Inspection on 11/05/06 for Red House, The

This inspection was carried out on 11th May 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.

Other inspections for this house

Red House, The 22/07/08

Red House, The 23/08/07

Red House, The 27/10/05

Red House, The 19/06/05

Red House, The 06/09/04

Red House, The 26/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Red House, The 423 West Green Road Tottenham London N15 3PJ Lead Inspector Karen Malcolm Key Unannounced Inspection 09:35 11th & 12th May 2006 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, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Red House, The Address 423 West Green Road Tottenham London N15 3PJ 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) 020 8889 0097 020 8888 0311 London Borough of Haringey Care Home 35 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (27) of places Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. A maximum of 8 of the 35 persons may have a diagnosed dementia (DE (E)). These persons who are in the category DE (E) must be accommodated in the living unit identified for this purpose. The home may provide accommodation and personal care for up to 35 persons of either gender who are over 65 years of age (OP). 27th October 2005 Date of last inspection Brief Description of the Service: The Red House is a purpose built home located in the West Green area of Tottenham. The home is close to local shopping and transport facilities, and a short distance from the shopping and entertainment facilities of Wood Green. The home is provided and managed by the London Borough of Haringey Social Services Department with the aim being to provide care with dignity for up to 35 people who are elderly. The home is arranged over two floors, with two units on each floor. Each unit has its own lounge and kitchenette, and there is also a large communal lounge located on the ground floor. Some service users have additional physical disabilities and dementia needs associated with ageing. In addition to providing care for its residents, the home recognises the importance of appropriate stimulation through the employment of a full time activity co-ordinator. Inspection reports produced by the Commission of Social Care Inspection (CSCI) are available upon request from the registered manager/provider. The current scales of charges are from: - £388.50 per week. Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days and the duration was approximately ten hours. On day one, were the interim manager, two assistant managers, the administrator, four carers, the handy person, the cook, the assistant cook and several contractors. During the inspection two members of staff left the home, to attend an external training. On the second day several contractors were visiting, including the fire officer. The same staff ratio, as that of the first day were present in the building. Since the last main inspection in October 2005 the Commission has undertaken six additional visits regarding major safety concerns for service users’ care and support needs, which were being inappropriately managed. Following on from each visit, meetings were held outside of the inspection with the registered provider. At this time the Commission is reasonably satisfied that the registered provider has ensured that service users’ needs are now being managed appropriately. However, there are some gaps that need to be addressed and these have been highlighted in the main body of this report. During this period the registered manager has left and two interim managers have been appointed to manage the home until an appropriate manager has been identified. The Red House at present is in the middle of a major refurbishment programme, which started in January 06 and is target to be completed in August 06. The interim manager and the lead contractor informed the inspector that the work schedule is on target. Part of the works programme was that two units had to move out of The Red House. One unit of seven service users is temporarily housed in Broadwater Lodge and eight service users are at Cranwood, both are which are Local Authority (London Borough of Haringey). Both homes had adequate accommodation in place and are currently registered to support older people in a residential setting. The remaining two units on the ground floor are still on site. The update on the works schedule is that the top floor is nearly completed and Phase 2 of the works schedule is to start at the end of the month. • • Phase 1 - top floor units, lift, kitchen and laundry Phase 2 - ground floor units, office and small kitchen area. The registered provider has ensured that all service users needs are being managed appropriately by increasing the overall staffing level. Consultations with the registered provider, contractors and the Commission have taken place over a number of months. The Commission is satisfied at this stage of the process with the works schedule and with the consultation process that has taken place. Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 6 The second day of the inspection was the interim manager’s last day and he had been in post since November 2005. His impact on the home has been positive, open and transparent. The inspection involved sampling five care plans, examining records, completing a tour of the building, speaking to service users, carers and relatives, observing staff and service users interacting, talking to the management team, visiting service users and staff at Broadwater Lodge and observing the afternoon medication round. Feedback was given to the registered manager/provider, one of the providers and the assistant manager. The findings from this inspection were that the overall ethos of the home had improved. The staff, service users and management team had a clearer understanding of each other’s roles and responsibilities. One of the assistant managers assisted the inspector throughout the inspection process with the assistance of the interim manager. The inspector would like to thank the assistant manager, the management team, carers, service users and the relative for their time, patience and co-operation during the inspection process, which was positive and open. What the service does well: What has improved since the last inspection? At the previous inspections there were a number of areas of improvement identified in each report. Two Statutory Enforcement Notices were issued, details of which are outlined in the October 05 report. Both Statutory Enforcement Notices have been addressed fully by the home. A detailed action plan was submitted to the Commission addressing the two Statutory Enforcement Notices and the other requirements made. The areas of improvement are: • The specific service user with linguistic needs has now addressed Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 7 • • • • • • • • • • • • • • • • • • • • • • Healthcare needs of service users are appropriately addressed and documented All service users have a contract regarding their placement There is evidence that the staffing levels in the home have been reviewed Records of complaints received have been appropriately addressed Records of individuals risk assessments have been addressed on individuals’ files Appropriate consultation has been sought with regards to the Local LEFPA Records of supervision notes were on file The manager has undertaken the task of reviewing the training needs of staff The offensive odour within the home has been eliminated The manager alerted the local authority’s Protection of Vulnerable Adults team and the specific service user’s social worker regarding a POVA issue Appropriate referral was made to the relevant professional with regards to a specific service user having cot sides in place The registered person has completed at least weekly Regulation 26 report All service users have had a current medical review with regards to individual medication and health It was evident that all Medication Administration Records (MAR) have been completed correctly Temperature of the areas where medication is stored is recorded daily The registered person has ceased taking any referral for placements until the programme of works has been completed All service users have on their files a statement of terms and conditions issued by the home Notifications under Regulation 37 have been submitted to the Commission Meetings with relatives and carers have taken place Care staff interacted with service users appropriately Appropriate liquid detergent and conditioner containers are now in place Service users care needs are recorded. What they could do better: This inspection has identified fifteen areas of improvement and five recommendations. While it’s evident that the staff are experienced and competent, the home has failed to ensure that service users needs are consistently being supported, recorded, reviewed, monitored and up-dated appropriately. It is therefore required that the registered person submits an action plan to the Commission for Social Care Inspection (CSCI), which describes how they will address these matters. The summary of findings is that the registered person is to review the current security system within the home. Service users who are deemed high risk of Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 8 falling are to have in place an up to date risk assessment and referral to either a falls clinic or the relevant professional. Magnetic door holders or release mechanisms are to be fitted to any fire doors in the home that are constantly in use. The registered person is to review and risk assess the current practice of having a gate at the top of the stairs and this is to be included in the home’s environmental & fire risk assessments. The medication policy is to be updated to include homely medication. Menu plan needs to be legible for service users who are visually impaired. Monthly summaries are to address all areas of risk and goals set for the individual. The registered person is to update the Statement of Purpose to reflect the current changes in the home. Care staff are to undertake food hygiene, dementia care, fall prevention, fire safety and back care training and the cook and the handy person to undertake POVA training. The registered person is reminded that notification is to be completed by the home for all Regulation 37 incidents that take place at Broadwater Lodge and Cranwood with any of their service users. The recommendations addressed in the table at the back of this report are deemed good practice. 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, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 9 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, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 10 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 & 5 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service. Prospective service users are able to make a decision on whether they feel the home will meet their needs. However, there have been a number of changes and the information presented is not fully correct. Therefore service users are not been given the right information to make clear informed choices. Service users can be confident that the home is able to meet their day-to-day needs. EVIDENCE: The home has a Statement of Purpose pamphlet in place. However, since its publication there have been a number of changes within the home management structure. Therefore the present document does not reflect the current changes. It is therefore required that the registered person amends the Statement of Purpose to reflect both the manager’s and provider’s relevant qualifications. The section relating to ‘For whom will accommodation be provided’ is to be amended to state that the home can support up to eight service users who may have dementia DE (E). Under the section relating to Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 11 ‘what happens if nursing care is required’ This paragraph is to be amended to reflect the home’s Conditions of Registration and the final amendment relate to the home’s current numbers and sizes of rooms. At present the home supports twenty-seven service users and has eight vacancies. Since the previous inspection six service users have died and registered provider has voluntarily ceased to admit any further service users to the home, until such time as the refurbishment works have been completed. This agreement was still in place at the time of this inspection, and evidence of this was examined in the home’s admission and discharge book. Copies of individual contracts of care were on file. The home does not supply intermediate care. Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service. Personal support in the home is offered in such a way as to promote and protect service users’ health, personal and social care needs, ensuring that individuals’ privacy, and dignity and independence are promoted. However, monitoring those service users’ who are deemed high risk with regards to falls is to be appropriately managed. The medication at this home is well managed. EVIDENCE: Five care plans were examined. The service users’ plan were well organised and managed; clearly setting out in detail the actions which need to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service user are met. Daily care and monthly summaries notes are completed. The information written appears to be more informative and reflective of individuals’ daily needs. However, the only comment made by the inspector Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 13 related to the monthly summaries and that care staff only record significant events such as a hospital appointments. No information is recorded with regards to individuals’ goals and risks on whether or not they have improved. Service users healthcare needs are recorded, presented separately in a linear and clear fashion. There was a clear audit trail of what actions had been taken and what the outcomes were. This was impressive, from the last inspection and was commended by the inspector, on the home’s achievement of ensuring that a proper system of monitoring and reviewing healthcare needs is in place. One service user’s relative was spoken to. It was evident from the discussion that the relative is much happier with the support and care the home has given to their relative. On the second day the GP visited the home as part of their twice-weekly visits. The GP was impressed with the current works in progress and she praised the assistant manager on duty. The assistant manager informed the inspector that the service users who are currently residing at Broadwater Lodge have been able to keep the same GP who supports The Red House. The service users at Cranwood have been temporarily registered with a GP locally. Records of falls were examined. It was evident that a number of service users who have moved on or have died since the previous inspection, their records remained on file. Those service users, who were deemed high risk, did not have their care plans updated nor had the home pulled this together from the evidence written. In discussion with the assistant manager it was evident that professional input is limited even when requested. It was advised that falls training with regards to prevention and intervention is needed for all care staff. The other area of support is for the home to liaise with the local falls clinic to ensure the ethos of care with regards to falls monitoring is seen as preventative and restorative. It was evident from the discussion with the assistant manager that one service user who is currently residing in Broadwater Lodge is constantly being sent to hospital because of their diabetes levels going up and down. The home has documented all the incidents and how this has been managed. However, no notification under Regulation 37 has been reported to the Commission. The home’s weights and fluid monitoring is excellent. Records of service users weight monitoring are completed monthly. Service users who have lost or gained weight, a recorded explanation of why this has occurred is on file. For example one service user was in hospital lost weight and then gained weight after their return to the home. A part of the inspection was to observe staff completing a medication round. The records for the receipt, administration and disposal of medicines were generally satisfactory at the time of the visit. One service user was receiving a Controlled Drug, which was being kept in a locked separate wood compartment Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 14 inside a locked wooden cupboard. The home has a Controlled Drug register, which is being completed satisfactorily. One area of concern related to one service user whom seems to refuse their medication at night due to them being asleep. It was advised that this must be reviewed with the GP. On the second day of the inspection the GP visited. The assistant manager raised the concern regarding the specific service user being asleep when a particular medication is being administered to them at night. The decision made by the GP was to discontinue that particular time slot and a new prescription was issued. Records of the room temperatures of where medication is stored are completed daily. The interim manager stated that he is in the process of updating and completing the medication policy. This was a requirement from the previous inspection with the CSCI pharmacist inspector. The new policy will include a section on covert medication, controlled drugs and homely remedies. It was recommended that to make every unit responsible for their own service users’ medication should allow this to be achieved. The medication for each unit should be supplied separately for each unit. One of the assistant managers stated that this proposal is being considered. Wandering around the home it was observed that service users are being treated respectfully and their dignity is upheld. The interim manager praised the care staff for their commitment and hard work through this difficult transitional period of change. Service users in the two homes visited seemed happy and not too concerned with the temporary arrangement. All stated when asked, that they cannot wait to return back to the home and that the care staff are good and supportive. During a brief tour of the home it was evident that individual’s personal clothing is hung appropriately and presented differently. Service users care plans are kept securely and this was evident at The Red House and Broadwater Lodge. Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 15 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service. The home offers service users a good choice of various activities and support. Service users maintain family contact and participate in various planned in house activities. Culture needs are met either through social and family needs. The meals in this home are good offering both choice, variety, and catering for special needs. EVIDENCE: Service users interests are recorded and they are given opportunities for stimulation through leisure and recreational activities in and outside the home, which suit their needs, preferences and capacities. The home has an activity worker, who at present is currently off. However, activity records show that activities are still been offered and service users spoken to confirmed this. On day two the inspector observed service users and care staff playing dominos. The dominos game was observed to be loads of fun and laughter with a surprise winner. Those service users who did not participate in the game, were involved in the atmosphere that surrounding it. Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 16 Visitors are welcomed, at any reasonable time. The inspector spoke to one relative of a service user. It was evident that the service user’s relative is very supportive, ensuring that their relative’s needs are addressed by the home on a daily basis, as their first language is not English. The service user is able to communicate with carers on a daily basis by using actions or the same words, which the carers have become familiar with. Any issues relating to hospital or GP appointments, a family member always supports the individual’s to ensure their linguistic needs are properly heard. The relative stated that they have seen a number of changes with regards to staffing levels; continuity of staff and the general care of their relative’s support. The service user relatives’ visits regularly to ensure the service user’s linguistic needs are stimulated. The relative also stated that in the autumn they attended a review meeting at the home, however, they have not received any feedback or action following this. Reviews were discussed with the assistant manager who confirmed this. It was evident that there are a number of service users who reside at The Red House of various cultures, diversity, gender and needs. This is matched by the staffing team supporting. The inspector observed during the tour of one of the homes, carers and service users of all races and genders were playing a game, which could be seen, as culturally or gender specific. This was impressive and refreshing in a care home that has a diverse cultural and gender difference to support on a daily basis. The meal served in the home on the day was varied, appealing, wholesome and nutritious to suit all individuals. All received healthy portions and it was observed they seem to enjoy their lunch. The menu plan is recorded daily on the notice board in each unit. However, it was evident that in Maple unit the information recorded as well as the daily menu had the date and the weather. This was impressive as the information recorded was clearer and easier to read. It was recommended that the same format could be copied in each unit. Each day it is the responsibility of the care staff to consult with individual regarding their menu choice for the following day. This is recorded and given to the cook. Vegetarian option was discussed, as this seems to be eliminated from the menu. The assistant manager stated that there are no vegetarians in the home; however, if a service user would like something different that is not on the menu, the cook is able to prepare this. The cook’s training certificates were examined. It was evident that the food and hygiene certificate had expired. Service users spoken to stated that the ‘food is good and there is plenty.’ Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using evidence gathered both during and before the visit to this service. Service users know that their views are listened to, as these are present in other languages or large print if requested. Staff have a good practical knowledge and understanding of adult protection issues, which protects service users from abuse. EVIDENCE: One complaint was on file regarding a service user complaining that on their return back to the home after a hospital appointment no meal was left. The manager responded to the complainant appropriately. The organisation has produced a pamphlet call ‘what do I do? On how an individual can complain, make suggestion or give complements appropriately, the pack includes a feedback form and on the back the pamphlet can be produced in other languages and larger prints if requested. Since the previous inspection there has been three Protection of Vulnerable Adult (POVA) investigations. The local authority has investigated each POVA in full. A number of recommendations were made and one POVA alerted resulted in the Commission issuing a Statutory Enforcement Notice regarding a specific service user’s care, support and linguistic needs not been fully met. Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 18 All care staff are currently undertaken or have completed their POVA training, evidence was on file. It was reminded that all staff including, the handy person and the cook are to undertake this training. Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service While maintenance works are in progress the environment of the home is being made suitable for service users to live comfortably. EVIDENCE: At present the major refurbishment of the home is underway. The interim manager stated that Phase 1 has been completed and the contractors are moving towards Phase 2. During the second day a number of contractors were on site inspecting the current progress. This included a visit from the local fire officer. Consultations with the registered provider, contractors and the Commission have taken place over a number of months. The main aim of the meetings is to keep the Commission informed of what works are being completed; the contractors and the timescale of the works; and to monitor the impact on the service users, their care needs and staffing. The Commission is satisfied at Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 20 this stage of the process with the works schedule and with the consultation process that has taken place. The inspector was able to tour the building whilst works were being carried out. This was completed with the head contractor and the assistant manager. It was evident that progress has been made and the transformation is very good. Rooms have been made brighter, new carpet, curtains, kitchen units and bathing facilities have been installed. The service users in the units on the ground floor are to be transferred to the top floor (newly decorated units), for works to continue on Phase 2. Care staff, service users and relatives and friends have been consulted and kept updated on the progress through the home publication ‘Newsletter’. The relatives visiting during the inspection confirmed this. Door closures were discussed with the head contractor and the interim manager. As it was evident during the tour of the building that bedroom doors did not have any door closure devices in place. From previous inspections it was evident that a number of service users’ request to have their bedroom doors open at all times. These were either wedged or propped open. Under fire regulations it is advised for safety that all fire doors must remain shut, unless a safety door device is in place, which is activated by the fire alarm. Further discussion with the contractors is needed by the homes management with regards to ensuring appropriate safety measures are in place within the home. Requirements relating to maintenance were not checked at the time of this inspection, as these were within the timescales for compliance to be achieved. The inspector was given a copy of the home’s update version of ‘Infection Control’ guidelines for care homes. The document covers all aspect of infection and how it can be minimised. Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service. Staff morale has improved resulting in an enthusiastic workforce that now works positively with service users to improve their whole quality of life. Care staff are competent, skilled and qualified to support the service users on a daily basis. However, service users cannot be confident that all staff are fully competent in all aspects of their care needs. Therefore service users could be placed at risk if these shortfalls with regards to training are not addressed. EVIDENCE: The home has four separate units. At present two units are based at two separate locations. During the transition period the management team have increased the staffing levels to ensure two carers are assigned to each unit. This is to ensure that there is adequate support in place, since the assistant managers are unable to be at each of the homes full time. The home has a large diverse staff team. Six staff records were examined. A number of staff records examined were care staff that have been employed for a number of years. All information pertaining to individuals were in place. However, copies of Criminal Records Bureau (CRB) certificates were not on file. It was advised that CRBs are kept by the organisation’s Human Resource Department. It was required that the registered person submit to the Commission a list of all staff employed, their CRB number and whether the certificate in place is either an enhanced or standard level check. Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 22 Training gaps found were: • Customer service training (pertaining to the administrator) • Qualified First aiders • Food & hygiene • Infection control • Dementia care • Falls prevention and management • Fire safety • Back care update The interim manager stated that the Chief Executive of the organisation is holding a staff conference inviting eight staff from the home to attend. The conference is to look at what the achievements and to obtain staff views on what can be improved. The management team have regular meetings. The last meeting was held on 28th April 2006. A carer was asked about individual service users care needs and what training they had received. The carer shared with the inspector that they had worked in the home for a number of years and that they had undertaken a number of training courses, including NVQ level 2. The carer is also aware of individuals care needs within the units, for instance, their likes and dislikes. However, the carer did state that although they do have supervision this is not regular. Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 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, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service. Since the last inspection the standard of care has improved. Therefore service users are safeguarded and the home is run to the best interest of the service users. Service users know that their health & safety is promoted and protected. EVIDENCE: Since the previous inspection the management structure of the home has changed a number of times. The last manager left and in the interim there has been two managers job sharing the post for a couple of months. A week and half before this inspection a new manager, was appointed. Prior to this inspection a letter regarding the current changes of manager was submitted to the Commission. The inspector was able to meet the new manager on day two of the inspection. The interim manager has created an open, positive and inclusive atmosphere. This is evident through the publication of the newsletters Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 24 to service users family and friends and the interim manager’s commitment to ensuring equality is upheld through its working practices and the service being delivered. The interim manager stated that the home’s policies and procedures are being revamped. It was evident that a number of policy and procedures were out of date and not in line with current legislation. As the home is going through some major structural changes and at each stage of the process health and safety contractors are involved, it was not feasible for the inspector to inspect all the health and safety documents until the works are completed. However, the fire drill records were examined and the last recorded fire drill that had taken place was on 3/04/06. Supervision records were in place. One member of staff had returned to work recently after being off sometime. It was evident that since the member of staff returned to work no form of induction had taken place, with regards to the current changes, their roles and their training and development needs. It was advised that this is good practice after a period of absence. Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 25 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 2 X 3 X 3 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 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 26 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 OP8 Regulation 17(1)(a) Sch 3.3(o) Requirement The registered person must ensure that any changes in care needs such as falls, must be updated accordingly on the service user’s care plans and risk assessments. This must detail the health concerns and what measures have been put in place. Evidence is to be recorded on the individuals care plan. (Previous timescale of 20/03/06 partially met.) The registered person must seek advice and guidance with regards to service users who are deemed high risk of falls from either a relevant professional or a local falls clinic. Magnetic door holders or a release mechanisms must be fitted to any fire doors in the home that young people/staff members routinely prefer to leave open for extended periods of time during the day or night. Alternatively the registered person consult with the London Fire Emergency Planning DS0000033328.V291224.R01.S.doc Timescale for action 30/06/06 2. OP19 23 30/08/06 Red House, The Version 5.1 Page 27 3. OP19 13(4) Authority (LFEPA) fire officer with regards to the safety aspect of having fire doors propped open and provide evidence that the LFEPA are satisfied with this arrangement. (Previous timescale of 30/12/06 partially met) The registered person must review and risk assess the current practice of having the gate at the top of the stairs. This is to be included in the home’s environmental risk assessment. The registered person must complete an environmental risk assessment that includes a fire risk assessment. This is to be reviewed at least once annually. (Previous timescale of 30/12/05 partially met. Unable to assess at this inspection and however, within the current timescale for compliance) The registered person must review the current security system within the home. (Previous timescale of 30/05/06 not met) 30/08/06 4. OP19 13(4) 30/08/06 5. OP9 13(2) The registered person must ensure that all care staff are aware of the security protocol, based on service users vulnerability in the home and that this is reviewed and monitored accordingly. (Previous timescale of 20/12/05 partially met. Unable to assess at this inspection and within the current timescale for compliance) The registered person must 30/06/06 update the medicines policy and include a section dealing with the DS0000033328.V291224.R01.S.doc Version 5.1 Page 28 Red House, The 6. OP19 13(4)(a) (b) 7. OP7 17 possibility of disguising the medication, if non-administration will seriously endanger a service user’s health. (Within the timescale for compliance at the time of this inspection.) The registered person must ensure that all radiators are either low surface temperature or are appropriately guarded and that the standing bath is serviced and repaired. (Not assessed & within the current timescale for compliance.) The registered person must ensure that the monthly summaries address all the areas of risks and goals set for individuals’, showing clearly whether or not a risk or a goal has been achieved. (Previous timescale of 30/03/06 partially met.) The registered person must ensure all records of deceased service users are filed appropriately. The registered person must amend the home’s Statement of Purpose to reflect the current changes that have occurred. The registered person must ensure that any person who prepares or handles food in the home has completed essential Food Hygiene training, especially the cook whose certificate has expired. The registered person must ensure all care staff undertake Protection of Vulnerable Adults (POVA), Dementia care, fall prevention, fire safety and back DS0000033328.V291224.R01.S.doc 30/08/06 30/06/06 8. OP1 6 30/07/06 9. OP30 18(1)(c) (i) 30/08/06 10 OP30 18(1)(c) 30/09/06 Red House, The Version 5.1 Page 29 11. OP8 13(4) 12. OP7 15 13. OP37 17 14. OP8 37 15. OP29 7, 9, 19 Sch 2 care training. The POVA training schedule is to include the handyperson and the cook. The registered person must ensure that on each shift there is a qualified first aider. The named care staff should be indicated on the rota. Past copies of rotas must be kept for the purpose of the inspection. The registered person must liaise with the placing authorities with regards to service users reviews as to what is the protocol with regards receiving summary of action addressed at each meeting. The registered person must update those policies and procedures that are out of date and not in line with current legislation. The registered person must ensure any Regulation 37 reportable incident regarding a service users who is currently residing in Broadwater Lodge and Cranwood is notified through The Red House to the Commission. The registered person must submit to the Commission a list of all staff currently employed Criminal Records Bureau (CRB) certificate numbers. This is to also include whether the check is enhanced or standard. 30/08/06 30/06/06 30/08/06 20/06/06 30/06/06 Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 30 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 OP9 Good Practice Recommendations It is recommended that the registered person ensure that the morning medication round is completed within an hour. The proposals to make every unit responsible for it own service users’ medication should allow this to be achieved. The medication for each unit should be supplied separately. The registered person should re-evaluate the roles and responsibilities of the assistant manager within the home. It is recommended that the menu plan layout in Maple should be adopted in each unit. The registered person should ensure that the menu plan displayed is legible for service users with visual impairment It is recommended that the registered person should have in place a ‘back to work’ policy alongside the home’s supervision policy for staff that have been off on long-term sick or maternity leave. It is good practice that a vegetarian option is included in the daily menu plan. 2. 3. OP27 OP17 4. OP36 5. OP17 Red House, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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, The DS0000033328.V291224.R01.S.doc Version 5.1 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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