodation is provided in single rooms, some of which have an en-suite facility. Communal toilets and bathrooms are suitably positioned throughout the home. There is a large secure and private outdoor garden and seating area. Red House accommodates people admitted by virtue of old age or infirmity, some of whom may be suffering from dementia. The staff provide personal care, an in-house catering service, laundry service and a domestic and cleaning service. Staffing cover is available throughout the 24hours each day. Leisure and recreational facilities are offered in-house. Residents are registered with local general medical practitioners who address their primary health care needs and can access the more specialised health services as required. Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection upon which this report is based was the second to be carried out in the inspection year April 2005 to March 2006. It was carried out over five hours including preparation time. The focus was on those key standards not assessed at the first inspection in August 2005 together with those that were the subject of a requirement or recommendation. An inspection of some parts of the premises including a small number of bedrooms was undertaken. Documents including care plans, case files and policies and procedures were examined. One staff file was seen. Discussions were held with the registered manager, care staff, catering and domestic staff. A number of residents and visitors were spoken with and their comments are included in this report. What the service does well:
Staff in the home were very much focused on the needs of residents which had been well assessed and recorded. A high level of satisfaction was noted in discussion with residents and visitors. Residents were at the forefront of all work undertaken by staff whether in direct care, provision of food or maintenance of the building. Residents and visitors praised the manager and her staff team for the high standards achieved and maintained. Good attention was paid to the dietary needs of residents with the catering staff providing a choice of wholesome, nutritious and well-presented food. Residents and visitors (who had eaten at the home) were very complimentary towards the service on offer. The building was well maintained, clean and odour free. The housekeeper and her staff took great pride in providing a homely and safe environment for residents and visitors. Sufficient care staff were employed, a number of whom had achieved a National Vocational Qualification. Good recruitment procedures were in place to safeguard residents from harm. There was a firm accent on training, both induction and on-going. Visitors commented that there was a definite awareness of residents’ needs especially those with dementia. The home was well managed with attention given to matters of health and safety to ensure the premises were a safe and secure place to live and to visit. Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Residents were assured their needs and choices would be properly assessed prior to admission ensuring they would be fully known and understood. EVIDENCE: The files of residents (3) admitted since the last inspection in August were examined. They all contained appropriate pre-admission information and assessments. The files had a full assessment and initial care plan provided by the placing authority or present carers. The registered manager said she visited all prospective residents wherever possible. If this was not possible because of distance then a discussion was held over the telephone. This further information was recorded on the file. All the assessments seen were comprehensive in nature and recording. They clearly detailed each resident’s strengths and needs and how those needs were to be met. The registered manager said she took the final decision as to whether an admission was appropriate based on the information gained.
Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9. There was a clear and consistent care planning system in place to adequately provide staff with the information they needed to properly meet residents’ needs. Improvements to medication procedures ensured the promotion of residents’ good health. EVIDENCE: All residents had an individual care plan kept under separate cover. A number were seen and examined. A new care plan format was being introduced that it was believed would provide ease of reference, retrieval of information and use. Residents’ individual strengths and needs were fully recorded under a number of headings of daily living, for example personal care and nutrition. The assessment of needs was then transferred to support plans that showed the objective to be achieved, how and by whom. Risk assessments were completed as and when required, with appropriate updates. Care plans were formally reviewed every six months and those seen had the reviews signed and dated by the residents or their representative. These formal reviews were supported by monthly evaluation of needs carried out by
Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 10 key workers (a staff member with particular responsibility for one or more residents). Copies were seen. Any changes were recorded on the care plan. A daily record of events as they affected the individual resident was also maintained. A number of care plans were audited by the registered manager each month and copies of the audit sheet were seen. Residents and visitors felt individual needs were known and acted upon. All felt the care given was appropriate and met requirements. Proper procedures and systems were now in place for the receipt, storage, administration, recording and return of medication. The registered manager was carrying out regular weekly checks on all aspects of the medication procedures. All staff who administered medication had received external training. Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15. The meals in this home were very good offering both choice and variety and catering for special dietary needs. EVIDENCE: Good attention was paid to detail in the catering service provided in the home. The chef and his staff were well qualified and experienced in providing a catering service for older people. They were able to discuss the dietary needs of the resident group and how they were to be met. The menu was devised centrally but subject to change given individual choice, preferences, likes and dislikes of the residents in the home. Fresh produce was used wherever possible. All pies, cakes, etc were made in the home in preference to buying in ready prepared items. The midday meal was observed. Food was served by staff from hot trolleys in the kitchenettes. It was well presented. A choice was offered of main course and dessert. For those on dietary restrictions, the same desserts were offered that had been prepared with low sugar or low fat content. Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 12 For those needing assistance, help was provided discreetly, quietly and with the minimum of fuss or disruption. The required aids in terms of adapted cutlery and crockery were readily available to help residents maintain their independence in eating. All residents were extremely complimentary about the catering service provided in the home. One visitor who had taken a meal at the home was full of praise for the quality and quantity of food provided. A record of all food provided was now maintained. The last inspection of the kitchen by the Environmental Health Service recorded no requirements nor recommendations. Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 0 None of these standards was assessed. EVIDENCE: Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Staff’s clear attention to detail in the maintenance of the premises meant the home presented as a homely and comfortable environment for residents. EVIDENCE: The premises were well maintained internally and externally. Attention was given to the proper maintenance of the property. The building was a single storey with enclosed private gardens and courtyards. A brief tour of the premises was undertaken. A small number of bedrooms were seen. All parts of the home were in good decorative order, with re-decoration carried out as part of a rolling programme. Furnishings, fabrics and carpets were in good condition. Some new furnishings had been ordered. A number of bedrooms had an en-suite facility. There were however sufficient communal bathrooms and toilets. Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 15 Wheelchairs and other equipment was being stored in appropriate areas rather than bathrooms. Those parts of the premises seen were clean, tidy, warm and odour free. In discussion with the housekeeper, it was acknowledged that continence management was a daily on-going task. However staff were diligent and thorough in their efforts to combat and eliminate any odours. The housekeeper stated that the domestic staff were provided with the necessary equipment and cleaning products. A separate laundry was in use with dedicated staff. Appropriate systems were in place to ensure the proper laundering of bedding, linen, towels and personal clothing. A visitor made complimentary remarks about the domestic staff. She said the building was always warm, clean and free from any odours. Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Residents’ overall care was promoted by a properly recruited, well-trained, competent and highly motivated staff team. EVIDENCE: The staff rota for January and February was seen. The numbers on duty on each shift appeared sufficient to meet residents’ current assessed needs. The higher dependency unit had more staff on duty to meet the greater demands of the residents. Extra staff were employed on both units at peak times. Personal care staff were supported by the registered manager, care managers, activities organisers, catering and domestic staff. The registered manager said the role of the carers was strictly to give personal care. Other duties were carried out by the ancillary staff. There was adequate night staff cover. The registered manager said she carried out night-time “spot checks.” Of the 27 care staff, 12 had a National Vocational Qualification to level 2 with five having the award at level 3. A further five were working towards this award. Robust recruitment and selection procedures remained in place. Examination of the file of the last staff to be appointed showed these procedures were being followed.
Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 17 Attention was given to training. Staff received a five day block induction offsite and had to complete the course before they could give personal care. Ongoing training with updates was offered to all staff with courses relevant to their particular role in the home. Certificates were seen. Regular supervision and appraisals identified training and development needs. Residents and visitors were very complimentary towards all staff in the home. Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 and 38. The home was well managed providing residents with a safe and secure place in which to live. EVIDENCE: The registered manager was experienced, knowledgeable and competent to manage the home. She had achieved the Registered Managers (Adults) NVQ4 award in March 2005 and a National Vocational Qualification in care to level 4 in January 2006. She displayed a good and sound knowledge of all matters related to the management and running of a care home for older persons. Staff spoke in complimentary terms about her management ability, supervisory role and the general support she gave. Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 19 The registered manager held money for some residents. Money was banked under an umbrella account held in the home’s name. This system had been agreed with the regulatory authority. Records showed the daily balance for each resident, both of money held in the home and in the bank account. Residents and visitors expressed their satisfaction with this system. Proper attention was being given to matters of health and safety. Some safety certificates were held centrally. The fire manual was seen and examined. All certificates and records were up-to-date. Risk assessments were in place. Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? NO. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Red House DS0000019714.V277469.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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