Inspection on 21/07/08 for Red House Residential Home

This inspection was carried out on 21st July 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Red House Residential Home 31/07/07

Red House Residential Home 07/08/06

Red House Residential Home 06/03/06

Red House Residential Home 07/07/05

Red House Residential Home 17/02/05

Red House Residential Home 02/10/04

Red House Residential Home 24/03/04

Red House Residential Home 05/11/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Red House Residential Home Meadow Lane Sudbury Suffolk CO10 2TD Lead Inspector Julie Small Unannounced Inspection 21st July 2008 09:50 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 Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 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 Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Red House Residential Home Address Meadow Lane Sudbury Suffolk CO10 2TD 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) 01787 372948 01787 377528 regmanager@btconnect.com The Red House Welfare and Housing Society Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st July 2007 Brief Description of the Service: The Red House is registered as a care home for 34 older people. The Red House Welfare and Housing Society was founded after the Second World War by a group of local religious, civic and business people on a non-profit making basis, to provide communal accommodation to meet the needs of older people. The home was opened in 1950 and has been extended over the years. The original house is 18th century and set in its own gardens enclosed by an unusual ‘crinkle-crankle’ brick wall. The grounds are very well maintained and provide a pleasant and substantial area for residents to take short walks. The home is sited very close to the centre of Sudbury and there is a range of local facilities within walking distance for the more able. Bedroom sizes vary although all are designed for single occupancy. Within the home there are four small flats, two of which have been made by converting the former accommodation known as ‘Matron’s flat’. Communal space is located on the ground floor and consists of two spacious lounges and a pleasant dining room. There is a shaft lift to carry residents to the first floor. The fees for accommodation in the home range between £422.00 and £565.00 per week depending on the accommodation occupied. Respite fees are set at £60.00 per night. Fees do not include hairdressing, chiropody, telephone accounts, newspapers and specialised toiletries. The service does provide some basic toiletries if required. Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The unannounced inspection took place on Monday 21st July 2008 from 09.50 to 18.15. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. The deputy manager was present for part of the inspection and provided the requested information promptly. Not all records were available for inspection, the manager was on leave during the inspection and staff did not have access to records, such as people’s financial records, complaints records and staff recruitment records. During the inspection the care plans of five people who lived at the home, the home’s policies and procedures and fire safety records were viewed. Further records viewed are detailed in the main body of this report. Twelve staff members and six people who lived at the home were spoken with. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) and surveys were sent to the home to provide people with an opportunity to share their views about the service. The AQAA, nine service user surveys, five staff surveys, three relative/friend surveys and one health professional surveys were returned to us. What the service does well: The home was clean, well maintained and attractively furnished. People spoken with reported that they were happy with the environment that they lived in. The home’s grounds were well maintained and attractive. People spoken with were complimentary about the support that they were provided with and the attitude of the staff toward them. They reported that staff treated them with respect at all times. Staff spoken with had a good knowledge of their roles and responsibilities and were committed to providing a good quality service to the people that lived at the home. Comments received from the service user surveys included ‘the resident is very appreciative of all (the person’s) care that (the person) receives and that staff are very friendly’ and ‘good out weigh the bad’. Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 6 Comments received from the relative/friend/visitor surveys included ‘most services very good, very homely and excellent catering’, ‘the residents are treated respectfully and as individuals. I love to see the fresh flowers in the entrance hall. The garden is always beautiful and the staff helpful and friendly’ and ‘treat everybody with great warmth respect and dignity at all times’. What has improved since the last inspection? What they could do better: There had been some improvements in the provision and record keeping of staff training. However, there were shortfalls in the training provision which did not ensure that staff were appropriately trained to safeguard people that lived in the home. Newly appointed staff were not provided with a Skills for Care Common Induction Standards induction course and staff had not been provided with safeguarding training. The home’s Statement of Purpose and complaints procedure needed to be updated to show the current contact details of CSCI (Commission for Social Care Inspection) and reference to the previous inspection commission in the complaints section of the document should be amended to CSCI. To ensure that people were informed of who they could contact with concerns and the inspection and registration of the home. The home’s policies and procedures had not been reviewed since October 2004 and needed updating to provide the information to staff that they needed to safeguard people and meet their needs. It was noted that there were no policies that related to safeguarding, working with people who displayed aggressive behaviours and the infection control procedures required further information which advised staff of good infection control procedures when working with people with infectious diseases. Arrangements to ensure that records, such as staff recruitment records, complaints records and people’s financial records, are kept in the home and available for inspection must be made. Alternative methods of recording in the home’s ‘communication book’ must be provided to ensure that people’s confidentiality is maintained. Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 7 The pre-admission assessments that were viewed did not provide sufficient information regarding people’s individual needs and diagnosis of mental illness to ensure that the home was appropriately equipped to meet the people’s needs. The home had not ensured that they had the appropriate equipment to meet people’s needs prior to them moving into the home. Risk assessments had not been completed for all areas of concern that had been identified in the assessments to ensure that people were safeguarded. People’s care plans that were viewed did not include their wishes and preferences at the time of death. The staff rota must show the actual hours and staffing arrangements for each day to ensure that the home is appropriately staffed and that the actual numbers of staff in the building are available in case of an emergency, such as a fire evacuation. Faults to the fire safety equipment must be remedied promptly to ensure that people are safeguarded in the event of a fire. An immediate requirement letter was sent to the home the day after the inspection. A comment in the relative/friend/visitor survey was ‘communication sometimes not that good, all staff (especially agency) not always in possession of all facts and needs of individual residents’. 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. The summary of this inspection report can be made available in other formats on request. Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 8 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 Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People can expect to be provided with the information that they need to make an informed choice about where to live. People cannot be assured that their needs will be assessed prior to moving into the home and that they will be met. EVIDENCE: The Statement of Purpose was viewed, which included details about the home and the services that people could expect from the home. Details included a description of the service, the home’s quality assurance processes, room sizes, fire precautions and the complaints procedure that stated that people could contact the previous inspection agency, this needed updating to show the current inspection commission. CSCI previous contact details were included on the back page of the Statement of Purpose and they needed updating to reflect the current contact details to ensure that people were provided with the up to Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 10 date information that they may required should they wish to contact CSCI. The document provided information about the manager and they were referred to as the ‘registered manager’. The manager was not yet registered with CSCI and should not be referred to as a ‘registered manager’. Eight service user surveys stated that they were provided with enough information about the home before they moved in so that they could decide if it was the right place for them and one said that they were not. The relative/friend survey asked if they and the person that used the service were provided with enough information about the home to help them to make decisions. One answered always, one answered usually and one answered N/A. The AQAA stated ‘Individuals and their families/advocates are given as much information as possible at point of enquiry’. There was a policy and procedure regarding admission to the home, which stated that an initial needs assessment would be undertaken, risk assessments would be undertaken and that they would assess if the home could meet their needs. The document was last reviewed November 2004 and may benefit from being updated and reviewed to show if any changes had occurred in the procedures. The AQAA stated ‘assessments/visits to home are acted upon according to need’, ‘we respond fast to queries/ assessments. Encouraging individuals to view when they are ready. I have found that visiting to assess introduces a friendly face/allays fears’ and ‘I always try to meet the new resident when they arrive. Each person has flowers and a card in their room as a way of welcoming them when they arrive’. There were concerns raised by staff that were spoken with and in surveys that were received regarding the needs assessments that had been undertaken prior to people moving into the home. They felt that the home could not meet the needs of some people that were recently assessed, that the people had moved to another environment that could meet their needs and that staff were not provided with the information that they required about the people to enable them to meet their needs. Examples used included a person that was physically and verbally abusive to staff and to other people that lived at the home and there were no evidence of risk assessments and training provided to staff of how they support people that display aggression. One person’s records were viewed and a statement made in the needs assessment that was viewed included ‘little forgetful’. However, this had not been explored fully, such as the extent of their forgetfulness and if the person had a diagnosis of dementia. The person was admitted to the home and further information recorded after admission included that they were vulnerable from exploitation from others, however, no risk assessment had been completed Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 11 regarding their vulnerability, that there were hazards from wandering unaccompanied, that they ‘could not say where they had come from’, there was a risk assessment in place for their wandering and that they had a history of falls, there was no falls risk assessment. Their safety could not be assured, there was a comment that their family had concerns about the persons access to rivers when they ‘wandered’, the home had a fish pond in the garden that was not secured and the grounds and the home were not secured, which might be a hazard to the person. Another person’s records viewed stated that their mobility was ‘very poor (wheelchair only)’ and their handling assistance to transfer was ‘not independently’. There was no further information provided regarding how staff were to support them. The daily records were viewed and it was noted that on the day of admittance the hoist was out of use as the ‘battery had been unplugged’. There were further issues of manual handling and their daily needs in the daily records that included ‘could not transfer from the wheelchair to the commode’, ‘managed to get into the bath’, ‘manually lifted from wheelchair to commode’ and an accident report stated that the hoist sling had marked the persons arm because it was not the right size. The minutes from a staff meeting 14th July 2008 were viewed and stated that a hoist sling had been ordered for the person, this was six days after they had been admitted to the home. It was noted that the manual handling provision to the person placed them at risk. However, they left the home on the day of the inspection and they were no longer at risk. An assessment was viewed which had been completed for a person that had not yet moved into the home, which included details of their preferences such as their bed times and preferred getting up times. The assessment stated ‘needs help washing and bathing’ and no further details were present as to what help was needed. There was no care plan which identified how the home could meet the person’s needs. The minutes from a committee meeting 18th July 2008 were viewed and stated that a senior carer should accompany the manager when they undertake the needs assessments. Needs assessments were viewed and it was noted that further information should be sought and recorded to ensure that people’s needs were met, that they were appropriately safeguarded and details about their mental health diagnosis be sought and recorded to ensure that the home is registered to accommodate them. Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect to be protected from the home’s medication procedures and to be treated with respect. They cannot be assured that their needs are set out in an individual plan of care, that their health needs are fully met and that their wishes are sought regarding the time of their death. EVIDENCE: The care plans of four people were viewed. Issues with the needs assessments and care plans are identified in the previous section of this report. The care plans would benefit from increased detail, the existing care plans did not identify the specific individual support that people required. For example ‘assist with personal hygiene’ did not identify how the person needed and preferred to be supported. One care plan that was viewed was detailed to show the support that the person needed and preferred. There were ‘admission sheets’ which were completed at the time of admission to the home, two were not fully Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 13 completed on page two which included areas of history of falls, continence, personal safety and medication, weight and mental health. There were records of regular care plan updates, which identified people’s changing needs and preferences. It was noted that there were risks identified in care plans and not all had risk assessments in place to ensure that the identified risks were minimised. One care plan stated that the person had a history of falls and there was no risk assessment in place, a risk had been identified that a person wandered and got up at night and wandered into other people’s rooms and there was no risk assessment in place to ensure the person’s and other people’s safety. The appropriate equipment was not in place to ensure that a person’s manual handling needs were met , which is identified in the previous section of this report. The service user survey asked if they were provided with the care and support that they needed. Seven answered always, one answered sometimes and one answered usually and one commented ‘dont receive care for my blindness’. Care plans that were viewed did not include specific support that people required with sensory loss. People that lived at the home that were spoken with said that their needs were met and they were complimentary about the support that they were provided with in a daily basis from the staff that worked at the home. The relative/friend survey asked if they felt that their relative’s/friend’s needs were met. Two answered always and one answered usually. The survey asked if their friend/relative received the support that they agreed or expected. Two answered always and one answered usually. The staff survey asked if they were provided up to date information about the needs of people. Three answered usually and two answered sometimes. The survey asked if the ways that they passed information about people who used the service worked well. Two answered usually, two answered sometimes and one answered never. Comments made in the staff surveys included ‘manager does not communicate directly with staff information is sometimes relayed between senior and care staff rather than coming from the manager who carries out assessments, care plans are sometimes incomplete leaving out relevant care information’ and ‘more recently we have had more clients come into the home with very basic information and incomplete care plans’. Staff that were spoken with reported that they were often provided with minimal information regarding people’s needs and that they updated care plans when they learned information about people’s needs through speaking to Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 14 them. Staff reported that there was a handover meeting at each change over of staff shifts where they discussed people’s well being. Daily records were viewed, which detailed the support that people had been provided with on a daily basis, their well being and if any issues had arisen. The communication book was viewed and it was noted that it contained people’s personal information. The deputy manager was spoken with regarding alternative methods of recording people’s personal information that ensures their confidentiality. The AQAA stated ‘we have a comprehensive period of handover on every shift and good communication between the departments’, ‘care staff are fully aware of the changing needs of each resident’ and ‘care plans are reviewed/updated regularly’. People’s care plans that were viewed stated if people preferred to be buried or cremated at the time of death. However, their preferences and arrangements were not included in the care plans, such as if they had arranged a funeral and who they wished to be notified. The care plans did contain a section regarding if people wished to be resuscitated and this section had not been completed in the care plans that were viewed. Staff spoken with shared positive experiences of how they had supported people and their families. A relative/friend survey stated ‘(the person) was always appreciative of the kindness and care (the person) received from the staff. I was kept informed of (the person) condition, sat with (the person) right before (the person) died and the Red House phoned and said I could spend an hour with (the person) before the funeral directors come the day (the person) died. All the staff were so good - we were always being offered a cup of tea!!’ People’s care plans included information of medical support that they had been provided with, such as from doctors, opticians and dentists. The AQAA stated ‘individuals have access to GP/ Nursing services (of their choice)’ and ‘residents are escorted to all appointments (if they so wish) and if family and friends are unable to support them. Liaise with relevant agencies including District Nurses/ CPNS/Speech Therapy/Occupational and Physiotherapy services’. People spoken with reported that their health care needs were met and that the staff at the home always supported them to access medical support when they needed it. The service user survey asked if they were provided with medical support when they needed it. Seven answered always and two answered usually. The health professional survey that was received stated that people’s health needs were always met by the home and that the home always sought advice and acted upon it to manage individual’s health care needs. Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 15 The deputy manager explained that people were provided with the opportunity to participate in exercise activities. A person that lived at the home confirmed this. Part of the afternoon medication administration was viewed and it was noted that people were safeguarded by the home’s medication practices. The medication was stored in a secure trolley, which the AQAA stated had recently been purchased. The medication was administered one person at a time and the staff member was observed to ask the person if they wished to take their medication. The MAR (medication administration records) charts were signed when the person took their medication. The MAR charts were viewed and it was noted that they had been appropriately completed, there were no gaps identified and codes were appropriately used to show if the person had refused their medication or were out of the home, such as if they were in hospital. The care plan of a person that self administered their medication was viewed and it clearly identified the risks and methods of minimising the risks and the arrangements for ordering and storing the medication. People’s care plans that were viewed included details of their prescribed medication. The AQAA stated ‘Individuals are given choices of when to take medication/ timescales/ compatibility with other medication. They are aware that they have a right to refuse/coupled with the implications of doing so’. A health professional survey stated that the home always supported people to administer their own medication or manage it correctly where this was not possible. During the inspection staff were observed to knock on people’s bedroom doors and wait to be invited in before entering to ensure that their privacy was respected. People spoken with stated that their privacy was always respected and that staff always knocked on their bedroom and bathroom doors before entering. The health professional survey stated that people’s privacy and dignity was always respected. The AQAA stated ‘residents choose when to have a bath. They are treated with privacy, dignity and respect and are encouraged to do as much for themselves as possible, in order to remain independent and in control of their lives’. People spoken with reported that the staff always treated with respect and comments included ‘oh definitely’ and ‘always’. They said that staff used the form of address that they preferred. The interaction between staff and people that lived at the home was observed to be friendly, respectful and professional. Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to be provided with an activities programme which meets with their interests and preferences, to be supported to maintain contacts, to be supported to exercise choice and control over their lives and to be provided with a health and balanced diet. EVIDENCE: Some people were provided with an activities programme which met with their interests. However, comments from people with sensory loss included ‘because of hearing and sight but enjoys the company of other residents and staff’ and ‘cant take part because of my blindness and deafness’. The service user survey asked if there were activities that they could participate in. Three answered always, two answered usually, one answered sometimes and three answered never. People that were spoken with said that there were activities provided at the home that they could participate in, one stated that they preferred not to join in with all of them and one person stated that they preferred to chat to their friends. Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 17 During the inspection people were observed to be enjoying the sunshine in the garden, chatting to each other and to staff, reading books and knitting. There was an activities co-ordinator that worked at the home three times a week. The minutes from a committee meeting were viewed and stated that people had enjoyed outings to a local farm. The minutes from a residents meeting was viewed and people stated that it was good to have the activities co-ordinator and that they enjoyed trips out to see the countryside. The activities book was viewed, which identified the activities that were provided and the people that had participated in them. The activities included five people participated in floristry, ten people played bingo, eight people participated in music and movement, two people participated in art, thirteen people attended singing by a visiting entertainer and eight people watched a Fed Astaire film. There were no records of individual support that was provided to people that did not wish to participate in the group activities. However, the AQAA stated that they were planning to ‘organise small group activities on a regular basis to suit individual need. Suggestions have been visits to the local theatre/ Newspaper group/Possibly a library of audio books’. The AQAA stated ‘we have a range of activities taking place regularly including music and movement, bingo, three different entertainers with varying types of music. Reminiscence evenings including music and poetry. Quizzes. Scrabble sessions. Craft sessions including painting/ collage and jewellery making. We have listened to residents and included two annual excursions to the coast’ and ‘we hold an annual garden party and two coffee mornings’. People’s daily records were viewed and recorded when people had maintained contact with their family and friends. People that were spoken with said that their visitors were always made welcome at the home and that they could have their visits in the communal or private areas of the home. During the inspection people were observed entertaining their guests in the garden and in the privacy of their bedrooms. People spoken with stated that they chose what they wanted to do in their lives. They said that the staff listened to their views and that they had resident’s meetings where they could discuss their preferences. The minutes from a recent resident meeting were viewed and showed that people shared their views about staff in the home, the menu and activities. The dining room had been redecorated since the last inspection, which provided an attractive environment for people to enjoy their meals. People spoken with stated that the food was very good at the home and that they were provided with enough to eat. The service user survey asked if they enjoyed the meals at the home. Four answered always, three answered usually and two answered sometimes. Comments included ‘I think we have too many sausages or sausage meat’ and ‘too much pastry for older people’. The menu Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 18 was viewed and there were two choices, including a vegetarian option each day. The recent menus did include sausages or sausage meat once or twice a week. A staff member was spoken with and reported that a person had recently stated that there was too much sausage on the menu in a recent resident meeting and that they were changing the menu to ensure that a further variety of foods were provided. The menu was displayed on a notice board and previously people made choices about what they wanted to eat at breakfast. A staff member reported that they were changing the way that people were asked about their menu choices for reasons such as that all people do not choose to have breakfast in the dining room and that not all people could see the notice board. They said that staff would approach each person and ask for their choices. A person that lived at the home was spoken with and confirmed that they were asked for their choices of menu by staff on a daily basis. The AQAA stated ‘residents preferences regarding diet are always adhered to, organic jam is purchased by the home for one resident and sugar free for special exclusion diets. Residents have a range of food offered to them e.g. Breakfast fruit juice/ tea and coffee. Range of cereals/ porridge cooked every day. Fruit including prunes. Cooked breakfast/ Kippers if requested. Residents have their newspapers/ post on the table when they enter the dining room’. Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People cannot be assured that staff will be trained to ensure that they are protected from abuse and to have their complaints acted upon. EVIDENCE: During the inspection the records of actions taken as a result of complaints that had been received were not available, therefore we could not be assured that complaints were acted upon appropriately. There were records of complaints that were viewed, which included complaints from people who lived at the home regarding issues with other people that lived at the home. A complaints log book was viewed which recorded the dates of complaints that had been received and who they were from. We did not view any records of compliments that had been received by the home. However, staff members spoken with stated that they had been told by a senior staff member that compliments from people’s relatives had been received. Staff members spoken with had a clear understanding of how they should support people if they wished to make a complaint about the service that they received. Four staff surveys stated that they knew what to do if a person whished to make a complaint and one stated that they did not. Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 20 The service user survey asked if they knew who to speak to if they were not happy. Eight answered always and one answered usually. The survey asked if they knew how to make a complaint about the service that they were provided with. Eight answered yes and one answered no. People who lived at the home that were spoken with said that they knew what to do if they wished to make a complaint. Three relative/friend surveys stated that they knew how to make a complaint. The relative/friend survey asked if the service had responded appropriately if they or the person that lived at the home made a complaint. Two answered always and one answered usually. The health professional survey that was received stated that the home always responded appropriately to concerns that had been raised by them or the person living at the home. The complaints procedure was summarised in the Statement of Purpose and needed amending to show the current CSCI details as noted in the ‘choice of home’ section of this report. The complaints procedure was viewed and detailed how people could make a complaint and what they could expect when they had made the complaint. The CSCI contact details needed updating to ensure that people were provided with the information that they needed should they wish to contact CSCI for any reason regarding the service that they were provided with at the home. The AQAA stated ‘we respond to complaints while they are still fresh in the mind of the individual who has made them. All complaints no matter how trivial they may seem are treated with the utmost seriousness and are fully investigated. Residents have been satisfied up to now that their complaints have been handled sensitively and dealt with thoroughly. Complaints are often recorded by two members of staff if the complaint is given to them separately or each member of staff will give their own account individually’. Staff members reported that they had raised concerns regarding the management of the home and that they had met with the manager to discuss the issues, which included staffing levels at the home, inappropriate placements of people and issues of manual handling. The minutes of the meeting were viewed and discussions about the issues had taken place. The staff that were spoken with reported that they felt that their concerns were listened to but they had not been acted upon. Due to the manager’s absence during the inspection actions that they had taken could not be verified. Staff spoken with had a good knowledge about actions that they should take if they had concerns about a person’s safety and about the types of abuse that may occur. They reported that they had not received recent safeguarding training. A list of staff training was viewed and there was no reference to safeguarding training. The minutes from a recent staff meeting were viewed Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 21 and the manager had advised staff that there would be safeguarding training arranged and no date for the training had been provided. The home’s policies and procedures were viewed and there was no policy and procedure regarding safeguarding and working with people that display aggression. Therefore the policies and procedures in these areas were not available to staff for reference to enable them to safeguard people. Staff spoken with stated that they had recently worked with people that had been aggressive to staff and other people that lived at the home and they reported that they had received little support and no training to enable them to work with the people. The people no longer lived at the home and were no longer a risk to people and staff. Incident report forms had been completed by staff, which reported incidents of aggression. The home’s policy and procedures regarding safeguarding people’s finances was viewed, which had last been reviewed November 2004. The document may need updating the reflect current practices if there had been any changes since 2004. The records of people’s finances were not available during the inspection and as a result we could not be assured that people’s financial interests were safeguarded. The AQAA stated that ‘all members of Staff/ Volunteers including Committee members have all been police checked and been cleared through the Criminal Records Bureau’. The records were not available during the inspection to verify the statement. Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to live in a clean, well maintained and safe environment. They cannot expect to be protected by the home’s infection control procedures. EVIDENCE: The home was clean, homely, well maintained and attractively furnished. There were no offensive odours in the home. The dining room had recently been redecorated and it was noted that the area was a pleasing environment for people to enjoy their meals in. There were two lounge areas that people could use and both were in use by people during the inspection. The home provided a hairdressing room, which had been refurbished since the last inspection and it provided people with a safe and comfortable environment to have their hair styled. Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 23 People spoken with reported that they were happy with their home. The service user survey asked if the home was fresh and clean. Eight answered always and one answered usually. The grounds were well maintained and attractive and people that lived at the home and their visitors were observed to be enjoying the gardens during the inspection. The AQAA stated ‘continue to provide a safe and homely environment, that meets residents needs and complies with health and safety legislation. Whilst reducing odours and providing a welcoming environment. We are told that the home has a warm and homely feel to it’ and ‘the house has been totally painted on the outside. A prominent feature at the top of the building a round Georgian window has had a rotten section completely remade. Damp proofing work has been carried out to the dining room and some remedial work outstanding regarding capping garden wall/ maintenance of brickwork, and incorporating some French drains is in hand over the next few months’. The laundry room was viewed and it was noted that it was clean and uncluttered and provided suitable hand washing facilities, which included liquid soap and disposable paper towels to prevent the risk of cross infection. The AQAA stated ‘the laundry room has been cleaned and rearranged. Storage bins have been provided/ labelled for different kinds of linen. Infection control measures have been implemented red bags/ special bins are used for individuals on return from hospital or if individuals have a hospital acquired infection. A ducting system has been installed to extend/ remove the risk of carbon monoxide fumes re entering the laundry/ resident’s toilet or rooms’. During the inspection staff were observed to practice good infection control procedures, such as washing their hands and wearing protective clothing when working with food and when supporting people with personal care. Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect to be provided with staff support levels that meets their needs and that staff are appropriately qualified to meet their needs. They cannot be assured that they are protected by the home’s recruitment procedures due to the unavailability of staff recruitment records during the inspection and that they are provided with care specific and safeguarding training to support staff to meet their needs. EVIDENCE: The staff rota was viewed and showed that the home was staffed throughout each 24 hour period. The rota did not reflect the actual hours that the manager worked. The rota for the week of the inspection showed that the manager was working 8.00 – 16.00 Monday to Friday, however, they were not present during the inspection and the deputy manager reported that the manager was on leave for that week. The rota showed that there were three care staff working on each day shift and two waking night staff during each night. Staff spoken with reported that there had been some staff vacancies and agency staff had been used to cover shortfalls. The staff survey asked if there was enough staff to meet the individual needs of all the people that lived at the home. One answered usually and four answered sometimes. Comments Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 25 included ‘agency staff is often relied on to fill shifts’ and ‘we have been working understaffed for over 1 year. We now rely on agency staff for many shifts which is something which rarely occurred previously, on occasions shifts have been totally covered by agency staff to run the home alone’. The staff rota that was viewed for the week of the inspection showed that one agency staff was used for one shift. For the week after the inspection one agency staff was down to cover a night shift. There had been more agency staff used June 2008, with between four to ten agency cover each week, which showed that there had been some improvements in the use of agency cover to ensure that people were supported by a consistent staff team. The deputy manager reported that there had been activity co-ordinator, handy person, cook, domestic, day and night care staff employed recently. People that lived at the home that were spoken with stated that they received support from staff when they needed them and that call bells were answered promptly. The service user survey asked if staff were available when they needed them. Five answered always, two answered usually and two answered sometimes. During the inspection it was noted that there were three care staff working on the morning and afternoon shifts, they answered call bells promptly and were attentive to people’s needs. The AQAA stated ‘we have experienced staff shortages over the last few months and had to bring in agency cover. This has not compromised the quality of service offered to the residents as there has been continuity. Some of this was due to sickness/accidents/annual leave. CRB checks have been very slow after individuals have been recruited and has resulted in some people going elsewhere. However we have always had a good core staff team who work very hard to ensure that the needs of the residents are met’ and ‘on a Monday and Friday morning we have additional carer support for three hours. Also an extra carer is on shift when we are at full capacity or brought in at busy times. Four carers on shift instead of three’. The manager was on leave during the inspection and the deputy manager had not been provided with access to staff records, therefore we were unable to view staff recruitment records to ensure that people were safeguarded by the home’s recruitment procedures and practices. The staff survey asked if the employer had made checks before they started working at the home, which included CRB (Criminal Records Bureau) checks and references. Five answered yes and comments included ‘all checks were carried out before employment started’ and ‘when I first started at the home we did not have CRB checks but when they were put in place we were checked’. The home had met the target of 50 of staff to have achieved a minimum of Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 26 NVQ (National Vocational Qualification) level 2 by 2005, which was stated in the National Minimum Standards relating to older people. The AQAA stated that nineteen care staff worked at the home and fifteen staff had achieved their award and three were working towards their award, which showed that staff had been assessed as competent during their assessment for their award to meet the needs of the people that lived at the home. The deputy manager showed the inspector a document which they were working on which identified which staff had been provided with training and which staff required training. It was noted that staff had not been provided with a Skills for Care Common Induction Standards training programme. The deputy manager stated that it was identified that the home needed to provide the induction and that all new starters would be provided with the training to ensure that they were provided with the information that they needed when they started working at the home. It was noted that staff had not been provided with safeguarding training to ensure that people were protected from abuse. The minutes to a recent staff meeting were viewed and it stated that safeguarding training was to be provided, however, there was no date stated. Further training identified in the staff meeting minutes were COSHH (control of substances hazardous to health), dementia, health and safety and infection control. There were no care specific training provided such as recording practices and working with people that display aggressive behaviours or distress. Recent staff training had been provided June and July 2008, which included first aid and manual handling. The list of training provided to staff that was viewed included first aid, manual handling, food hygiene and COSHH/infection control, which showed that staff were provided with information that they needed to support people in a safe manner. The communication book and the minutes from a recent staff meeting were viewed and the manager had stated that staff were not to record (in the communication book) people’s HIV or MRSA status and that staff should respect people’s confidentiality with regards to HIV and MRSA. Staff spoken with were concerned about the risks that they may face. The infection control procedures did not refer to this issue, regarding if people maintained good infection control procedures that they would be protected from such risks. The list of staff training was viewed and it was noted that staff had been provided with infection control training. However, their lack of understanding regarding the risks to themselves and others from MRSA and HIV showed that the staff would benefit from being provided with a comprehensive policy and procedure regarding infection control and information of how they should work with people who may be HIV positive or have contracted MRSA to ensure that they safeguard people and themselves from cross infection. The AQAA stated ‘statutory training has taken place in some areas however Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 27 some had to be cancelled due to staffing levels. More is taking place at the moment’. Five staff surveys stated that they had been provided with training which was relevant to their role and helped them to understand the individual needs of people that lived at the home. Four staff surveys stated that they had been provided with training which kept them up to date with new ways of working and one said that they were not. Comments included ‘training is quite good and available’ and ‘we have had regular training e.g. first aid, health and safety, NVQ training, moving and handling, food hygiene’. Staff spoken with reported that the training provision had recently improved and that they were due to be provided with further training which would provide them with the information that they needed to meet people’s needs. Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People cannot expect that their financial interests are safeguarded and that their health and safety is promoted and protected. EVIDENCE: The manager had been in post since June 2007, they had made a registered manager application to CSCI, which was returned to them December 2007 due to the lack of a CRB check. A letter was sent to the home’s responsible individual following the inspection to ask what arrangements were in place for the management of the home and the registration of a manager as at this stage an application was not in progress. It was noted that in the Statement of Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 29 Purpose the manager was referred to as the registered manager, however, they were not registered with CSCI at the time of the inspection. Staff spoken with and staff surveys that were received reported that they did not feel supported by the manager, that they rarely received verbal information from the manager regarding people’s needs, that messages were recorded in the communication book and that they were often unaware of people’s needs when they were newly admitted into the home. Staff reported that they did not receive regular supervision. Due to the records being not available and the manager being on leave during the inspection the issues could not be adequately explored. However, the minutes from a recent staff meeting were viewed and it was evidence that staff were provided the opportunity to raise their issues to the manager. The AQAA stated ‘fully support all staff. Have an open door policy. Have regular supervisions/ Meetings. Communicate through all departments’ and ‘a happy workforce that works together for a common goal’. People that lived at the home were provided with the opportunity to share their views about the home and the support that they received. People were provided with the opportunity to participate in resident’s meetings and they were spoken with during regular Regulation 26 visits. The deputy manager reported that the menu had been changed and specific activities had been provided as a result of listening to people’s views that were made during a recent resident’s meeting, the minutes to the meeting were viewed during the inspection. Nine service user surveys stated that the staff listened and acted upon what they said. People who lived at the home were spoken with reported that they felt that their views were listened to and sometimes they completed questionnaires about what they thought of the service. They stated that they had raised some issues regarding the menu during a recent resident meeting and they had been told that the menu would reflect their choices. The home’s policy and procedure regarding the safeguarding of people’s finances were viewed. Records of people’s finances were not available during the inspection. The deputy manager reported that in the manager’s absence people could use money from the home’s petty cash and pay the money back when their finances were available in the manager’s return, which did not provide people with the opportunity to access their financial records if they chose to. The home’s policies and procedures were viewed and included accidents and incidents, admission, assessment, manual handling, code of conduct, complaints, health and safety, fire safety, infection control and missing persons. It was noted that people were not safeguarded by the availability of the policies and procedures to staff for reference when they were supporting Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 30 people. There was no safeguarding policy and procedure and no procedure for working with people who displayed aggression. The policies and procedures needed updating or reviewed to ensure that staff were provided with the most up to date guidance of how they should meet people’s needs. The procedures were last reviewed 2004. The AQAA stated that they ‘comply with statutory legislation, adhering to policies procedures and guidelines’. The home maintained a communication book in which people’s personal information was recorded. The deputy manager was spoken with regarding confidentiality, the safeguarding of people’s personal records and alternative methods of handing information over to staff, such as in their individual daily records. During the inspection it was noted that the fire system was on ‘mute’, people could not be assured that the fire alarm would sound in case of fire and they were at risk. The deputy manager was spoken with regarding the safety of people and they smashed the glass in one of the fire safety boxes and the alarm sounded. The deputy manager rang the fire safety provider who stated that they could not guarantee that the fire alarm would sound if there was a fire. They telephoned the manager to ask for permission to call out the fire safety provider and they reported that the manager stated that they were aware of the issue and that an electrician was visiting the home the following week to repair an electrical fault which was causing the system to show ‘mute’. It was not clear how long the system had been faulty and we had not been notified of the fault. An immediate requirement was sent to the home following the inspection regarding the issue that people were not safeguarded by the home’s fire safety system. Fire safety records were viewed and fire safety checks were regularly undertaken, which included sounding the fire alarm in different areas of the home. Staff and people that lived at the home knew what actions to take in the event of a fire. The staff training list that was viewed showed that staff had not been provided with fire safety training and staff were informed during a staff meeting, for which the minutes were viewed, that they would be provided with fire safety training in the future. The records of health and safety checks were viewed, which included water temperature, electrical appliance and temperature checks for the milk cooler, which ensured that people were safeguarded. The maintenance book was viewed and showed where repairs had been reported and when they had been completed in a timely manner. Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 31 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 3 X 1 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 3 X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X 2 2 Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 32 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. 1. Standard OP3 OP4 Regulation 14 Requirement Needs assessment must show the specific needs of people in order to assess if the home can meet their needs and to provide staff with the information that they require to support people. Care plans show specific support that people require to meet their individual needs. People’s personal information must be recorded in their personal records and not in a communal communication book to ensure confidentiality is respected. Records must be maintained in the home and be available for inspection. A safeguarding procedure must be available for staff reference to ensure that people are safeguarded against abuse. Staff must be provided with safeguarding training to ensure that people are protected from abuse. The infection control procedures must reflect good practice guidelines with regards to HIV DS0000024477.V368739.R01.S.doc Timescale for action 15/08/08 2. 3. OP7 OP7 OP37 15(1) 12(4)(a) 30/08/08 30/08/08 4. 5. OP16 OP29 OP35 OP18 OP37 17, Schedule 4 13(6) 10/08/08 15/08/08 6. OP18 OP30 13(6), 18(c)(i) 13(3) 30/08/08 7. OP26 OP37 15/08/08 Red House Residential Home Version 5.2 Page 33 8. OP27 18 9. OP30 18(c)(i) 10. OP37 24 11. OP38 23(4) 12. OP35 16(l), Schedule 4, 9 and MRSA to provide information of how staff should protect themselves and people that live at the home. The rota must reflect the actual working hours of staff to ensure that the home is adequately staffed to meet people’s needs. An appropriate induction must be provided to newly employed staff to ensure that they are provided with information to meet people’s needs when they start working at the home. The home’s polices and procedures must be reviewed, be available to staff and provide the information that staff require to safeguard people and to meet their needs. The fire safety equipment must be in good working order to ensure that people are safeguarded. People must be provided with access to their financial records and finances when they choose to, to ensure that their dignity is respected. 15/08/08 30/08/08 30/08/08 21/07/08 15/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations People with sensory loss to be provided with the opportunity to participate in activities. Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Red House Residential Home DS0000024477.V368739.R01.S.doc Version 5.2 Page 35 - 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. 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