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Inspection on 07/08/06 for Red House Residential Home

Also see our care home review for Red House Residential Home for more information

This inspection was carried out on 7th August 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home was an attractive and well maintained environment, the gardens were well cared for and comments from service users confirmed that they were happy with the environment which they lived in. Staff spoken with were committed to the care of service users living at the home. Interaction between staff and service users was observed to be positive and respectful.

What has improved since the last inspection?

The service users guide had been updated and met a previous requirement. The kitchen had been upgraded with new work surfaces and equipment. There had been an addition to the homes infection control policy, which included reference to the use of hand wash gel for hand cleansing and its limitations. The home had provided a financial incentive for staff to achieve their NVQ (National Vocational Qualification) award. A risk assessment had been developed for service users who self medicate, which included multiple choice questions and was available in service users records, however, it is recommended that this be developed further.

What the care home could do better:

The service users guide directs its reader to obtain a copy of the staff and managers qualifications and experience from the office, it is recommended that this information be included in the guide. Risk assessments must be developed to identify risks that service users may face in their day to day living and what actions were taking in to prevent them. Risk assessments should be completed with regards to the furniture situated on the first floor landing. A record of falls was kept in the accident and daily records, however a separate record of falls would provide the opportunity to identify patterns and risk factors. The administration of medication must be improved to ensure a safer working practice. There was an offensive odour identified in the home, there must be a strategy developed to prevent offensive odours. Previous requirements regarding staff training had not been actioned. A strategy for promoting the safety of one service user who has left the building on occasions should be developed. The results of service user surveys should be made available to service users and their families and friends. Food stuffs stored in containers should be labelled to identify use by dates.

CARE HOMES FOR OLDER PEOPLE Red House Residential Home Meadow Lane Sudbury Suffolk CO10 2TD Lead Inspector Julie Small Unannounced Inspection 7th August 2006 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.V307188.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.V307188.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 dgs@rhwhs.fsnet.co.uk The Red House Welfare and Housing Society Mrs Heather Jean Choat 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.V307188.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th March 2006 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 three ‘flatlets’. One of these, formerly known as the Matron’s Flat, is not currently occupied as it is being converted into two rooms. Approval under the Building Regulations 2000 has been granted and after the final inspection by the Building Regulations Inspector an application for variation for one more person will be made. Communal space is located on the ground floor and there is a shaft lift to carry residents to the first floor. The pre inspection questionnaire stated that the current fees were £330 to £495, with additional charges for chiropody, hairdressing, newspapers and telephone accounts. Red House Residential Home DS0000024477.V307188.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 inspection which was undertaken by regulatory inspector Julie Small on Monday 7th August 2006 between the times 9.50 to 17.30. The homes manager was on leave during the inspection, so staff recruitment, training and residents finance records were not available for inspection. During the inspection the inspector undertook a tour of the building, observed usual work practice and spoke with four residents and four staff members. Records were viewed which included the homes policies and procedures, statement of purpose, resident care plans and assessments, medication records, accident book, staff rotas and menus. Prior to the inspection several questionnaires were sent to the home. The pre inspection questionnaire, ten staff comment cards, fifteen relatives/visitors comment cards and thirty residents ‘have your say about…’ questionnaires were returned to the inspector. One relatives/visitors comment card had no comments and a letter from the relative was attached stating that they were happy with the care their relative received and one had not responded to any questions and stated that their relative no longer lived at the home. One resident ‘have your say about…’ questionnaire had not been completed. What the service does well: What has improved since the last inspection? The service users guide had been updated and met a previous requirement. The kitchen had been upgraded with new work surfaces and equipment. There had been an addition to the homes infection control policy, which included reference to the use of hand wash gel for hand cleansing and its limitations. The home had provided a financial incentive for staff to achieve their NVQ (National Vocational Qualification) award. Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 6 A risk assessment had been developed for service users who self medicate, which included multiple choice questions and was available in service users records, however, it is recommended that this be developed further. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 The quality in this outcome area is good. Prospective service users can expect that they have the information they need to make an informed choice about where to live and that they have their needs assessed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose was viewed and included copies of the homes policies, essential telephone numbers, the fire routine, instructions for an emergency, residents and finance agreement, the maintenance action plan and staffing details. All parts of the statement of purpose were stored loosely in a lever arch file in the manager’s office. The service user guide was sent to CSCI (Commission for Social Care Inspection) following a requirement made during the last inspection. The service users guide should be amended and show the manager’s experience and qualifications and staff numbers and qualifications to fully meet the requirements of the standard. Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 9 The service user guide included contact information for CSCI and explained their role. There were detailed pre admission assessments undertaken by the manager in resident’s records. In records viewed not all ‘admission sheet 1’ were dated and signed by the individual completing them. New resident assessments included information regarding allergies, health, sight, communication, personal care needs, oral health, foot care, mobility, falls, continence, personal safety, medication, mental health, social behaviour, interests and hobbies and social history. Six residents records were viewed and all had care plans which identified the care they require to meet their day to day living needs. Twenty two residents ‘have your say about…’ questionnaires stated that they were provided with a contract by the home, four said they had not and three were not answered. Twenty five said that they had received enough information prior to moving into the home, three said they had not and one was not answered, one included a statement that they had received a brochure and visited the home before they moved in. The home does not provide intermediate care. Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The quality in this outcome area is adequate. Service users can expect that they are treated with respect and their privacy is upheld, their health and personal health needs are set out in their individual plan of care and their health needs are met. However, they cannot be assured that risks will be assessed. Service users cannot be assured that they are protected by the homes policies and procedures for dealing with medicines. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Six service users records were viewed and each had a detailed assessment of need, including health care and a care plan. Care plans provided information to meet the service users day to day needs. There was evidence that the care plans were updated regularly with service users changing needs. Updated care plans had dates of when they were completed, not all of the care plans were signed by the individual who completed them. Care plans did not provide detailed risk assessments which identified risks and actions that staff should take to prevent the risks relating to issues such as when service users leave the home or falls. Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 11 Two service users living at the home have been diagnosed with dementia, staff spoken with confirmed that one resident was awaiting a place in an alternative home and the second service user was being assessed by an alternative placement in the afternoon of the inspection. Incident reports viewed showed that one resident with dementia had been missing from the home on several occasions, there were no risk assessments in their records to identify how staff may reduce the risk and actions staff should take to maintain the residents safety. There was a letter in the service users records from a family member stating that the home would not be held responsible if they were hurt when they were outside the home. Service users records viewed included details of their health appointments and any treatment they had received. They contained weight charts, details of continence, any aids such as walking and hearing used by the service user and what their oral hygiene needs and preferences were. The pre inspection questionnaire stated that service users were provided with activities such as music and movement, which was confirmed in the activities records. Service users were also provided with visiting services such as massage, reflexology and chiropody for which payments would be charged. A question in the service users ‘have your say about…’ questionnaires asked if they received medical support when they needed it, twenty two said always, five said usually, one said sometimes and two did not respond. The lunch time medication administration was observed, when administering the medication an open trolley was used, and left unattended when the staff member approached each service user. Medication was not always taken by the service user, the staff member said that some prefer to take them after their meal, yet the medication records were signed to show that the medication had been administered. Medication records were viewed. It was noted that with some medications such as creams and paracetamol different codes were being used on the record, ‘A’ for refused and ‘F’ for other to mean that the medications were not needed. There was appropriate storage and recording of controlled medication. Records for the disposal of medication was viewed. There were several certificates in the staff office, which evidenced that staff had received medication training. The pre inspection questionnaire stated that there was Boots medication training booked for September 2006. The previous inspection report had made a requirement that the home have risk assessments for service users self administration of medication. This had been actioned and there were the risk assessments available in service users records. However, the risk assessments included multiple choice questions Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 12 which were completed by staff. A staff member explained how they were monitoring one service user who had not been taking their medication, there was no detailed information about the issue found in their records. The home had procedures regarding assessment and care planning, missing persons and resident’s medication which included self administration and controlled medication. During a tour of the building, a pay telephone for the use of service users was seen, whilst some service users had personal telephones in their bedrooms. One resident said that when they receive letters they were unopened. Staff were observed to knock on service users bedroom doors before entering. Residents spoken with confirmed that they were called by their preferred name by staff. A staff member said that they ask service users what they prefer to be called when they move into the home. The laundry was viewed, there was boxes allocated for each service user where clean clothing was placed. A staff member said that service users clothing was labelled with their name. Interaction between staff and service users was observed to be positive and respectful. Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 The quality in this outcome area is good. Service users are able to choose their lifestyle, social activity and keep in contact with family and friends. Social and recreational activities should be developed to provide an equal provision to all service users. Service users receive a healthy and varied diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A staff member said that the home does not have an activities co-ordinator and that staff at the home support service users in activities. The activities records were viewed and identified the dates of the activity and which service users had participated. Activities included music and movement, cake baking, musical entertainers, bingo, garden party and quiz. There were photographs in the dining room of service users enjoying cake baking and Easter bonnet activities. There was an invitation to service users posted on a notice board for a royalty and reminiscence activity. There was a list of religious services, which a staff member said took place every Sunday and Holy Communion was provided on a monthly basis. Service users were observed undertaking various activities during the inspection which included playing cards, going for a walk and reading the newspaper. There was a selection of books and video films around the home. Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 14 Service users were asked if there were activities arranged in the home which they could take part in, in the ‘have your say about…’ questionnaire. Fourteen said always, seven said usually, five said sometimes and two did not respond. Statements received were; ‘I am not really able to get to the lounges or dining room’ and ‘activities are not always to my liking, I participate in activities to my interest’. Service users spoken with confirmed that they receive visitors and that they were made welcome. Visits were recorded in service users records. Minutes from a service users meeting was viewed and evidenced that they had been asked for their suggestions with regards to the homes menus and activities. Relatives/visitors comment cards asked ‘do staff/owners welcome you in the home at any time?’, ‘can you visit your friend/relative in private?’ and ‘are you kept informed of important matters affecting your relative/friend?’ Thirteen answered yes to all three questions. Service users questionnaires asked whether the staff listen and acted on what they said, twenty eight said yes and one said usually. One stated ‘staff should talk to us more and stay longer in the room’ and another stated ‘all help from staff is excellent’. Residents spoken with said that they were provided with choice in their daily lives. The service users guide stated that they could bring personal possessions into the home and one service user said that they had bought the majority of the furniture in their room from home. The homes menus were viewed and there was a balanced and varied diet provided, with a vegetarian option for each meal. A staff member said that if service users do not like what was on the menu, they would be provided with something else. Kitchen staff said that they had got to know service users preferences and likes and dislikes with regards to food. They had a good knowledge of the specific dietary needs of service users. There was a cold water machine on the ground and first floors of the home, however, the one on the first floor was empty. Service users were provided with drinks throughout the day, and their lunch looked and smelled appetising. Meals were served and staff offered more food to the service users. Service users spoken with said that the food was very good at the home. One service user said that they choose to have breakfast in their room and join their peers in the dining room for lunch and dinner. Comments received from relatives/visitors comment cards included ‘they should be commended on the food’ and ‘the food could be better’. Service users questionnaires asked if they liked the meals at the home, thirteen said Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 15 always, thirteen said usually, one said sometimes, one said never and one was left blank. Comments received included ‘there is a sameness about them and a lack of salads. Vegetables are often over cooked’, ‘enjoy breakfasts, nice deserts, could be more varied lunch meals’, ‘my favourite is fish and chips on Friday’ and ‘I always found the food very good indeed’. There was a good selection of fresh vegetables and fruit in the kitchen stores. A staff member said that they provide a fruit basket to service users to help themselves from and that they provide fresh fruit salad. Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The quality in this outcome area is good. Service users can expect that they are protected from abuse and that their complaints will be listened to and acted upon. This judgement has been made using available evidence including a visit to this home. EVIDENCE: There were no complaints received since the last inspection. The homes complaints and comments procedure was viewed and included details about how to make a complaint, what actions the complainant can expect and contact details of CSCI. There was a summary of the complaints procedure displayed in the entrance hall of the home for the attention of service users and visitors. Service users spoken with said that they were aware of how they could make a complaint, they were unaware of the role of the CSCI and the reasons for inspection process and why the inspector had asked to speak with them. Ten staff comment cards stated that they were aware of the homes complaints procedure and had received training in the homes abuse policy. Five relatives/visitors comment cards stated that they were aware of the homes complaints procedure, six said they were not aware, one was not answered and one stated ‘never been necessary. Thirteen relatives/visitors comment cards stated that they had never made a complaint. The service users questionnaire asked if they knew how to make a complaint, nineteen answered always, four answered usually, three answered sometimes and one did not respond. Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 17 The home had a robust procedure for dealing with service users finances, which included information of where they can keep valuables in the home and any transactions made with the home would be provided with a receipt. The service users guide stated that staff were not permitted to receive gifts from them. There had been no allegations of abuse since the last inspection. Staff information forwarded to CSCI with the pre inspection questionnaire shows that all staff working at the home had received CRB (criminal records bureau) checks. Evidence was viewed that the manager had attended protection of vulnerable adults training (POVA) and staff spoken with confirmed that they had received POVA training, this could not be confirmed because the manager was on leave and there was no access to staff training records. Incident records viewed identified that one service user had been verbally rude to staff, the records stated that this was unacceptable and that their behaviour was to be monitored, however, this was not identified in detail in their care plan. The pre inspection questionnaire stated that the home had a whistle blowing and an adult protection procedure which had been implemented in November 2004. Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 The quality in this outcome area is adequate. Service users can expect that they live in a safe, well maintained environment, the home was clean and hygienic, however, an unpleasant odour was present. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was a well maintained and homely environment, with attractive grounds which service users could enjoy. A staff member said that service users use the gardens to walk around. The home had a maintenance worker, who was observed working on a refurbishment of an area which was the matron’s flat. The inspector was informed that they were being converted into two flats and an application would be made to CSCI when they were ready for accommodation. The maintenance in the home was undertaken when required. Records viewed included information such as fire inspections and equipment services, food hygiene inspection and repair reports. Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 19 A staff member showed the inspector the kitchen and pointed out work surfaces and appliances which had been recently purchased and fitted. During a tour of the building it was noted that all bathrooms and toilets were provided with hand wash gel and disposable hand drying towels. There was a hand wash basin located in the kitchen. There was a disinfecting steamer for the cleaning of urine bottles stored in the ground floor sluice area. Kitchen staff were observed to be wearing tabards and hats and the inspector was provided with a clean tabard and hat to wear during the inspection of the kitchen area. The previous inspection report made the requirement that the homes control of infection policy must include reference to the use of hand gel for hand cleansing and its limitations, this had been actioned and forwarded to CSCI. The laundry was viewed and there was a dedicated staff member who worked there, they confirmed that appropriate laundering of soiled clothing and bedding was undertaken. There was a strong odour of urine in an area of the home, staff said that this was from one bedroom. A domestic staff member said that the home had a new carpet cleaning machine and that they had cleaned the carpet in the bedroom the week before the inspection. The service users questionnaire asked if the home was fresh and clean, twenty four said always, four said usually and comments were ‘very clean’ and ‘cleanliness is excellent’. Comments made in relatives/visitors comment cards were ‘lovely building and staff, also the gardens are superb’ and ‘they should be commended on very well kept gardens’. Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The quality in this outcome area is adequate. Service users can expect that their needs are met by the numbers of staff, that they are protected by the homes recruitment procedures and that they are in safe hands. Service users cannot be assured that staff are provided with training required to do their jobs, particularly with regards to kitchen staff and newly appointed staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing rota was viewed and a staff member explained that there was three care staff and one senior staff on duty throughout the day, with one further staff working early evening and two waking staff members throughout the night. They said that there was sufficient staff to meet the needs of service users. There was dedicated domestic, laundry and kitchen staff that worked at times throughout the day. Relatives/visitors comment cards asked if in their opinion there were sufficient numbers of staff on duty, twelve answered yes and one answered no. Service users questionnaires asked if staff were available when they need them, eighteen said always, ten said usually, one said sometimes. Comments made in service users questionnaires included ‘staff are always kind’ and ‘sometimes I have to wait but they explain why’. Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 21 Staff meeting records viewed included congratulations given to two staff members who had achieved their NVQ (National Vocational Qualification) level 2 in care award. A staff member said that the home had introduced an increased payment for staff that had achieved their award and that this had encouraged those staff who had not wished to complete their award to reconsider. The pay enhancement was confirmed in the action plan received from the previous inspection report. There was no staff working on their NVQ at the time of the inspection. The pre inspection questionnaire stated that there were twenty three care staff and eleven had achieved their NVQ level 2 or above. The home had almost met the target of 50 of staff to achieve a minimum of NVQ level 2. NVQ certificates were displayed in the staff office. Staff training and recruitment records were not available to view during the inspection, the manager was on leave. A staff member said that there had been one staff member recruited since the last inspection. The previous two inspections found that the standard required for staff recruitment was met. The home had a robust recruitment procedure which was appropriate. A list of staffing details was forwarded to CSCI with the pre inspection report and confirmed that all staff had received CRB checks. There were several certificates displayed in the staff office which evidenced that staff had attended training on appointed person first aid, administration of medication, infection control and training from a funeral service. Ten staff comment cards stated that they felt the home had a good training and development programme to support staff, they felt that they had received sufficient training to undertake their role and had received training in the homes abuse policy. Requirements made from previous inspections regarding staff training had not been actioned and are repeated in this report. The action plan received from the previous inspection stated that they were seeking reasonably priced training and a consultant to provide forms, which had been received. It was found in the previous two inspections that seven staff had received an induction, however, it was not established that it met TOPSS standards. The previous inspection report stated that the registered manager had advised that the home was working on developing the induction programme and that it now had to meet Skills for Care standards. There was a requirement for all kitchen staff to receive food hygiene training, this had not been met. Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 22 Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 The quality in this outcome area is adequate. Service users can expect that they live in a home which is managed by a person who is fit to be in charge and that their financial interests are safeguarded. They cannot be assured that their health and safety is protected. Service users cannot be assured that their comments through service user surveys and quality assurance exercises are published and results are made known to prospective service users and visitors to the home. This judgement has been made using available evidence including a visit to the service. EVIDENCE: There were certificates provided in January 2006, displayed in the managers office to evidence that they had achieved the NVQ level 4 in care and RMA (registered manager award). There were training certificates also displayed evidencing that the manager had attended training on POVA, budgeting, Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 24 reflective accounts, recruiting and selecting staff and effective communication in 2004. The previous inspection report identified that the registered manager had conducted a service user and relative’s survey, which they had used for their NVQ award. They stated that the results would be published in the service users guide, this had not been actioned. There was evidence that service users have regular meetings, where they discuss the service they receive and had been asked for their suggestions and comments regarding the homes menu and activities. There was a detailed procedure regarding the safeguarding of service users financial interests. The procedure included details that all transactions would be receipted and service users would be provided with safekeeping facilities for their valuables. Staff spoken with said that there was a safe, where service users can keep their finances and valuables. The pre inspection questionnaire stated that eleven service users were subject to power of attorney and none were subject to guardianship. All service users received their full personal allowances to dispose of as they wish and records were kept of the management of personal allowances. The homes manager was on leave during the inspection and finance records were not available for inspection. This standard was not inspected at the last inspection, it had been inspected and met in the previous two inspections. The previous inspection report made the requirement that the homes control of infection policy must include reference to the use of hand gel for hand cleansing and its limitations, this had been actioned and forwarded to CSCI. Staff spoken with said that there were sufficient aids to assist in the moving and handling of service users in the home and showed the inspector the hoists situated on the two floors of the home. Ten staff comment cards stated that they felt that the home had sufficient mobility aids (e.g. hoists) to support individual service users needs. Staff said that there were regular fire safety checks and fire drills. A staff member said that records were kept by the maintenance staff however they had gone home. Records of services of fire equipment were viewed. A first aid box was viewed and found to be well stocked, a staff member spoken with said that they have responsibility for the stocking of the first aid box, they explained where others could be found in the home. The home maintains accident records, which were viewed. The kitchen was viewed, and it was noted that the pantry had stored foods such as rice and flour, in plastic containers. None of the containers had the use Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 25 by date or the date that contents were put into the containers. A staff member said that they were often refilled. A staff member said that all use by dates were checked when food was delivered to the home. Not all electrical items in the kitchen had stickers identifying that they had been safety checked, a staff member said that they had been checked but was unsure where the checks were recorded. Checks were made on the temperatures of cooked food and refrigeration temperatures. The home had a COSHH (control of substances hazardous to health) manual, which was viewed. It was noted that all cleaning materials were securely stored in the home. During a tour of the building the inspector identified that there was a commode chair stored on the first floor landing, staff said that the service user liked it to be removed from their bedroom during the day because it looked untidy. The chair posed a falls and possible cross infection hazard. There were also two tables, one having a kettle on it, situated on the first floor landing in the home, which may also be tripped over. There were incident reports completed regarding one service user who frequently leaves the home, however, there was no risk assessment or assessment regarding their vulnerability when they were outside the home. There was a handwritten letter from a family member in the service users file stating that they would not hold the home responsible if they were hurt when outside the home. This was not sufficient to provide a safe placement to this vulnerable individual. The home had policies and procedures relating to accidents and incidents, health and safety, action to take in the event of a fire, health and safety staff handbook and infection control. Red House Residential Home DS0000024477.V307188.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 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 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 1 Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 OP30 Regulation 18(1) (c)(i) Requirement The homes must have foundation and induction training programmes which comply with standards. A copy of the training programmes must be forwarded to CSCI. This is a repeat requirement. The Registered Persons must ensure that all kitchen staff have appropriate food handling training. This is a repeat requirement. There must be risk assessments present in service users records which identify risks and the prevention of risks in their daily living There must be consistency in the recording of the non administration of medication developed Medication records must not be signed until the service user has taken their medication The security of medication must be maintained during DS0000024477.V307188.R01.S.doc Timescale for action 30/09/06 2. OP30 18(1)(c) (ii) 30/09/06 3. OP7 12(1)(a) 14(4)(c) 01/09/06 4. OP9 13(2) 01/09/06 5. 6. OP9 OP9 13(2) 13(2) 01/09/06 01/09/06 Red House Residential Home Version 5.2 Page 28 7. 8. 9. OP26 OP38 OP38 16(2)(k) 12(1)(a) 13(3)(4)( a) 10. 11. OP38 OP38 12(1)(a) 12(1)(a) 13(4)(a) 12. OP38 12(1)(a) 14(4)(c) administration. The registered person must take action to ensure that there are no offensive odours in the home The use by dates for food must be added to storage containers A suitable alternative storage space must be found for the commode chair on the first floor to minimise the risk of falls and cross infection posed to service users Safety checks for electrical items must be undertaken Risks posed by furniture and electrical items situated on the first floor landing must be assessed and remedial action taken as necessary Risks to service users when they leave the home without permission must be assessed and remedial action identified 01/09/06 01/09/06 01/09/06 01/09/06 01/09/06 01/09/06 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 OP33 Good Practice Recommendations A service user survey had been carried out at the end of September 2004. The results of this should be disseminated, and future surveys used whilst they are still contemporary to influence development planning for the home. It is recommend that details regarding the staff and managers qualifications and experience be included in the service users guide It is recommended that all records be dated when they were completed and signed by the individual completing them It is recommended that a separate record of service users falls be maintained DS0000024477.V307188.R01.S.doc Version 5.2 Page 29 2. 3. 4. OP1 OP7 OP3 OP7 OP8 Red House Residential Home 5. 6. OP9 OP12 It is recommended that a more detailed risk assessment regarding service users self administration of medication be developed It is recommended that the activity programme provides equality to those service users who are unable to attend communal areas Red House Residential Home DS0000024477.V307188.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 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.V307188.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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