Inspection on 04/06/08 for Red House Residential Home

This inspection was carried out on 4th June 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 06/06/07

Red House Residential Home 15/06/06

Red House Residential Home 03/02/06

Red House Residential Home 11/04/05

Red House Residential Home 15/11/04

Red House Residential Home 14/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Red House Residential Home 236 Dunchurch Road Rugby Warwickshire CV22 6HS Lead Inspector Michelle McCarthy Unannounced Inspection 4th June 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 DS0000004285.V365887.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 DS0000004285.V365887.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Red House Residential Home Address 236 Dunchurch Road Rugby Warwickshire CV22 6HS 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) 01788 817255 F/P 01788 817255 wolston@pinnaclecare.co.uk Pinnacle Care Ltd Manager post vacant Care Home 23 Category(ies) of Dementia - over 65 years of age (23) registration, with number of places Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No wheelchair users are to be accommodated in rooms 19, 20 and 21. Date of last inspection 6th June 2007 Brief Description of the Service: The Red House Care Home is located approximately one mile from Rugby town centre. It is a converted detached domestic dwelling set back off the main Dunchurch Road. It provides long-term residential care without nursing for twenty-three older people with dementia. People living in the home who require nursing attention receive this from the Community nursing service, as they would in their own homes. Accommodation is provided on two floors and consists of seventeen single and three double rooms. En-suite facilities are available in some bedrooms there are also two assisted baths and four communal toilets. Written Information about the cost of accommodation was not available on the day of our inspection visit. People living in the home are required to pay for extras, such as private chiropody, optician, dental treatment, personal shopping and outings. Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection visit. This is the most thorough type of inspection when we look at all aspects of the service. We concentrated on how well the service performs against the outcomes for the key national minimum standards and how the users experience the service. Before the inspection, we looked at all the information we have about this service, such as information about: • • • concerns, complaints or allegations incidents previous inspections and reports. We do this to see how well the service has performed in the past and how it has improved. The manager completed the Annual Quality Assurance Audit (AQAA) comprehensively and sent it to us within the timescale we requested. We visited the home on Wednesday 4th June 2008 between 9.50am and 5.45pm. 20 people were living in the home at the time of our visit. It was the assessment of the home manager that the majority of people living in the home had medium to high dependency care needs. We used a range of methods to gather evidence about how well the service meets the needs of people who use it. This included talking to people who use the service and observing their interaction with staff where appropriate. We also looked at the environment and facilities provided and checked records such as care plans, risk assessments, staffing rotas and staff files. Three people using the service were identified for case tracking. This is a way of inspecting that helps us to look at services from the point of view some of the people who use them. We track peoples care to see whether the service meets their individual needs. Our assessment of the quality of the service is based on all this information, plus our own observations during our visit. At the end of the visit we discussed our preliminary findings with the home manager. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Systems must be in place for the safe handling and moving of residents appropriate to their individual needs. This is to protect residents and staff from the risk of injury. Arrangements must be made to ensure that staff can monitor residents’ weight at intervals appropriate to their needs. This is to minimise the risk of weight loss and deterioration in peoples’ health. Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 7 Arrangements must be made to limit the access to medicines to designated staff. This is to prevent unauthorised access to medicines and safeguard people. Arrangements must be made to make sure the ground floor bath and hoist is clean. Broken or cracked tiles around the handbasin must be repaired. This is to protect residents from the risk of infection. Systems must be in place to ensure that staff who have received a clear POVAFirst check are employed subject to the induction and supervisory arrangements until a full satisfactory CRB and POVA check is received. This is to ensure that people living in the home are protected from the risk of abuse. 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 DS0000004285.V365887.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 DS0000004285.V365887.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): Standard 3 was assessed. Quality in this outcome area is good. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager said that it was usual practice for a senior member of staff to visit people who are considering moving into the home to undertake an assessment of their needs and abilities. We examined the case files of two people admitted since the last inspection. Both files contained evidence of a pre admission assessment of needs that identified the abilities and needs of each person. Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 10 Information gathered about the needs and abilities of people living in the home is used to develop care plans to meet these needs. Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 11 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): Standards 7, 8, 9 and 10 were assessed. Quality in this outcome area is adequate. People living in the home are treated respectfully and are protected from harm by the safe management of medicines. Care plans for people with complex needs do not give clear directions about the actions staff need to take to meet their needs. There are not effective systems for monitoring people’s weight which might lead to a deterioration in their well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was evident from observation that the personal care needs of people living in the home are met. People looked cared for; they were well groomed and wore well laundered clothes. Three people, with varying levels of needs and abilities, were identified for case tracking. Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 12 Each person had a care plan, daily records and monitoring records. Care plans were based on information secured during the initial care needs assessment. The ethos of the home is to build on the strengths and abilities of each individual. Each case file contained a summary of the strengths and abilities of the person and identified ‘requirements to assist daily living’. This gives staff information about the actions they need to take to meet the care needs of residents. Two of the three residents identified for case tracking were admitted to the home since the last inspection; their case files contained care plans to meet their identified needs. There was evidence that care plans were reviewed with relatives and they had signed to indicate their agreement with plans of care. There was no evidence that care plans had been discussed or agreed with the residents themselves. We examined the case file of one person who has developed complex needs in the last year. The original care plans relating to strengths and abilities have not been rewritten since admission over three years ago. On some of the care plans notes were added at the bottom of the page at intervals recording ‘no change’. On other care plans instructions about changes in care required were added in such a way that it was not clear what staff needed to do. As the person had lived in the home for three years; the amount of changes and notes recorded on some care plans were confusing or contradictory. It was difficult to make out the current care required. The moving and handling assessment for this person recorded that the assistance of two carers was necessary to help move the person. It was evident from our observations and discussions on the day of our visit that the person had a limited ability to weight bear. This means that it would be necessary to use specialist equipment, such as a hoist, to assist the person to move because of their limited ability to support their own body weight, even with assistance from staff. We asked care staff how they assisted the person to move and they said, ‘we lift XXXX from the bed to a wheelchair and back again’. Staff told us they did not use specialist equipment (such as a ‘slide sheet’) to change the position of the person while they were in bed; they moved the person manually. It is unsafe practice to lift people who are unable to support any of their own weight; in these circumstances specialist equipment must be used to reduce the risk of injury to the person and staff assisting. The moving and handling care plan for this person did not give direction for moving the person safely. The manager was aware that the person was being lifted manually; and, as a manual handling trainer was aware that this was not safe practice. No action had been taken to make sure systems were in place to move the person safely although a need had been identified. The manager Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 13 discussed that she would contact the community nursing service to arrange for equipment to be made available to move the person safely. Risk assessments were available for falls, nutrition, moving and handling and developing pressure sores. Records were available to demonstrate that when a decision is made to use bed rails it is in the best interests of the resident and risk assessments were in place to minimise the risk of entrapment. One person’s risk assessment for nutrition recorded an increase in risk which, according to the home’s own procedures, should have resulted in an increase of weight monitoring from monthly to weekly. Records of weekly weight monitoring were not maintained. This leaves this person at continued risk of weight loss because it is not monitored. There were no records of weight monitoring in the case files of the two other residents examined. The home does not own a set of weighing scales to monitor residents’ weight. Staff borrow a set of scales from another Pinnacle care home when they need to weigh someone. Arrangements must be made to ensure that staff can monitor residents’ weight at intervals appropriate to their needs to minimise the risk of weight loss and deterioration in their health. Access to other healthcare professionals such as the district nurse, GP and optician were recorded in the case files of people living in the home. The systems for the management of medicines in the home were examined. Medicine keys were hanging on a hook in an unlocked office. This practice does not prevent unauthorised access to medicines and leaves people at risk. Access to medicines must be limited to designated staff. Medicines are stored in locked cupboards within a small locked storeroom. There was no record of temperature recording. Medication must be stored below 25°C to ensure the stability of the medicines. A medicines fridge was available with daily recordings of the temperature using a maximum-minimum thermometer. A monitored dosage (‘blister packed’) system is used. The home has no trolley to transport the medicines to the people who live in the home. This could increase the risk to the residents because there is nowhere to secure to the medicines in the event of an emergency. Staff told us that their procedure involves dispensing one person’s medicine at a time and locking the door of the medicine storeroom each time they leave it to go to administer medication. Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 14 A medicines fridge is available with daily recordings of the temperature. The fridge thermometer reading at the time of inspection was 10°C. The inspector recommends the use of a fridge thermometer with maximum-minimum temperature recordings to ensure that medicines stored in the fridge are at the correct temperature to ensure their stability. The facility for storing controlled drugs is satisfactory. A controlled drug register was available although the home is not currently storing any controlled drugs for residents. The home has a system for checking residents’ prescriptions before they are sent to the pharmacy for dispensing. This practice protects people from medication errors. Medicine administration records (MAR) were completed correctly. Audits of the medication of the people involved in case tracking were undertaken and were correct indicating that medicines had been administered as prescribed. There was evidence that staff had sought advice from GP and pharmacist to confirm the safety of crushing one particular tablet for a person who needs their medication in liquid form. This practice confirmed that the action of the medicine would not be altered by crushing it and therefore protected the person from potential harm. People living in the home were observed to be treated with respect and their dignity maintained; for example, personal care was provided in private and residents were spoken to respectfully. During observation of working practice it was evident that staff are knowledgeable about the likes and dislikes of people living in the home and were kind, caring and attentive towards them. It was evident that the psychological needs of people with dementia were met in this service. The atmosphere in the home was cheerful, calm and relaxing. Staff supported people in their choices of how they wanted to spend their day; several people chose to sit in the reception area passing the time of day with whoever walked past. One person walked around the garden several times. We observed signs of well being among the residents on the day of our visit. People living in the home engaged with each other, expressing concern for each other’s well being. Two residents read a newspaper together and discussed the headlines. People walked about the communal areas freely and were sensitively diverted by staff when, for example, they wanted to leave the home by the front door. Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 15 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): Standards 12, 13, 14 and 15 were assessed. Quality in this outcome area is good. People living in the home are supported to maintain their independence and enduring interests which enhances their quality of life. Mealtimes are celebrated as a social occasion and residents benefit from a varied and nutritious choice of food. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an ethos of building on a person’s strengths and abilities. This is reflected in the case files of each person where a ‘life history’, interests, important relationships and personal preferences are recorded to assist staff in providing ‘person centred’ care. We observed evidence of well being among the people with dementia living in the home. For example, people engaged with staff and other residents and expressed concern about the well being or feelings of each other. Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 16 The home does not have a planned programme of activities but staff support people living in the home to participate in activities and plan how to spend their time on a day to day basis, depending on their preferences for that day. Staff told us that resources for a number of activities were always readily available in the hobbies storeroom. Some residents continue to enjoy playing dominoes and sat down to a game after lunch. Another group of residents enjoyed making greetings cards. This stimulated a discussion about important life events for residents in the home and their loved ones, such as birthdays, anniversaries and new babies. Some residents enjoyed helping with domestic tasks such as folding the laundry and setting the tables for lunch. Staff spoken to were familiar with the preferences of residents and the type of activities that might engage and stimulate each individual. It is recommended that the home maintain a record of group or individual activities to demonstrate how they meet peoples’ social and recreational needs. The home has an open visiting policy. People are encouraged to maintain links with their family, friends and local community. Residents told us their visitors are made welcome and there are no restrictions on the time of visits. The home has a minibus and there are weekly trips out. A dedicated dining room has been created in what was a second communal lounge and conservatory in the home. Staff discussed that it created more space for people to walk around in the large lounge area. Tables were attractively set creating a ‘restaurant’ environment and enhancing the social occasion of people coming together socially to eat their meal. We observed people starting to gather in the dining room for their midday meal at 12.30pm. The meal was served from a hot food trolley that left the kitchen at 12.50pm. A three course midday meal continues to be provided at the home which usually consists of three main courses. The service has maintained the quality and variety of food since the last inspection. The most recent Environmental Health Officer’s inspection of the home’s kitchen awarded a Gold Standard for Food Hygiene in march 2008. Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 17 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): Standards 16 and 18 were assessed. Quality in this outcome area is adequate. People living in the home can be confident that their concerns will be listened to and acted upon. Staff respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a formal complaints policy which is accessible to people living in the home and their families. People are encouraged to raise their concerns with the manager. Residents were observed to be familiar with the senior staff on duty and felt confident to make requests. This suggests residents would be confident in raising concerns with staff. We have not received any information raising complaints or concerns about this service since the last Key Inspection in June 2007. The manager was unable to find the home’s own record of complaints and concerns made directly to them. The manager told us it had not been necessary to maintain the complaints register as no complaints had been made since the last inspection. Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 18 Staff training records demonstrate that most of the staff had received training in recognising and responding to signs of abuse. It was evident through discussion that the manager is aware of her responsibilities when she is alerted to allegations or suspicion of abuse. The manager responded appropriately in November 2007 when there was suspicion of physical abuse of a person living in the home. The manager alerted the police and referred the allegation for investigation to social services. This practice safeguards people living in the home. The incident was documented in the resident’s case files but a separate record of the allegation, subsequent investigation and outcome was not maintained. It is recommended that a system is developed to maintain these records. We also recommend that the service obtains a copy of the local joint agency (including police and social services) guidelines for responding to suspicion or allegation of abuse. Evidence in the ‘Staffing’ section of this report records shortfalls in the supervision of staff who start work in the home before a criminal record bureau (CRB) check is obtained. This must be improved to safeguard people living in the home. Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 19 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): Standards 19 and 26 were assessed. Quality in this outcome area is adequate. The quality of décor and furnishings is variable and the home is cosy and ‘lived in’. Some of the bathrooms are not clean enough to protect people from the risk of infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was bright and tidy and no unpleasant odours were noticed. A homely feel is achieved in the large communal lounge by placing chairs and furniture in a way that encourages people to interact. Residents ‘pottered’ about the home freely making use of all the communal areas including the reception area where some residents sat and enjoyed passing the time of day with others as they went by. Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 20 Some of the residents rooms have a photograph of the occupant or other meaningful objects on the door to identify who the room belongs to. This should help residents who have dementia to identify their own rooms more easily. The bedrooms of three people case tracked were viewed. The quality of décor and furnishing of individual accommodation was variable. One room’s décor was ‘tired’ and worn but the resident had personalised it with their own belongings which made it homely and cosy. Another room was furnished with good quality furnishings and a new carpet but looked very sparse as there was no evidence of the person’s own ‘bits and bobs’. The walls of another room were very marked and grubby in places which did not provide a pleasant environment for the person to live in. Specialist equipment, including beds, specialist seating, assisted baths, pressure relieving mattresses and hoists are available to support meeting the individual needs of residents. Some equipment is provided by the community nursing service. Single use hand towels have been placed into communal toilets and bathrooms so people can dry their hands on clean hand towels each time; these are then laundered appropriately. The laundry room is very small and there appeared to be no system for identifying separate areas for clean and dirty laundry. This presents a risk of cross infection. The service has introduced a colour coded system for separating soiled laundry. There is still potential for contamination as the limited space does not adequately promote a laundering pathway from soiled through to clean linen. During the inspection visit residents were observed to wear appropriate and well-laundered clothing. Single use hand towels have been placed into communal toilets and bathrooms so people can dry their hands on clean hand towels each time; these are then laundered appropriately. The service employs domestic cleaning staff for 25 hours each week, Monday to Friday. Some parts of the home were not clean. For example, the bath and hoist seat in the ground floor bathroom was dirty and some of the tiles around the sink handbasin were cracked and broken. This presents a risk of infection and is not pleasant for people to use. Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 21 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): Standards 27, 28, 29 and 30 were assessed. Quality in this outcome area is adequate. There are sufficient numbers of staff on duty most of the time to meet the needs of people living in the home. Recruitment practices are not sufficiently robust to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager confirmed that the usual staffing complement for the home is: 7.30am – 2.30pm 2.30pm – 9.30pm 9.30pm – 7.30am 3 care staff 3 care staff 2 care staff (who are awake throughout the night) Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 22 The manager’s hours are mostly supernumerary; she ‘works the floor’ to cover staff absence. The home does not use agency staff to cover unplanned absence but relies on permanent staff working overtime. There is a member of catering staff in the kitchen between 8am and 2pm each day to prepare breakfast and the main midday meal. Kitchen staff prepare the evening meal but it is heated and served by care staff. The home has one person undertaking cleaning duties between 8am and 1pm from Monday to Friday; care staff undertake essential housekeeping duties at the weekends. Care staff undertake laundry duties. Three weeks of the home’s duty rota between 17th May and 6th June 2008 was examined and demonstrated that the staffing levels set by the home (in the table above) are usually achieved. There was a member of care staff short on three early shifts in the three week period examined. This reduced the number of care staff from three to two. The manager was on duty for each of these shifts. The manager told us that staffing levels depend upon the occupancy levels of the home. The staffing complement has been reduced since the last inspection because the home is not fully occupied. No evidence was available to confirm that the needs and abilities of residents are considered when deciding how many staff are needed on each shift. Eight of the 13 care staff employed in the home have a National Vocational Qualification in Care (NVQ) at level 2 which, at 62 , meets the National Minimum Standard for 50 of staff to be qualified. This should mean that people living in the home are cared for by competent staff. The personnel files of two recently recruited staff were examined and both contained evidence of satisfactory checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) and references. However, records evidenced that both staff members started working in the home with a before a satisfactory CRB was obtained. Both staff had a satisfactory PoVA First check before they started to work in the home and, although there was evidence of an induction programme, there was no evidence of supervision. This practice does not protect people living in the home from the risk of abuse. Care staff who have received a clear POVAFirst check can only be employed subject to the induction and supervisory arrangements stipulated in the Care Standards Act 2000 (Establishments and Agencies)(Miscellaneous Amendments) Regulations 2004. The employee can only work with vulnerable adults in accordance with these prescribed supervisory arrangements until a full satisfactory CRB and POVA check is received. A training matrix is maintained and used to record staff training and to identify any gaps in learning. Records demonstrate that staff complete an induction Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 23 programme and receive mandatory training in moving and handling, infection control, first aid, abuse awareness, fire safety and food hygiene. This should mean that staff are updated in safe working practice; however, evidence in the ‘Health and Personal Care’ section of this report demonstrates that manual handling guidelines are not being followed despite staff having training. Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 24 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): Standards 31, 33 and 38 were assessed. Quality in this outcome area is adequate. The manager has the necessary qualifications to manage a care home. The failure to review working practices and poor recruitment procedures do not support the safety of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has previously managed a care home for Pinnacle Care and has the necessary qualifications to manage a care home. She has been in post for a year but we have not received an application to register with us. Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 25 The manager completed the Annual Quality Assurance Audit (AQAA) and sent it to us within the timescale we requested. The service has undertaken surveys of the opinion of relatives and other stakeholders (such as GPs) since the last inspection. The results were collated and analysed and action plans were developed to address issues raised. There was no evidence of any other review of working practices against outcomes for people living in the home. There was no formal action plans developed to address shortfalls made during the last inspection although evidence is available throughout this report demonstrating that the service has met most of the requirements issued at that time. The manager told us that she has not seen the last inspection report for the home. We discussed the difficulty of developing plans for improvement if she was not aware of the requirements made. We recommended that she download a copy of the report from our website. The manager said that medication is audited every three months, care plans are audited by the operations manager for the home and regulation 26 visits are made regularly. The service does not hold residents’ personal monies for safe keeping so standard 35 is not applicable and was not assessed. Service users are invoiced for additional costs such as hairdressing or chiropody. A sample of service and maintenance records were examined. This demonstrated that systems for monitoring when essential service and maintenance of equipment is due is not sufficiently robust. For example, Labels on the fixed bath hoist in the ground floor bathroom indicate the service was due in April 2008. This was overdue at the time of our inspection and there was no evidence that the service had been undertaken. The date of the last service was not recorded in the AQAA dataset. The certificate for the annual Landlord’s gas safety check was issued in April 2007 so was overdue. Fire alarm systems are checked weekly, hot water outlet temperatures are recorded weekly and were noted to be within recommended limits and Annual Electrical Portable Appliance Testing was completed in December 2007. People’s health and safety is supported by the programme of mandatory training for staff. Recruitment procedures must be improved to safeguard people using the service. Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 26 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 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X N/A X X 3 Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 27 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 OP8 Regulation 13 Requirement Systems must be in place for the safe handling and moving of residents appropriate to their individual needs. This is to protect residents and staff from the risk of injury. 2. OP8 12 Arrangements must be made to ensure that staff can monitor residents’ weight at intervals appropriate to their needs. This is to minimise the risk of weight loss and deterioration in peoples’ health. 3. OP9 13(2) Arrangements must be made to limit the access to medicines to designated staff. This is to prevent unauthorised access to medicines and safeguard people. 4. OP26 13 Arrangements must be made to make sure the ground floor bath and hoist is clean. Broken or cracked tiles around the DS0000004285.V365887.R01.S.doc Timescale for action 31/07/08 31/07/08 31/07/08 31/08/08 Red House Residential Home Version 5.2 Page 28 handbasin must be repaired. This is to protect residents from the risk of infection. 5. OP29 19 Systems must be in place to 31/07/08 ensure that staff who have received a clear POVAFirst check are employed subject to the induction and supervisory arrangements until a full satisfactory CRB and POVA check is received. This is to ensure that people living in the home are protected from the risk of abuse. 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 OP7 Good Practice Recommendations Residents should be encouraged to participate in planning and agreeing their care plans. This should make sure peoples’ needs are met in a way that is acceptable to them. Care plans should clearly record what actions staff have to take to meet the needs of people using the service. This should ensure that people get the care they need. Records of the temperature of the medicines storeroom should be maintained. This is so the service can demonstrate that medicines are stored at the recommended temperatures to maintain their stability. The service should maintain a record of group or individual activities to demonstrate how they meet peoples’ social and recreational needs. 2. OP7 3. OP9 4. OP12 Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 29 5. OP16 The service should maintain a record of concerns or complaints they receive so they can demonstrate how they respond and record an outcome. The service should obtain a copy of the local joint agency (including police and social services) guidelines for responding to suspicion or allegation of abuse so that staff can refer to it. A system should be implemented to make sure that the numbers of staff required to meet the needs of residents are available on duty at all times. The service should be able to demonstrate that the needs of residents are considered when deciding the number of staff required. This should make sure that the needs of people living in the home are consistently met in a way that is acceptable to them. 6. OP18 7. OP27 8. 9. OP31 OP33 The manager should apply to us for registration as manager of this service. The service should be able to demonstrate the review of working practices and quality of care delivered to people living in the home. This should ensure that the home is run in the best interests of people living in the home. 10. OP38 Systems should be in place to ensure the effective maintenance of equipment and services in the home and records should be available for inspection. This should promote the safety of people in the home. Red House Residential Home DS0000004285.V365887.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 DS0000004285.V365887.R01.S.doc Version 5.2 Page 31 - 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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