Inspection on 23/08/07 for Red House, The

This inspection was carried out on 23rd August 2007.

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

The inspector 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 11/05/06

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 Caroline Mitchell Key Unannounced Inspection 02:00 23 August, 5 & 12 September 2007 rd th th 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.V337111.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, The DS0000033328.V337111.R01.S.doc Version 5.2 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 Joy Ohiri Care Home 35 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (18) of places Red House, The DS0000033328.V337111.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. These persons who are in the category DE (E) must be accommodated in the living unit identified for this purpose. 11th May 2006 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 residents have additional physical disabilities and dementia needs associated with ageing. In addition to providing care for residents, the home employs 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. Placements at the home cost around £530 for each person per week. Residents are expected to pay separately for some items and activities, such as hairdressing or eating out. Following Inspecting for Better Lives the provider must make information available about the service, including inspection reports, to service users and other stakeholders. Red House, The DS0000033328.V337111.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over three visits and took around 14 hours to complete. The registered manager and other senior members of staff assisted the inspector throughout the inspection. The home is organised into 4 units, on a core and cluster basis and went through a major refurbishment programme recently. The inspectors were able to speak to several residents and staff during the inspection and toured the building. It was observed that 2 of the units were catering for residents who were more vulnerable and confused. The inspector reviewed the written records of several residents and staff, saw the records of complaints, staff training, monitoring records of falls, day-time activities, policies and procedures, records of health and safety and a sample of the menus. As part of the inspection process the inspector checked whether the requirements from the previous inspection had been complied with. What the service does well: What has improved since the last inspection? What they could do better: The areas that need to be addressed include that a number of the residents are propping open their bedroom doors. Some work has been done to address Red House, The DS0000033328.V337111.R01.S.doc Version 5.2 Page 6 this issue, but there is still work to be done to ensure people’s safety in relation to this. The staff have been provided with some relevant training. However, not all staff have received all the training that they need. This is area that the home needs to concentrate on, to ensure that residents best interests a met, and includes some core health and safety training, safeguarding adults and working with people with sensory impairments. Some work also needs to be undertaken to ensure that falls prevention is reemphasised in the home. There is quite a complex alarm and call system and staff need clear guidance about their responsibilities in relation to responding to this. There is an emphasis placed on diversity and a nice, diverse resident and staff group. However, there is room to improve the service to some people from some minority backgrounds. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Red House, The DS0000033328.V337111.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, The DS0000033328.V337111.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home understands the importance of having sufficient information when choosing a Care Home. It has developed clear information to help people understand what specialist services the home can provide. The home provides a Statement of Purpose that is specific to the individual home, and the resident group they care for. It clearly sets out the objectives and philosophy of the service. Admissions are not made to the home until a full needs assessment has been undertaken. EVIDENCE: At the previous inspection the registered person was required to ensure that the Statement of purpose for the home was amended. At this inspection the inspector was able to confirm that this task had been completed. The inspector reviewed the written records for 5 residents and found that 1 contract had not been signed by the resident or their representative and a requirement s made in respect of this. Red House, The DS0000033328.V337111.R01.S.doc Version 5.2 Page 9 The inspector reviewed the records of 1 resident who had recently been admitted to the home in some detail and found that the home had been provided with a professional assessment of the person’s needs prior to their admission, so that the home could make an informed decision as to whether this person’s needs could be met in the home, and was clear about any risks. Red House, The DS0000033328.V337111.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. 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 available evidence including a visit to this service. People who use services have access to health care services both within the home and in the local community. People who use services unable to access local services are managed by visits to the home by health care professionals. Health needs are monitored and appropriate action and intervention taken. The home is able to provide the aids and equipment recommended. There is evidence in the Care Plan of health care treatment and intervention, and a record of general health care information. There is a need generally, to re-emphasise the importance of falls prevention. Staff encourage people to be independent and to take responsibility for their own personal care. The views of people who use services are sought in the way personal care is delivered. The home has a medication policy which is accessible to staff, medication records are generally up to date for each resident and medicines received, administered and disposed of are recorded. The home understands the need to comply with the administration, safekeeping and disposal of controlled drugs. Medication systems have not always followed good practice guidelines and has needed action, the registered person has responded. EVIDENCE: Red House, The DS0000033328.V337111.R01.S.doc Version 5.2 Page 11 Each person has a care plan and risk assessment in place and the inspector noted that good clear records were kept of health care received by each person, such as visits by the GP, dietician, speech therapist, district nurse and dentist. At the previous inspection the registered persons were required to ensure that any changes in care needs, must be up-dated accordingly on the resident’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. At this inspection the inspector found health concerns and changes in need were being recorded promptly as they arose. In particular, the inspector reviewed the written records of 1 person who had returned to the home the day prior to the inspection, after stay in hospital, and found that the person’s care plan and risk assessments had been updated to include the changes in their needs, and guidance for staff regarding the increase in risk that were relevant. However, the moving and handling risk assessment for 1 particular resident had not been completed properly and a requirement is made in respect of this. At the previous inspection several requirements and recommendations were made regarding improving the way in which medication is stored, handled and recorded in the home. At this inspection the inspector found that improvements have been made. The manager has reviewed the policy, procedure and the practice in the home and has made several improvements. The written, local policy and procedure regarding dealing with medication in the home is improved and better reflects the practice in the home, the arrangements for storing and administering medication in each unit is improved, with the responsibility being devolved to care staff and training having been provided. The arrangements regarding PRN medication are clearly documented. The system of recording all medication that comes into and goes out of the home is improved, the system of ensuring that medication is ordered in good time is improved, the information available to staff regarding the uses and side effects of the medication that is prescribed to people living in the home is improved. All of the previous requirements had been met and the inspector noted only very minor areas that could still be improved upon. The manager explained that staff are observed by a senior member of staff when first administering medication, but that a written record is not kept of this. A recommendation is made in respect of this. The inspector reviewed the records of accidents and incidents with particular reference to the prevention of falls. The inspector is aware that a falls prevention project was recently undertaken in all of the Haringey Council older people’s homes and that staff received training about the prevention of falls at that time. Unfortunately, since the previous manager left the home, some records are no longer available and this includes the records of which staff Red House, The DS0000033328.V337111.R01.S.doc Version 5.2 Page 12 members have attended training and workshops regarding falls prevention. It would seem timely for staff to receive further training, as the inspector noted that there has been an increase in the number of people who have had falls since the last inspection. There are a number of things that impact on this, for instance there have been an increase in the numbers of residents living in the home since the previous inspection. It is worth noting that there was evidence that resident’s care plans and risk assessments were being updated to reflect any changes in their needs where the risk had increased of them falling. The staff spoken to at the time of the inspection about one person, who has been found on the floor a number of times recently, were clear about the person’s needs, the risks and how they can intervene to minimise these risks. Where people had a history of falls there was evidence that aspects of their care such as appropriate health care advice, appropriate footwear, and the placement of furniture in their rooms were being considered as part of efforts to minimise the risks. The inspector did note that the system of recording falls duplicated information that is being recorded by staff in the accident record and that the time of falls was not always recorded. The previous requirement for staff to receive training in falls prevention is restated as part of this report and recommendations are made in respect of reviewing the system of recording and monitoring falls. The manager stated her commitment to repeating falls prevention training for the staff team. Some residents told the inspector that staff respected their privacy and 1 said that they felt safe and “treated very well” by staff. In the case of difficulty arising with 1 resident’s relationship with a staff member, and the inspector reviewed the records of this person. They reflected that this issue had been taken seriously and dealt with appropriately. Red House, The DS0000033328.V337111.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have the opportunity to develop and maintain important personal and family relationships. Although, there is room for improvement in supporting residents with communication, where there are cultural or sensory needs. People who use services are involved in meaningful daytime activities of their own choice and according to their individual interests and capability and the home employs a full time activities co-ordinator. The menu is varied with a number of choices including a healthy option. It includes a good variety of dishes. The meals are balanced and nutritional and cater for the varying cultural and dietary needs of the individuals using the service. EVIDENCE: The home has an activity worker and records show that various activities are offered, most of the residents spoken to confirmed this, although one gave feedback that “activities are planned, and sometimes are cancelled and don’t happen”. The monitoring records of the activities that were undertaken by residents were reviewed by the inspector noted that these were carefully recorded and reflected that people’s interests were recorded and they are regularly given opportunities for stimulation through leisure and recreational activities, both in and outside the home, which are designed to suit their needs Red House, The DS0000033328.V337111.R01.S.doc Version 5.2 Page 14 and preferences. The inspector was shown the activities room, which is on the first floor, bright and airy, and well equipped. The inspector noted that someone also comes into the home on a regular basis, to provide chair based exercises sessions for residents and a hairdresser comes in on a weekly basis. Someone said, “we have coffee mornings” and “we put on old records and have a sing a long and dance”. It was evident that there are a number of residents who reside at The Red House of various cultures; there is diversity in religious belief, gender and needs. This is generally well matched by the staff team providing support, and it is evident that the differing needs and preferences of the residents are thought about sensitively, and provided for. There are small numbers of residents who do not speak English as their first language, there being Greek and Cantonese speaking residents in the home at the time of the inspection. In order to support their communication needs on a day-to-day basis, a recommendation is made regarding the recruitment of staff who are able to speak Greek and Cantonese. In addition, there are a number of residents who have specific communication and care needs relating to disabilities in hearing and sight. It is recommended that staff be provided with training in working with people with sensory impairments. It was evident that visitors are welcomed, at any reasonable time and records reflect that most residents have relatives who visit regularly. In some cases, where people are speaking English as a second language, this ensures that people’s communication needs are catered for to some extent. During the course of the inspection the inspector observed that one relative arrived at the home to attend a resident’s review. The inspector visited the kitchen and reviewed the planned menu. The menu provides a varied and well balanced diet and provides for any special nutritional needs that people might have. The menu plan is recorded daily on the notice board 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. There is also an opportunity for people to request any alternative dishes that are not on the planned menu, and from the records that were examined it was evident that people do request different dishes. The residents spoken to stated that the ‘food is good’ and that the cook ‘always tries to do it how I like it’. The inspector noted that people’s special dietary needs were carefully noted and very clearly displayed in their care plans and that guidance had been sought from health professionals such as dieticians and speech therapists regarding people’s needs, where appropriate. The manager and other staff told the inspector, that residents from different cultural backgrounds often chose to decline culturally appropriate options, because the don’t seem to wish to “put people to any trouble” but that the cook and care staff continue to offer these options. The manager added that people’s families often bring food in when they visit, and that this gives people further oportunity to keep in touch with their culture. Red House, The DS0000033328.V337111.R01.S.doc Version 5.2 Page 15 Several residents require special diets and soft or pureed food, due to their specific health needs and the inspector noted that this is very clearly documented in people’s care plans and risk assessments and that support and advice had been sought from the appropriate health care professionals, where this was the case. Red House, The DS0000033328.V337111.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that meets the National Minimum Standards and Regulations. Staff are aware of the complaints procedure. Complaints from individuals are fully recorded. When they are logged, with outcomes and actions properly logged. Policies and procedures for safeguarding people who use the service are in place. Some staff have had training around Safeguarding Adults but others have not. This may lead to inconsistent knowledge and practice within the service. People who use services say that they are satisfied with the care in the home and feel safe. EVIDENCE: The inspector reviewed the record of complaints and noted that 1 complaint had been recorded and responded to since the last inspection. The records kept were sufficiently detailed and the outcome and response was recorded. As this is a local authority home, there are clear policies and procedures in place. However, records reflect that about half of the staff team have received training in adult protection and a requirement is made for all staff to receive this training. Several people who spoke to the inspector did say that they were happy in the home and felt safe there. Red House, The DS0000033328.V337111.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that meets the specific needs of the people who live there. The home is comfortable, and has recently completed a programme to improve the decoration, fixtures and fittings. Although there remains a leak in a glass roof in 1 corridor. People who use services can personalise their rooms. They also say they the home is clean, warm, well lit and there is sufficient hot water. Bathrooms are accessible to all people using the service although people using the service report that they can always access a bathroom that meets their needs. Toilets for the use of people using the service are appropriately located within the home, are easily accessible and in sufficient numbers. The home has achieved small group living for people using services but is aware of the benefits of small units that have their own communal focus. The home is clean and tidy, hygiene equipment is available and maintenance records are kept up to date. An area for improvement that has been identified is that staff should have clearer guidance about their responsibilities in responding to the alarm and call system. EVIDENCE: Red House, The DS0000033328.V337111.R01.S.doc Version 5.2 Page 18 During the tour of the building the inspector noted that the home is organised in 4 units Maple, Cedar, Willow and Beech. Each unit consist of a number of single bedrooms, toilets, a shower room, bathrooms, lounge/dining area and a kitchenette. All residents have their own bedrooms. The home has undergone a major refurbishment and the standard of accommodation has been greatly improved and that the home was clean, with no unpleasant odours detected. However, there is an area of glass roof corridor on the ground floor that requires some work to prevent rain from leaking through and a requirement is made in respect of this. The registered persons were previously required to review and risk assess the practice of having a gate at the top of the stairs. The manager explained that this is no longer relevant as the gate has been removed. At the previous inspection the registered persons were required to ensure that there is a protocol in place regarding how the security system that is installed in the home is managed. At this inspection the inspector found that, although there is more clarity around the responsibilities of staff in responding to the security system and the residents’ call bell system since a member of administrative staff has been employed, this requirement has not been met. The alarm and call system is quite complex and includes an alarm going off if particular external doors are opened, to alert staff if vulnerable residents leave the building. As this requirement remains relevant and is reworded and restated as part of this report. Red House, The DS0000033328.V337111.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home have confidence in the staff that care for them. There are enough qualified, competent and experienced staff to meet the health and welfare of people using the service. Staffing rotas take into account the needs and routines of the people using the service. The service recognises the importance of training, and tries to delivers a programme that meets any statutory requirements and the National Minimum Standards. The manager is aware that there are some gaps in the training programme and plans to deal with this. The service is also able to recognise when additional training is needed, but due to the numbers of staff involved, this sometimes takes some time to address. The service has a recruitment procedure that meets the regulations and the National Minimum Standards. The procedure is followed in practice and there is accurate recording at all stages of the process. EVIDENCE: The staff rota provides sufficient care staff in each unit; there are sufficient senior and ancillary staff, and adequate staffing at night to ensure that people’s needs are met. At the previous inspection the registered person was required to ensure that all staff personal records are in place and on file. At this inspection the inspector reviewed the written personnel records of several staff in detail, and briefly Red House, The DS0000033328.V337111.R01.S.doc Version 5.2 Page 20 looked at the records for all staff employed in the home. The records for all of the staff whose files were reviewed were found to include all necessary documentation to indicate that they had provided adequate proof of identity and that proper pre-employment checks had been undertaken prior to them being employed. Additionally, at the previous inspection it was recommended that the registered person should ensure that staff personal records are clearly indexed to ensure current information can be easily found when needed. At The inspector found that the files were well organised and clearly indexed. Each staff member had a training record and plan on file and the manager was working on ensuring that clear monitoring information is available regarding the training that staff have undertaken, so training needs are clear for the team as a whole. A recommendation is made in respect of this. At the previous inspection the registered persons were required to ensure that all staff have fire safety and back care. Whilst it is evident that the home is proactive in encouraging staff to attend training, and a number of staff have attended training since the previous inspection, due to the large numbers of staff involved, there remains some work to do to ensure that all staff receive training in these areas. This requirement is restated as part of this report. The manager told the inspector that fire safety training had been provided recently and everyone has received training in dementia care, and that whilst some care staff are waiting the next round of food hygiene training, that the cook has recently completed a food hygiene update. Most of the staff team have completed training up to NVQ level 2. At the previous inspection it was recommended that the registered persons reevaluate the roles and responsibilities of the assistant manager within the home. At this inspection it was evident that this recommendation had been taken seriously, particularly with regard to devolving the responsibility of administering medication to the care staff, and that this has improved the time available for the senior staff in the team to do other work. The inspector spoke to a new member of staff and they said that because they were receiving a good quality induction, they were “feeling confident. “ 2 of the newer staff told the inspector that there is as good corporate induction and the inspector was provided with a copy of the induction programme that is designed for the home. This is very clear and comprehensive. Red House, The DS0000033328.V337111.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is qualified or has the necessary experience to run the Home; they are aware of and work to the basic processes set out in the NMS. The manager trains and develops staff who are generally competent and knowledgeable to care for the people who use the service. The service is planned to be user focused, to take account of equality and diversity issues, and generally works in partnership with families of people who use the service and professionals. The systems that are in place to support people around their money protect their best interests. The manager is improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home. The manager is aware of the need to promote safeguarding and has developed a health and safety policy that generally meets health and safety requirements and legislation. There is an ongoing area of concern around residents propping their bedroom doors open, and further work is necessary in this area to better ensure resident’s safety. Red House, The DS0000033328.V337111.R01.S.doc Version 5.2 Page 22 EVIDENCE: The inspector saw the minutes from the residents and relatives meetings and it was evident that peoples’ views were being gathered pertaining to the recent refurbishment and transition period. The manager said that she was committed to encouraging residents relatives to attend regular meetings and that efforts had been made to inform and include people in the process. Unfortunately, the most recent meeting had to be postponed due to an accident, and it is her intention to arrange another in the near future. The inspector discussed the arrangements that are in place around supporting people with their money with the new administrator in the home, who explained that it was their experience that there are a number of safeguards in place to ensure that peoples’ best interest are protected as that the petty cash system is used to pay outstanding amounts and all expenditure is recorded and accounted for. The manager reviews spending on a weekly basis, and the petty cash is checked on a monthly basis by the person undertaking visits under Regulation 26 each month. 8 people manage their own money, with the help of their families, and London Borough of Haringey is the appointee for the other residents. The inspector looked at random at the records of people’s expenditure and found that careful accounts are kept. At the previous inspection the registered persons were required to update those policies and procedures that are out of date and not in line with current legislation and to ensure that the Regulation 37 reports submitted to Commission are correctly completed. At this inspection the inspector was able to confirm that these issues had been addressed. At the previous inspection the registered persons were required to ensure that all staff have regular supervision at least six times a year. This is to be recorded, monitored and reviewed accordingly. At this inspection the inspector found that supervision is being provided to staff on a regular basis. In terms of health and safety, the issue of residents propping bedroom doors open has been an ongoing issue in the home since before the refurbishment, and requirements have been made previously in respect of this. At this inspection the inspector found that some progress has been made in that environmental risk assessments and fire risk assessments are in place and in these, there is reference to 1 resident who props their bedroom door open. However, there are now a number of residents who live in the home who are also propping their doors open, and the environmental risk assessments and fire risk assessments need to be updated. The inspector found that this issue is mentioned in the residents’ individual risk assessments, but that the guidance for staff regarding how to minimise the risks involved was not clear. This remains an area for improvement and the previous requirement is reworded and restated in respect of this. At the previous inspection it was Red House, The DS0000033328.V337111.R01.S.doc Version 5.2 Page 23 required that the registered person must obtain a copy of the fire officer suggestion with regards to having fire doors wedged open. The manager explained that the fire officer had given advice that it was acceptable for the residents to keep their doors open, if a proper risk assessment were in place along with arrangements to minimise the risks involved and these were reviewed regularly. The manager has stated her intention of looking into alternative methods of ensuring the safety of those people who keep their doors open, such as individual automatic door closures. A recommendation is made in respect of this. Red House, The DS0000033328.V337111.R01.S.doc Version 5.2 Page 24 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 2 3 X X N/A 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 3 X X 3 X 3 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 3 X 3 3 X 2 Red House, The DS0000033328.V337111.R01.S.doc Version 5.2 Page 25 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5 (c) Requirement The registered person must ensure that the written contacts of the terms and conditions of the home, that are in place for residents are signed up to by the resident and/or their representative. The registered person must ensure that the moving and handling risk assessment for 1 particular resident is completed properly. The registered person must ensure that the all staff receive training in adult protection. The registered person must ensure that a clear protocol is in place regarding how the security system is managed on a day-today basis. The registered person must ensure that all care staff are aware of the security protocol, based on the vulnerability of residents in the home and that Red House, The DS0000033328.V337111.R01.S.doc Version 5.2 Page 26 Timescale for action 30/11/07 2. OP7 13 15 30/11/07 3. OP18 13 (6) 30/12/07 5. OP19 13(4) 30/10/07 this is reviewed and monitored appropriately. (The previous timescales of 30/08/06 and 13/03/07 were not met.) 6. OP19 23 (2) (b) The registered person must 30/12/08 ensure that the area of glass roofing in the downstairs corridor is maintained to prevent rainwater from leaking in. The registered person must ensure all care staff receive training in falls prevention, fire safety and back care. (The previous timescale of 30/08/06 and 13/03/07 were partially met) 8. OP38 23 The registered person must 30/10/07 ensure that the risks associated with particular residents’ keeping their bedroom doors propped or wedged open are properly assessed, that there are arrangements and clear guidance in place regarding minimising these risks throughout the individual and environmental risk assessments that are in place, and that these are reviewed to keep place with any changes in individuals’ care needs or safety practices within the home. The previous timescale of 13/03/07 was not met. 30/01/08 7. OP30 18(1)(c) Red House, The DS0000033328.V337111.R01.S.doc Version 5.2 Page 27 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 OP8 Good Practice Recommendations It is recommended that the registered persons review the system of recording and monitoring the falls that residents have in the home, and that the monitoring information regarding the numbers of falls that residents are having is discussed regularly, as a standing item on the staff meeting agenda. It is recommended that staff be reminded to record the time of any fall that residents have to aid in monitoring and prevention. It is recommended that when first administering medication, staff’s competence be assessed and a record of evidence of this assessment be kept on their personnel file. It is recommended that the registered person consider methods of targeting staff recruitment to Greek and Cantonese speakers. It is recommended that staff be provided with training in working with people with sensory impairments. It is recommended that the manager continue to work on the task of correlating monitoring information regarding the training that staff have undertaken, so that training needs are clearer for the team as a whole. It is recommended that the registered person consider alternative methods of ensuring the safety of those residents who choose to keep their bedroom door propped or wedged open. 2 OP8 3 OP9 4 OP12 5 6 OP12 OP30 7 OP38 Red House, The DS0000033328.V337111.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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