Inspection on 27/10/05 for Red House, The

This inspection was carried out on 27th October 2005.

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 11/05/06

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 Unannounced Inspection 27th October 2005 09:30 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.V253553.R01.S.doc Version 5.0 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.V253553.R01.S.doc Version 5.0 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 Mrs Monica Burke-Newton 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.V253553.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The home may provide accommodation and personal care for up to 35 persons of either gender who are over 65 years of age (OP). 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. Two specified service users who are over 65 years of age and have dementia may be accommodated in the home. They may be accommodated in the general needs units until such times that the named service users can be transferred into the dementia (DE(E)) unit. The home must advise the registering authority at such times as either of the specified service users vacates the home. 19th May 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 mental health 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 coordinator. Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six half hours. Francis Czuba assisted the lead inspector on the day of the inspection. The registered manager and the senior member of staff assisted the inspectors’ throughout the inspection. There are thirty-three service users, two of whom were in hospital. At present the home had two vacancies. The home is going through a major refurbishment programme, which is scheduled to commence January 2006. While initial consultation has taken place, the Local Authority must keep the Commission informed of the plans with regards to the future refurbishment. The inspectors were able to speak to a number of service users during a brief tour of the building. It was observed that many of the service users were confused. All service users were sitting in their allocated lounges. While televisions were on, none of the service users were observed watching them. Staffing levels in the home were inappropriate to meet the changing needs of the service users within each unit. The manager stated that this is to be increased by the following week. This has been addressed in the main body of this report. The main part of the inspection was occupied by case tracking one specific service user’s care plan. This was in response to a complaint made to the inspectors by a relative visiting. Subsequently a number of areas of concern related to care were addressed to the registered manager. This has been addressed in the main body of this report. The main focus of this inspection process was to check whether the requirements from the previous inspection have been complied with, to examine service users care plans and to read through a number of policy and procedure records relating to the care of service users living in the home. A tour of the building and a fire risk assessment by the lead inspector was also completed. The staffing records were not examined at the time of this inspection. The CSCI plans to inspect these at following inspections. While there is a management structure in place, the records are not well managed. This practice could potentially place service users at risk. What the service does well: It is difficult to establish what the home does well as at the time of this inspection, as there were a number of areas of improvement that needed to be Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 Page 6 addressed from the previous inspection that remain unmet. These areas of improvements are ongoing issues and will be followed up by the CSCI with the registered persons outside of this inspection. What has improved since the last inspection? What they could do better: This inspection has identified twenty-four areas of improvement, ten of which have been restated. In addition, at the time of preparing this report two Statutory Enforcement Notices have been issued. This action results from the findings of the inspection, whereby it was identified that through a lack of documentary evidence, there are concerns that care needs are not been adequately addressed and met. The registered person is required to submit an action plan to the Commission for Social Care Inspection (CSCI), which describes how they will address these matters. The action plan must describe how the registered person ensures that no service user moves into the home without having an assessment of need completed, to ensure that all service users have a up-to-date medical review of their care needs completed by the GP and all service users to have a contract of terms and conditions in place. The Commission must be notified of any occurrence, which adversely affects the well-being or safety of any service users. This includes falls. The home must provide suitable leisure and social activities for service users with dementia. All complaints are to be recorded and addressed appropriately and all the maintenance areas addressed in the main body of the report must be addressed. Fire doors are not to be kept wedged opened and the registered person is to liaise with the London Fire Emergency Planning Authority (LFEPA) with regards to the fire doors. The manager is to complete an environmental and fire risk assessment and the security in the home is to be reviewed. The manager is to ensure all care staff undertake supervision and records kept on file and all training needs reviewed. Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 Page 7 The registered person must notify the local authority’s POVA team with regards the complaint raised by a relative in accordance with the local authority’s adult protection procedures. As stated previously while the London Borough of Haringey has informed the CSCI that the building works are to be addressed in January 2006, further information as to the specific details of the planned refurbishment works are needed. The recommendations stated in this report are deemed as 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.V253553.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 The home has failed to ensure all service users are provided with a contract of terms and conditions. Therefore service user cannot be satisfied that the home will support them appropriately according to their needs. The home has failed to ensure that service users needs are appropriately assessed prior to moving into the home. Therefore service users cannot be convinced that their needs will be properly met once they move in. EVIDENCE: The Red House is separated into four units, Beech, Willow, Cedar and Maple. The home’s Conditions of Registration is for thirty-five older people, eight of which may have a diagnosis of dementia. There is an additional condition of registration for two service users diagnosed with dementia to reside in a nondementia unit, until such time as a vacancy comes up in the home’s dementia unit. The manager informed the inspectors that the two specifically named service users have recently moved to the dementia unit. However, no official notification to the Commission has been received stating that the Condition of Registration relating to the two specifically named users can now be removed. It was advised that the manager must submit a letter to the Commission Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 Page 10 stating this change. At present the home has two vacancies and since the previous inspection two service users have moved from the home. A number of care plans were sampled from each of the units. It was evident that assessment prior to service users moving into the home had not been fully completed. It was noted on a number of service users care plans sampled that the main reason for an individual’s care was a diagnosis of dementia. These service users reside in units other than the unit allocated for service users with dementia. It was also evident that a number of care plans examined, did not have in place contract/terms of conditions between the home and service user. Prior to this inspection, an application to the Commission for a major variation to convert one of the units into a dementia care unit had been submitted. Due to the building works not being completed at time the application was submitted, there is a delay in being able to process the request for the major variation until such time as the building works have been satisfactorily completed. At this inspection it was advised that the registered person must ensure all service users are referred to a consultant with regards to ensuring service users care needs are addressed appropriately. Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The home has failed to record and monitor consistently service users health, personal and social needs. Therefore not ensuring that the appropriate support and care needs are followed by care staff supporting service users in the home. EVIDENCE: Following on from a complaint made by a service user’s relative, the inspectors undertook a thorough case tracking of the specific service exercise of the specific service user’s care, health, social and personal needs. The concerns raised by the service user’s relative had been highlighted in the service user’s review meeting that took place in August 2005. Upon examining the records kept in the home concerning the specific service user, there was a lack of evidence in support of the required action arising from the service user’s review having been instigated. It was evident from the care plan that a number of areas had not been appropriately addressed appropriately by the home. In response to the shortfalls identified two statutory notices have been issued. Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 Page 12 The inspectors were able to speak to a number of service users during a brief tour of the building. It was observed that many of the service users presented themselves as being confused and one service user was tearful. Service users in each unit visited were sitting in their chairs, the televisions and the music were on, but no was found to be actually watching or listening to either of these. Each unit visited had one staff member on duty assisting and supporting service users with daily care. It was observed that service users were left unattended for a long period of time. Staff interaction with service users was observed. This was not always positive. This was discussed with the registered manager at the previous inspection and evident that this has not improved. Therefore a requirement relating to this has been restated. The falls records were examined. It was evident that the care staff have ensured that records of falls are recorded, however, there was no evidence that monitoring had taken place or risk assessments for individual who fall frequently up-dated. The other areas of concern are that no records of individuals’ falls have been submitted to the Commission. Medication records were examined and were found to be in good order. Areas highlighted in the previous inspection were addressed relating to PRN medication, staff washing their hands before administering medication and medication being administered at suitable times to service users. Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 15 The home provides a weekly plan of activities for the service users. However, the home has failed to ensure that the activities provided suit all the needs of the service users, particularly those with dementia. The home has failed to ensure records of service users activities are recorded in service users daily records. Therefore not providing service users with the necessary information regarding their daily leisure pursuits. EVIDENCE: The home has appointed a new activity worker. The manager informed the inspectors that this appointment was transferred from one of the local authority homes that recently closed down. During the inspection the inspectors observed a resident’s meeting that was being held in the main reception area. Displayed on the resident’s notice board was the weekly timetable of planned activities. In the afternoon of the inspection, the shop was open, for service users and staff to purchase weekly supplies. The activity person runs the shop. The inspectors briefly interviewed the activity person regarding the activities planned and especially activities for service users with dementia. It was evident that the main activity provided by the home for the service users with dementia needs was the chair-based exercise. The activity person stated this was popular with service users. It Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 Page 14 was advised that the home must provide more appropriate activities for service users with dementia needs. One service user’s plan indicated that they liked sitting out in the garden. On enquiring with the activity co-ordinator as to whether this had taken place, it was reported that while it was clear that the plan included the service user enjoying sitting outside, this had not been possible during the summer as the home had no parasols. This is clearly not an acceptable reason for people not going outside. While the Commission would expect the home to take necessary precautions in protecting service users from the exposure of sun, parasols should have been purchased and/or hats and sunscreen in order to facilitate such preferences being met. Information with regards to service users contact details was recorded on file. The home has a visitor’s book that is positioned at the front of the home, which maintains a record of all visitors to the home. Service users are offered an appropriate diet. The menu plan for the day was lamb stew, beef curry or cauliflower & cheese and jam tart and custard for dessert. The menu plan was discussed with the manager and senior staff. They were asked whether or not they have tried any of the meals served. They said that they had not. It was recommended that the manager should try the meals provided by the home to make a clear judgement on whether or not the meals are appetising and tasty. Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The home has failed to ensure that service users and their relatives are able to raise concerns openly. Therefore service users and their relatives cannot be confident that any complaint/s made would be addressed appropriately by the home. EVIDENCE: There were no records of complaints recorded on file. At the previous inspection it was advised that any complaint must be recorded and monitored by the home. Complaints were discussed with the manager with regards to verbal complaints such as a ‘service user not happy with the food provided or that they are cold’. It was advised that the manager should discuss this with the care team as to how this is monitored and recorded appropriately. This requirement is restated, as it was evident that it remains unmet. One of the service user’s relatives complained to the inspectors, regarding the specific service user’s care needs. This has been addressed in full under the section relating to ‘Health and Personal Care’. Part of the complaints raised by the relative, were deemed a potential Protection of Vulnerable Adults (POVA) matter. This was addressed immediately with the manager. It was advised that a referral to the local authority’s POVA team must be made. The registered manager alerted the local authority’s POVA team and the specific service user’s social worker before the end of the inspection. Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 Page 16 Since the previous inspection there has been three referrals to POVA. It was evident that the Commission has not been notified of the referrals until after the meetings had been held. It is reminded that the registered person must under Regulation 37 give notice to the Commission without delay of any occurrence of any event in the care home, which adversely affects the wellbeing or safety of any service user. Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The standard of décor is unsatisfactory, therefore providing service users with an unpleasant environment in which to live. The manager has failed to ensure that the environment is maintained appropriately inside and out when repairs or improvements are needed to the home. The registered person has also failed to ensure all parts of the home to which service users have access are free from potential hazards to their safety. EVIDENCE: The home is split into four 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 service users have their own bedrooms. The bedrooms are in need of some re-decoration and the communal areas need of some urgent attention. At the previous inspection there were a number of areas concerning the building and general maintenance. Since the previous inspection upon request of the Commission a meeting took place with the London of Borough of Haringey with regards to the major refurbishment of The Red House, which is Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 Page 18 due to commence in January 2006. While the London Borough of Haringey has had preliminary discussions with the Commission about the proposed refurbishment works on the request of the Commission, more specific details are needed. Despite the planned refurbishment works, there were some maintenance issues that the manager had to address prior to this inspection. It was evident during the tour of the home that some areas were addressed and others areas remain outstanding. The areas addressed are: • New toilet brushes were present. • Paper towels were found in all dispensers examined • Cleaning products were all kept in an appropriate locked cupboard • New curtains in toilet 42 were clean • Shower curtain and bath mat in shower room 43 were replaced • Areas in front of the windows in lounge/dinning room were cleared and looked more homely • Cupboards for storing care plans were found to be secure and locked appropriately • Equipment such as walking sticks and wheelchairs were not found in bathroom areas • Window restrictors were in place. The areas not met are as follows: • No referral had been made to the occupational therapist regarding ensuring appropriate shower chairs are in place • A number of bins found in the bathrooms and separate toilets did not have lids • The damaged ceiling in toilet 41/42 was not repaired. No record of maintenance was recorded • Some toilet seats have been replaced however, there were a number that still need replacing • Fire doors were still found to be wedged opened • An offensive odour continues to be evident in the home The manager stated that the laundry room, liquid detergent for the washing machine and the appropriate washing liquid detergent has been ordered and will be installed. The other areas of concern were: • In Willow unit, the bin bag for the rubbish was hanging tied on the tap of the wash hand basin in the kitchenette. The staff were asked the reason for this. The answer given was that the new bin provided, when full, was hard to empty. This was discussed with the manager regarding health and safety. • Toilet 50’s blind needed replacing • One unit had a chest of drawers on the landing containing pads and items of clothing • Toilet 61 had a broken toilet seat and the lighting cover was missing Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 Page 19 • • Bathroom 43’s flooring was lifting and tiles missing. This bathroom was in an extremely poor condition. Bathroom 42’s lighting cover missing During the tour of the building many doors were found to be wedged opened. This was addressed with the registered manager at the previous inspection. The inspector highlighted that if doors which are designated, as fire doors need to be opened on a regular basis then magnetic door closures that are linked to the fire alarm system or appropriate self-releasing mechanisms which meet with the approval of the LFEPA (London Fire Emergency Planning Authority) must be fitted. The home’s environmental and fire risk assessment and individuals risk assessments must reflect this. It was also advised that the home’s admission assessment should be amended to include a section on individual’s likes and dislikes and day and night–time routines. This requirement is restated from the previous inspection. It is therefore a matter of concern of the continued failure to ensure that fire doors are not wedged open. Failure to comply with this requirement may result in the Commission taking appropriate enforcement action. At the top of the stairs there is a gate. This was discussed with the manager. The manager stated the reason for the gate was that the stairs are deemed hazardous for service users who wander. The units on the first floor both have a main front door, both doors when entering were found to be unlocked. It is advised that the registered person must complete a thorough environmental and fire risk assessment on the home. The document must be detailed and explore all the areas of risk such as the gate at the top of the stairs; each unit regarding access, service users needs, staffing levels and the service users and staff safety in the building. The call-alarm was tested during the inspection. While a member of the care staff answered the call bell, this was following the manager drawing staff’s attention to the call bell sounding. In addition, in the room where it was tested the lead was observed trapped under the service users bed and was therefore unable to accessed by the service users from the chair in their bedroom. The manager stated that the washing machine appropriate dispenser was not in place and will be installed soon. Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 30 Supervision and training needs for care staff are not consistently reviewed, therefore service users do not benefit from a well-supported and supervised staff team. Staffing levels within the home are, at present, not deemed adequate. Therefore service users care and support needs cannot always be met appropriately potentially placing service users at risk. EVIDENCE: A staffing rota was shown to the inspector. On shift was the manager, a senior carer/assistance manager, seven care staff, activity worker, cook, kitchen assistant, cleaning and laundry assistant. One senior carer, and two night staff cover nights. One carer was rota’d down to escort a service user to the dentist, but this was eventually cancelled. Two staff are currently on maternity leave. This includes one of the senior staff. One staff member was on annual leave and two staff members’ undertaking training in care plans. Staffing levels were discussed with the manager who stated that from Monday an extra member of staff per shift have been placed on the rota. Appropriate action must be taken to ensure that staffing levels are subject to review and appropriate to meet the needs of service users. Before the afternoon handover the two senior staff were interviewed. It was evident and observed that the senior staff are over stretched with the responsibilities they have on each shift. Senior staff are the only staff able to administer medication to service users, make appointments and referrals, complete supervision, open the front door, complete handovers and manage Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 Page 21 each shift. Training and supervision was discussed with the seniors. It was evident that due to the day-to-day duties and staff shortages, supervision with care staff does not take place regularly. A list of all staff supervision and dates was displayed in the senior’s office. It was also evident from the discussion that care staff that undertake external training do not always have the opportunity to discuss this with their line manager afterwards. The manager did stated that during staff meetings, care staff do have the opportunity to share and discuss any training undertaken, however it was felt by the inspectors that this was not followed through with staff in their one to one sessions. The current training on care plans being offered to staff was discussed by the inspectors with the two seniors on duty, one of who had attended the recent training. Comments from this discussion indicated a lack of commitment to the training. For example, inspectors were told that day one of the training concentrated on assessment and that they did not think this was relevant for care staff. Inspectors were concerned that this impression of the training could impact on how this is promoted to other staff, in particular to non-senior members of staff. Prior to the inspection the staff training programme list was submitted to the Commission. A number of staff have undertaken NVQ level 2 and above in Care. Staffing records were not examined. It is planned that staffing requirements stated in the previous report will be inspected at the next inspection. Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 Page 22 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, 36 & 38 The home is not being managed adequately and there is no proper leadership, guidance and direction to staff to ensure service users receive consistent and appropriate quality care. Service users health, safety, welfare and future are not being regularly reviewed and monitored. Therefore, the manager has failed to fully protect service users with regards to health and safety procedures. EVIDENCE: While it was evident that policies and procedures are in place, they are not consistently applied. Therefore, specific information relating to service users care needs was not in place on individual files. It is also evident that the registered manager has not monitored this process regularly. This is concerning, as since the previous inspection there has been three POVA (Protection of Vulnerable Adults) referrals made regarding care practice and monitoring. Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 Page 23 Prior to this inspection the Commission received eighteen comment cards from service users, five from relatives and friends, one from a care manager and one from the GP. Service users, their relatives and friends made some positive comments about the staff team, and service users felt that they were well cared for and their privacy is respected. One out of the five relatives stated that they had made a complaint. Records relating to this particular complaint were not recorded on file. One relative stated that care staff often did not engage with service users and that they were found reading papers instead. The GP also comments that the seniors and the manager are fantastic, however, the junior staff do not communicate well with service users. A quality-monitoring system must be in place, particularly given the concerns highlighted in this report. The registered person must ensure effective quality assurance monitoring systems are in place to seek views of service users and their relatives on individual’s behalf. Part of the inspection process included the inspector completing a fire risk assessment whilst touring the building. The purpose of the fire risk assessment was discussed with the manager. It was identified through the fire risk assessment that there were a number of good practices and some areas of concern. All the fire extinguishers are in place and the means of escape is clear. However, a number of fire doors were found to be wedged open. It is advised that the manager completes a environmental and fire risk assessment which is reviewed and monitored annually. Appropriate action must be taken in respect of fire doors that continue to be propped open, therefore rendering the self-closing device inoperative. Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 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 X 2 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 X X X X X X 2 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 3 Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 Page 25 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 3 Regulation 14(1)(a) Requirement Timescale for action 30/11/05 2. 3 12(1)(a) 3. 2 5(1)(b) 4. 8 17(1)(a) The registered person must ensure that no service user moves into the home without having their needs assessed and assured that these will be met by the home. (Previous timescale of 30/07/05 not met) The registered person must 30/12/05 ensure that all service users have a medical review of their care needs with the GP. Records of the reviews are to be kept on file. Any service users, whose needs have changed, must be reviewed accordingly. The registered person must 30/12/05 ensure all service users are provided with a statement of terms and conditions at the point of moving into the home. Appropriate action must be 21/11/05 taken to monitor the weight of all service users. The case tracking exercise conducted as part of this inspection highlighted one specific service user whereby their weight was not being monitored DS0000033328.V253553.R01.S.doc Version 5.0 Red House, The Page 26 5. 7 12(1)(a) & (b) appropriately. A referral must be made to the GP regarding this specific service user’s recorded weight loss and records must be kept up to date. Following a referral being made to the GP, any follow-up action must be monitored and reviewed accordingly. The registered person must ensure that appropriate action is taken to address this specific service user’s linguistic needs and a record must be kept in the care home that details the communication needs of this particular service user and the methods in place to meet these needs. Statutory Enforcement Notice Issued The Registered Person must 23/11/05 ensure that all care plans are completed appropriately. The case tracking exercise specifically identified a service user whereby this had not taken place. The Registered Person must ensure that with effect from 20th November 2005, all the areas highlighted, as requiring actioning by the home in one specific service user’s review meeting of 8th August 2005 must be complied with. Accurate records of the action taken must be kept, and subject to regular review and monitoring to ensure that any changes in the care needs of the service user are up-dated accordingly. A copy of the care plan is to be submitted to the Commission along with the action taken by the 23rd November 2005. Statutory Enforcement Notice Issued Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 Page 27 6. 7 & 27 18(1) The registered person must review the current staffing levels in the home and provide evidence to the CSCI that this has been conducted, together with the outcome and any action taken. 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 detailing the health concerns and what measures have been put in place. Evidence is to be recorded on the individuals care plan. The registered person must notify the Commission without delay of any occurrence, which adversely affects the well-being or safety of any service user. The registered person must provide suitable leisure and recreational activities for service users with dementia needs. Step-by-step records of activities participated in are to be recorded on each service users file. The registered person must find appropriate ways of ensuring that all complaints by service users, including verbal communication are recorded and acted on. (Previous timescale of 16/07/05 not met.) The registered person must address all the areas that remain unmet as detailed in the bullet points under ‘The Environment’ section in the main body of this report. (Previous timescale of 30/07/05 not met.) DS0000033328.V253553.R01.S.doc 30/12/05 7. 7 & 16 17(1)(a) &37 30/11/05 8. 12 16(2)(n) 30/12/05 9. 16 22 30/11/05 10. 19 23 30/12/05 Red House, The Version 5.0 Page 28 11. 7. 12(1) 12. 19 13(4)(a) (b) 13. 19 23 14. 19 13(4) The registered person must ensure that all service users healthcare, social and emotional needs are addressed and monitored appropriately. Risk assessments are to be updated accordingly when any changes occur. This is to be detailed with outcome and support needs. (Previous timescale of 30/07/05 not met.) The registered person must ensure that all fire doors are able to effectively self –close at all times and are not wedged open. (Previous timescale of 16/07/05 not met) Magnetic door hold or a release mechanisms must be fitted to any fire doors in the home that service users and/or staff members routinely prefer to leave open for extended periods of time during the day or night. Alternatively, the registered person must consult with the London Fire Emergency Planning Authority (LFEPA) fire officer with regards to risk assessment with regards to the safety aspect of fire doors and provide evidence that LFEPA are satisfied with fire doors being propped open. The registered person must review and risk assess the current practice of having a gate positioned at the top of the stairs. This is to be included in the home’s enivonmental risk assessment. The registered person must complete an environmental risk assessment that includes a fire risk assessment. This is to be reivewed annually. The registered person must DS0000033328.V253553.R01.S.doc 30/12/05 30/11/05 30/12/05 30/12/05 15. 19 13(4)(a) 20/12/05 Page 29 Red House, The Version 5.0 (c) 16. 36 18(2) 17. 18. 30 33 18(1)(c) (i) 24 19. 31,32 18(1)(c) (i) 20. 19 16(2)(k) 21. 7 12(5)(b) 22 26 13(4)&23 (2)(d) ensure that all care staff are aware of the secuity protocol, based on service users vulnerabilty in the home and that this is reviewed and montoried accordingly. (Previous timescale of 30/07/05 not met.) The regisered person must ensure that all care staff receive regular supervised ( the NMS specifies at least six times a year) Records of supervision undertaken are to be kept on file. The registered person must review individual staff members training and development needs. The registered person must produce an effective quality assurance and quality monitoring systems, based on seeking the views of service users, relatives and friends and stakeholders. The registered provider must ensure the registered manager is appropriately supervised and monitored to ensure that the home is being managed satisfactorily and that service users are being appropriately cared for. The registered person must ensure the home is free from offensive odours at all times. (Previous timescale of 30/08/05 not met.) The registered person must ensure that care staff are respectful to service users wishes with regards to their preferred choice and needs on a daily basis. (Previous timescale of 16/07/05 not met.) The registered person must cease the practice of using the inappropriate liquid detergent DS0000033328.V253553.R01.S.doc 20/11/05 30/01/06 28/02/05 30/12/05 20/12/05 30/12/05 20/12/05 Red House, The Version 5.0 Page 30 23. 19 13(4)(a)& 23(2)(c) 24. 18 13(6)&37 and conditioner containers. This is deemed a health and safety hazard. The registered person must therefore purchase the correct liquid detergent and conditioner containers for the washing machine and these are to be installed appropriately and safely. The registered person must repair the washing machine that has a faulty lead for the liquid detergent dispenser. (Previous timescale of 30/07/05 not met.) The registered person must ensure that all radiators are appropriately guarded and the standing bath is serviced and repaired. (Previous timescale of 30/08/05 not met.) The registered person must alert the local authority’s Protection of Vulnerable Adults team and the specific service user’s social worker before the end of the inspection. 28/02/06 16/11/05 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 15 Good Practice Recommendations It recommended that the registered manager should sample the meals provided by the home to make a clear judgement on whether or not the meals provided to the service users are appetising and tasty. The registered person should re-evaluate the roles and responsibilities of the senior staff within the home. 2. 27 Red House, The DS0000033328.V253553.R01.S.doc Version 5.0 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. 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