Inspection on 06/06/07 for Red House Residential Home

This inspection was carried out on 6th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 04/06/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Red House Residential Home 236 Dunchurch Road Rugby Warwickshire CV22 6HS Lead Inspector Michelle O`Brien Key Unannounced Inspection 6th June 2007 09:45 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.V338817.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.V338817.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 Pinnacle Care Ltd vacant post Care Home 23 Category(ies) of Dementia - over 65 years of age (23) registration, with number of places Red House Residential Home DS0000004285.V338817.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 15th June 2006 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. The current weekly fee is £508. People living in the home are required to pay for extras, such as private chiropody, optician, dental treatment, personal shopping and outings. The current weekly charge for a person living in the home is £508. Red House Residential Home DS0000004285.V338817.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 which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for people living in the home. This report uses information and evidence gathered during the key inspection process which involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. The visit to the home was made on 6th June 2007 between 9.45am and 5.45pm. 23 people were living in the home on the day of the visit. It was the assessment of the home manager that half of the people living in the home had high dependency needs and the remaining half had medium dependency needs. Documentation maintained in the home was examined including staff files and training records, policies and procedures and records maintaining safe working practices. A tour of the building and several bedrooms was made. The systems for the management of medication were also examined. The inspector had the opportunity to meet most of the residents by visiting them in their rooms, spending time in the communal lounges and talking to several of them about their experience of the home. The inspector was present during the midday meal. General conversation was held with others, along with observation of working practices and staff interaction with the people living in the home. The day of this inspection visit was the first day in post for the new home manager; she was beginning a period of induction under the supervision of the area manager. The care of three people living in the home was identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence of the care provided is matched to outcomes for the people using the service. The manager completed and returned an Annual Quality Assurance Audit before the inspection visit. What the service does well: Red House Residential Home DS0000004285.V338817.R01.S.doc Version 5.2 Page 6 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. People living in the home are treated respectfully. 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. 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 The home is generally well maintained providing a safe, attractive, homely and clean place for people to live in and enjoy. 56 of care staff employed in the home have a National Vocational Qualification in Care (NVQ) at level 2 or above, which should mean that people living in the home are cared for by competent staff. Robust recruitment procedures safeguard people living in the home from the risk of abuse. The home is well managed and is run in the best interests of the people living there. What has improved since the last inspection? What they could do better: Care plans must be available for each of the identified needs of people living in the home and contain details of the actions required to meet each need. Care plans must be reviewed when there is a change in need. This is to make sure that people get the care they need. Red House Residential Home DS0000004285.V338817.R01.S.doc Version 5.2 Page 7 Systems must be in place to minimise any identified risks to the health or well being of people living in the home. This must include people who have an identified risk of developing pressure sores or weight loss. This is to make sure the health and well being of people living in the home is maintained. Systems must be in place to minimise any identified risks to the health or well being of people living in the home. This must include people who have an identified risk of developing pressure sores or weight loss. This is to make sure the health and well being of people living in the home is maintained. Medicines must be transported around the home in a lockable medication trolley. This is to make sure that medicines can be secured in the event of an emergency Arrangements must be made to ensure that medicines are stored at the recommended temperatures. This is to make sure the stability of medicines is maintained and reduce the risk of residents being administered ineffective medication. Arrangements must be made for all staff to have up to date moving and handling training. This is to ensure that residents and staff are protected from the risk of harm due to incorrect moving and handling techniques. 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.V338817.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.V338817.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 case files of three people identified for case tracking were examined to assess the pre-admission assessment process. 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. This was evident in two of the files. The third file did not contain a completed copy of the home’s standard assessment tool but there was evidence of detailed information about the person’s needs from a Social Service’s assessment and from the care home the person was living in before they came to Red House. Red House Residential Home DS0000004285.V338817.R01.S.doc Version 5.2 Page 10 One of the assessments was not dated or signed so we cannot be sure who completed the assessment or when it was undertaken. It is important to include this information so that staff can evaluate the care they have given. Each of the files examined contained information about all of the person’s needs and abilities and confirms that the home can meet their needs. Files also contained pre-admission information provided by professional health and social care agencies. 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.V338817.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. Care plans do not consistently describe what staff have to do to meet the identified needs of people living in the home which puts them at risk of not having their needs met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Observations during the key inspection visit found that people living in the home looked well cared for and were clean, their hair had been combed and nails were trimmed and clean. They were well presented and wore clothes that were suited to the time of year. It was evident from observation that the personal care needs of people living in the home are met and those residents with more strengths and abilities are provided with a good quality of life. The majority of people living in the home Red House Residential Home DS0000004285.V338817.R01.S.doc Version 5.2 Page 12 at this inspection visit looked well and happy and are supported to maintain their abilities. Three people were identified for case tracking. Each person had a care plan, daily records and monitoring records. Care plans were generally 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. Case files contained information about each person’s life experience, enduring interests and relationships before they moved into the care home. This allows staff to provide ‘person centred’ care. Good practice was noted in that each case file contained detailed information about the strengths and abilities of the person along with identified needs. However, much of the information contained in files relates to assessment; care plans do not consistently describe the actions staff need to take to meet each individual need. One person had no care plans for meeting their psychological needs despite a recorded diagnosis of Alzheimer’s disease. The daily records of another person document dressings applied to wounds. The district nurse visits this person but the inspector was told that staff apply dressings in between the nurse’s visits. There was no care plan documenting details of what dressings were used or how frequently they could be changed. The home uses risk assessment tools to monitor each person’s risk of developing pressure sores, falls, poor nutrition, moving and handling and any other risks specific to the individual. For example, staff identified one person has a specific risk of harm because of their attempts to leave the home unaccompanied and information was available to give staff directions about how to reduce the risk. There is no consistency in the frequency that the risk assessments are reviewed. There was evidence that some were reviewed on every 3 or 6 months. Risk assessments should be reviewed each month or when there is a change in need alongside the care plans. For example, there was no evidence that one person’s increased risk of developing pressure sores was identified and preventative measures taken to reduce the risk until the person developed large pressure sores on each heel. One person’s risk assessment for nutrition records 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. There was no evidence of a care Red House Residential Home DS0000004285.V338817.R01.S.doc Version 5.2 Page 13 plan to address the increased risk of poor nutrition and records of weekly weight monitoring were not maintained. The home’s failure to develop and implement care plans to address identified risks to the health of people living in the home put them at risk of not having their healthcare needs met. Evidence was available in case files to demonstrate that residents have access to their GP, District Nurses, Dietician, Chiropodist and Optician. The inspector spoke to a resident who complained of toothache. Examination of the person’s case file recorded that a telephone call was made to the dentist to request an appointment at the end of April but there was no evidence that this was followed up. The person was obviously still in discomfort. The systems for the safe management of residents’ medication were examined. Medicines are stored in locked cupboards within a small locked storeroom. The temperature of the room was quite warm but there was no record of temperature recording. Medication must be stored below 25°C to ensure the stability of the medicines. 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 increases the risk to the residents because there is nowhere to secure to the medicines in the event of an emergency. 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 home retains photocopies of prescriptions dispensed. This is good practice but could be further improved by keeping the copies of the prescriptions with the MAR sheets so that staff can easily refer to them. Audits of the medication of the people involved in case tracking were undertaken. There was one discrepancy that indicated one tablet had been signed for but not given. Medicine administration records (MAR) were completed correctly. On one of the MAR sheets it was evident that a telephone instruction had been taken form the GP to reduce the dosage of haloperidol for a resident and the MAR sheet had been amended by a member of staff. It is not safe practice to Red House Residential Home DS0000004285.V338817.R01.S.doc Version 5.2 Page 14 accept telephone instructions to alter the medication of residents. This puts residents at risk of harm from medication errors. The facility for storing controlled drugs is satisfactory. A handwritten notebook is used as a controlled drug register. Although the home is not currently storing any controlled drugs for residents, a controlled drug register that complies with legislation must be obtained for future use. 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. Red House Residential Home DS0000004285.V338817.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. The home’s AQAA informed that managers have attended 2 day training sessions to support the range of activities in the home. 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. Residents told the inspector that their current favourite past time is dominoes. Red House Residential Home DS0000004285.V338817.R01.S.doc Version 5.2 Page 16 A group of residents sat around the table and their was fun and laughter during their game! Some residents enjoyed helping with domestic tasks such as folding the laundry and setting the tables for lunch. A couple of residents sat in the small, quieter lounge watching television. Staff spoken to were familiar with the preferences of residents and the type of activities that might engage and stimulate each individual. A record of group and individual activities is maintained in the home. The home has an open visiting policy. People are encouraged to maintain links with their family, friends and local community. The home has a minibus and there are weekly trips out. Staff invited residents to the dining tables to have their midday meal which was served at 12.15pm. There was a sense of social occasion as people came together to enjoy each other’s company during the meal. Tables were set attractively with linen tablecloths. It was observed that even the most physically dependent residents in the home were supported to use ‘proper’ cups and saucers as opposed to plastic cups or beakers to promote their selfesteem and dignity. Residents were offered a starter of soup followed by a choice from roast pork, corned beef hash or omelette accompanied by cabbage, carrots, roast and mashed potatoes and gravy. Dessert was a choice of chocolate sponge and custard, fruit flan or ice cream. Staff offered each resident a choice of meal at the table; those people who found it difficult to choose were assisted by staff who brought the meal to them as a visual prompt The meal was served through a hatch into the kitchen and was beautifully presented, nutritious and tasty. Residents made positive comments about the food they were offered in the home and told the inspector that if any choice of the main meal was not their preference an alternative was offered. Food was plentiful and ‘seconds’ were offered. Staff offered assistance to those people who required it in a sensitive and discreet manner at a pace suiting each individual. Soft or pureed meals for residents were served on plates with separators for each individually pureed portion of the meal; this allows people to enjoy the individual tastes of the food they are eating and is attractive in presentation. When staff were sure that people had been assisted to eat, they sat at the table and ate their own meals with residents. Red House Residential Home DS0000004285.V338817.R01.S.doc Version 5.2 Page 17 The most recent Environmental Health Officer’s inspection of the home’s kitchen awarded a Gold Standard for Food Hygiene in January 2007. Red House Residential Home DS0000004285.V338817.R01.S.doc Version 5.2 Page 18 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 good. 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. One person said, ‘I’d tell my family and they’d tell the manager.’ We have not received any complaints about this service since the last Key Inspection in June 2006. Evidence was available that the manager makes a timely and objective response to concerns raised. A record of complaints received by the home is maintained along with the action taken by the home regarding each issue raised. The service has recorded one complaint since the last key inspection from a relative concerned about limited opportunity for some residents to access the minibus trips. Red House Residential Home DS0000004285.V338817.R01.S.doc Version 5.2 Page 19 Staff training records were seen to demonstrate that most of the staff had received training in recognising and responding to signs of abuse. Discussion with the manager demonstrated that she was familiar with local Adult Protection Procedures and how to refer allegations of abuse; this was further evidenced by the manager identifying a complaint received as an allegation of abuse and referring the issue for investigation under adult protection procedures. The allegation was not upheld. Since the last Key Inspection in June 2006 there has been one referral for investigation under Adult Protection Procedures in response to information shared about an allegation of possible abuse. Records examined demonstrate the home co-operating with Social Services to investigate and take appropriate action. This good practice safeguards people living in the home. Red House Residential Home DS0000004285.V338817.R01.S.doc Version 5.2 Page 20 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 good. The home is generally well maintained providing a safe, attractive, homely and clean place for people to live in and enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean, 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.V338817.R01.S.doc Version 5.2 Page 21 The AQAA informs that in the last year the lounge/dining room and all the corridors have been redecorated and one corridor has been re-carpeted. Four of the bedrooms have been redecorated with carpets and soft furnishings also being replaced. All of the bedroom doors have been painted and numbered since the last inspection and residents were given a choice of ‘door knocker’ for their bedroom door. This should help residents who have dementia to identify their own rooms more easily. In addition, some of the rooms have a photograph of the occupant or other meaningful objects on the door to further identify who the room belongs to. The bedrooms of three people case tracked were viewed. Rooms were pleasantly furnished and decorated creating an environment where residents can feel comfortable. It was evident that residents are encouraged to personalise their rooms with their own items such as photographs or soft furnishings. Each room looked as though it ‘belonged’ to the person living in it. Specialist equipment, including beds, specialist seating, assisted baths, pressure relieving mattresses and hoists are available to support meeting the individual needs of residents. 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. During the inspection visit residents were observed to wear appropriate and well-laundered clothing. Protective clothing such as gloves and aprons were available for staff use. It was observed that staff did not use protective clothing such as aprons during the mealtime service. Consideration should be given to the use of protective clothing to minimise the risk of cross infection. Red House Residential Home DS0000004285.V338817.R01.S.doc Version 5.2 Page 22 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 but mandatory training must be updated to make sure people are cared for by competent staff. 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 4 Care Staff 4 Care Staff 2 Care staff (who are awake throughout the night) The manager’s hours are supernumerary. 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 Red House Residential Home DS0000004285.V338817.R01.S.doc Version 5.2 Page 23 between 9.30am and 1.30pm Monday to Friday; there are no domestic staff on duty at the weekend. Care staff undertake laundry duties. The service is not able to demonstrate that the current or changing needs of people living in the home are considered in calculating the number of staff required to be on duty. Staff were observed during the inspection to have a good awareness of the individual needs of people living in the home. There was positive interaction between staff and people living in the home; residents were observed to be at ease asking staff for help and staff responded promptly to any requests. One staff member spoken to said, ‘The work is well organised so that staff have sufficient time to complete all their tasks. We get lots of training opportunities. I think the home provides a good service.’ The home does not employ administrative staff but has support from the organisation’s Head Office for training, payroll and wages and recruitment. The home is currently using agency staff agency staff to cover absence such as sickness to ensure the staffing complement is maintained. An ‘On Call’ rota is planned in advance so that staff have access to senior staff members for advice outside of normal ‘office hours’. Three weeks of the home’s duty rota between 26th May and 15th June 2007 was examined and demonstrated that the staffing levels set by the home (in the table above) are usually achieved. However, on 2 or 3 days each week the staffing levels are reduced to 3 care staff in the afternoon between the hours of 2.30pm and 5pm; although the manager is also on duty during these hours it was noted that during one week when the manager was on annual leave the numbers of care staff were not increased during these hours. Training records demonstrate that nine of the 16 care staff employed in the home have a National Vocational Qualification in Care (NVQ) at level 2 or above which, at 56 , is just above 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. This robust recruitment practice safeguards people living in the home from the risk of abuse. Staff training records demonstrate that staff receive training in Abuse Awareness, Fire Safety, First Aid, Food Hygiene, Health and Safety, infection Red House Residential Home DS0000004285.V338817.R01.S.doc Version 5.2 Page 24 control and medication. However, records demonstrate that 50 of staff have not received training in Moving and Handling and remaining staff require an annual update. This is not sufficient to safeguard people living in the home from the risk of harm. Staff have benefited from other training related to the client group they are caring for. One member of care staff said they benefited from a 3 day Dementia Care course that provided her with useful knowledge and skills, which can be applied in the home. Red House Residential Home DS0000004285.V338817.R01.S.doc Version 5.2 Page 25 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 good. The home is well managed and is run in the best interests of the people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s registered manager resigned from her post and left employment in April. The area manager has been managing the home in the absence of a manager and this has provided some continuity and effective leadership and direction for staff to maintain the quality of care for people living in the home. The newly appointed manager took up her post and was beginning her induction period on the day of this inspection visit. The new manager has Red House Residential Home DS0000004285.V338817.R01.S.doc Version 5.2 Page 26 previously managed a care home for Pinnacle Care and has the necessary qualifications to manage a care home. The manager must apply to the Commission for registration to manage this service. A residents’ survey was undertaken in November 2006. An action plan was developed from the results of surveys to target areas for improvement. These are displayed on the wall of the office so that staff, residents and relatives have access to the information. The service does not hold service users’ personal monies or valuables 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 and found to be up to date; hoists were serviced in April 2007, 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 August 2006. The home’s programme of mandatory staff training must be brought up to date to ensure the safety of people in the home. Red House Residential Home DS0000004285.V338817.R01.S.doc Version 5.2 Page 27 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A X X 2 Red House Residential Home DS0000004285.V338817.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? 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 OP7 Regulation 15 Requirement Care plans must be available for each of the identified needs of people living in the home and contain details of the actions required to meet each need. Care plans must be reviewed when there is a change in need. This is to make sure that people get the care they need. Systems must be in place to minimise any identified risks to the health or well being of people living in the home. This must include people who have an identified risk of developing pressure sores or weight loss. This is to make sure the health and well being of people living in the home is maintained. Medicines must be transported around the home in a lockable medication trolley. This is to make sure that medicines can be secured in the event of an emergency Red House Residential Home DS0000004285.V338817.R01.S.doc Version 5.2 Page 29 Timescale for action 31/07/07 2. OP8 12 31/07/07 3. OP9 13(2) 31/08/07 4. OP9 13(2) Arrangements must be made to ensure that medicines are stored at the recommended temperatures. This is to make sure the stability of medicines is maintained and reduce the risk of residents being administered ineffective medication. Arrangements must be made for all staff to have up to date moving and handling training. This is to ensure that residents and staff are protected from the risk of harm due to incorrect moving and handling techniques. 31/07/07 5. OP30 18 31/07/07 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. 2. Refer to Standard OP26 OP27 Good Practice Recommendations Consideration should be given to the use of protective clothing during mealtimes to minimise the risk of cross infection. The service should be able to demonstrate that the needs of residents are considered when deciding the number of staff required. This is to ensure that the needs of people living in the home are consistently met in a way that is acceptable to them. The newly appointed manager should apply to the Commission for registration as manager of this service. 3. OP31 Red House Residential Home DS0000004285.V338817.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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.V338817.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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