CARE HOMES FOR OLDER PEOPLE
Red Rose Care Home Brockton Avenue Farndon Newark Nottinghamshire NG24 4TH Lead Inspector
Mary O`Loughlin Unannounced Inspection 2nd April 2008 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 Rose Care Home DS0000024657.V361694.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 Rose Care Home DS0000024657.V361694.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Red Rose Care Home Address Brockton Avenue Farndon Newark Nottinghamshire NG24 4TH 01636 673017 01636 678423 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) Mrs M J Daniel Linda Claire Gee Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places Red Rose Care Home DS0000024657.V361694.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home can accommodate up to 44 service users within the OP category. Service users shall be within category OP Date of last inspection 3rd April 2007 Brief Description of the Service: Red Rose Care Home is a 44 bedded home for older people including nursing. It is a purpose built home in the residential area of Farndon village. Farndon is situated just off the A46, three miles south of Newark and there is access to a local bus route into the town of Newark if required. There are 42 single rooms, 11 of which have en-suite facilities; there is also 1 double room. There are communal lounges, dining areas, bathrooms and toilet facilities. The home is domestic in character and well maintained. The grounds are well maintained and service users are able to access these areas. There is also a reasonable size car park. The current weekly fees for the service range from £392 - £469, additional payments may also be applied; these would be discussed on enquiry. These fees do not include hairdressing and chiropody services. The previous report is made available on request. Red Rose Care Home DS0000024657.V361694.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. One inspector conducted the unannounced visit over 4.5 hours. The main method of inspection used was called ‘case tracking’ which involved selecting three residents and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. The registered provider, and members of staff were spoken with as part of this visit. Documents were read as part of this visit and medication management was inspected to form an opinion about the health and safety of residents at the home. A partial tour of the building was undertaken which included a sample of resident’s bedrooms, to make sure that the environment is safe and providing appropriate aids. A review of all the information we have received about the home and the previous requirements that were set at the last inspection was considered in planning this visit and this helped decide what areas were looked at. A range of additional information was used to determine the outcome of this visit, including information provided by service users, representatives of service users and staff within our pre-inspection surveys. The manager returned her Annual Quality Assurance Assessment, referred to in this report as (AQAA), it contained clear, relevant information that is supported by a range of evidence. The AQAA lets us know about changes they have made and where they still need to make improvements. It shows clearly how they are going to do this. The quality rating for this service is 2 star this means that people who use the service experience good quality outcomes. Red Rose Care Home DS0000024657.V361694.R01.S.doc Version 5.2 Page 6 What the service does well:
The home has more strengths than areas for improvement. There are no significant weaknesses in the key National Minimum Standards. Where areas for improvement emerge the service recognises and manages them well. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The well-maintained environment provides specialist aids and equipment to meet their needs. The home is a very pleasant, safe place to live. The manager has the required qualifications and experience and is competent to run the home. Before agreeing admission the service carefully considers the needs assessment for each individual prospective person and the capacity of the home to meet their needs. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow ensuring that service users receive the treatment they are prescribed in a manner and pace that suits their needs. Staff work to clear and robust practices when caring for individuals who have degenerative conditions and terminal illnesses. Staff work to a very high consistent standard and constantly monitor pain, distress and other symptoms to ensure individuals receive the care they need. Care staff are sensitive to the needs of those residents who find it difficult to eat and give assistance with feeding. They are aware of the importance of feeding at the pace of the service user, making them feel comfortable and unhurried. All staff understand what restraint is and alternatives to its use in any form are always looked for. Equipment that may be used to restrain individuals such as bed rails, keypads, recliner chairs and wheelchair belts are only used when necessary. People are involved in the decision making process about any limitations to their choice in this area. Individual assessments are always completed which involve the individual where possible, their representatives and any other professionals such as the care manager or GP. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. The process of recruitment ensures that people that may be unsuitable to work with vulnerable adults are not employed.
Red Rose Care Home DS0000024657.V361694.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Red Rose Care Home DS0000024657.V361694.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Red Rose Care Home DS0000024657.V361694.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken. For people who are self-funding and without a care management assessment, a skilled and experienced member of staff always undertakes an assessment. EVIDENCE: The last inspection of the service found compliance with meeting the requirements of standard 3. On this inspection we examined a care plan of a recently admitted service user. The plan contained evidence of a social services assessment document and a written comprehensive assessment done by the home, which ensures that people are only admitted to the home if their needs can be met and that the staff have the appropriate skills to provide the care they need.
Red Rose Care Home DS0000024657.V361694.R01.S.doc Version 5.2 Page 10 The service user had complex needs and staff had researched information on the complex conditions, included the guidance within the care file and used it to inform the actual plan of care, this ensured that all staff were informed of the best management of the service users condition at the point of admission. The service user was unable to fully inform me of the process of his admission, however he stated that he was being looked after properly and staff were kind to him. He said that he had heard about his care plan but not seen it. The plan contained evidence of consultation with relatives. Red Rose Care Home DS0000024657.V361694.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. EVIDENCE: We randomly selected three care plans of the service users; each had a number of risk assessments and an associated plan of care that addressed how staff should manage the identified problems. Each plan had a record of external specialists involved in the health care of the service user, this demonstrated a timely response by staff when the conditions
Red Rose Care Home DS0000024657.V361694.R01.S.doc Version 5.2 Page 12 of the service users changed and required specialist assessment such as speech therapy for swallowing problems. Once external specialists had seen the resident and made an assessment we identified within the plans how this assessment was used by staff to ensure that any new instructions were clearly written to enable the staff to provide the necessary up to date care. Staff spoken with said they were kept up to date at each change of shift when trained nurses passed on information on each service users needs. The AQAA shows us that they intend to implement a more person centred care planning system during the next 12 months which tells us that they are ensuring the best outcomes for the service users based on their individuality, including all the elements of equality and diversity. The home’s own performance and quality monitoring results for January 2008 show us that the management are seeking the views of the care they are providing, within this we saw that 100 of the service users said they were kept informed of their care and any changes that were required. We identified that improvements had been made in the recording of hand written medicine records; staff had ensured that these were signed and witnessed to reduce any error. The home has a good record of compliance with the receipt, administration, safekeeping, and disposal of medicines and controlled drugs, however it was noted at this inspection that two controlled medicines had been held for a considerable time whilst not in use. The qualified staff do audit these and had held on to them to ensure no delays in obtaining further supplies led to unnecessary waiting time for the service user, during end of life care. However to ensure that there is no future over prescribing, GP’may not be aware of the previous as prescribed medicines, it is necessary to review these medicines frequently. The Medicines Act 1968 does permit a care home (nursing) to purchase and use stocks of controlled drugs so long as they have a domestic licence issued by the Home Office. Red Rose Care Home DS0000024657.V361694.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. Service users are enabled to exercise choice and control over their lives and find the lifestyle experienced in the home matches their expectations and satisfies their needs. EVIDENCE: These standards were assessed as met at the last inspection. The AQAA states that they are improving on the opportunities that service users can participate in; the possible purchase of computers for service users to enable them to contact family and friends is part of their plan for the coming year. We spoke to one service user who told us they were happy with the opportunities available to participate in activities such as boat trips along the local river and visits to local pubs and restaurants with family and friends.
Red Rose Care Home DS0000024657.V361694.R01.S.doc Version 5.2 Page 14 A range of activities are provided within the home and records of the views of the service users show that they are happy with the provision. Staff were observed assisting service users to eat and did so with sensitivity, showing they are aware of the importance of feeding at the pace of the service user, making them feel comfortable and unhurried. Staff were heard to spend time explaining the choice of meals on offer to each service user, enabling and supporting them in their decision-making. Care plans did not provide sufficient information on how the social needs of the service users are considered or discussed with them, however the quality monitoring done by the home suggests that service users views are considered when planning activities and menu’s. Required improvements to the care planning system has been recognised and planned for by the manager. Red Rose Care Home DS0000024657.V361694.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16-18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected EVIDENCE: There have been no complaints or safeguarding referrals passed to the Commission since the last inspection. There has been a sustained track record of meeting these standards since 2006. 2 staff files and 2 staff spoken with evidenced that appropriate recruitment is undertaken to safeguard service users. Staff training records indicate that Adult Safeguarding training was provided to all staff in 2005 for the majority of staff and further updates are planned with the introduction of the revised safeguarding procedures. The homes revised procedures were seen to reflect the new Safeguarding Adults local policy documents. Red Rose Care Home DS0000024657.V361694.R01.S.doc Version 5.2 Page 16 3 service users told us during this inspection that they felt safe and looked after. The home’s own quality assurance results indicated that 100 of those service users that responded felt safe at the home. The homes complaint record book shows no new entries since the last inspection year. The complaints procedure is supplied to everyone living at the home at the point of admission. Identified at the last inspection; All staff understand what restraint is and alternatives to its use in any form are always looked for. Equipment that may be used to restrain individuals, such as bed rails, keypads, recliner chairs and wheelchair belts are only used when absolutely necessary, with the home promoting independence and choice as much as possible The AQAA told us that training has been provided in Dementia Care and safeguarding adults for senior staff during the last 12 months. Training records identified this during the inspection. They tell us in the AQAA that they plan to continue to develop skills of the workforce over the next 12 months through training in adult protection, challenging behaviour, dementia awareness and the implementation of the Mental Capacity Act requirements which will ensure that all staff are fully trained and up to date with safe care practices. Red Rose Care Home DS0000024657.V361694.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): 19-26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The home has a sustained track record of meeting these standards. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The well-maintained environment provides specialist aids and equipment to meet their needs. The home is a very pleasant, safe place to live.
Red Rose Care Home DS0000024657.V361694.R01.S.doc Version 5.2 Page 18 The home was found to be well maintained and clean throughout. The equipment required to support service users to live as independently as possible, as identified in case tracking, was in place. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the people who use the service. The AQAA states that they have accessed the Department of Health’s Essential Steps document for revised infection control procedures in care homes. The home’s plan for improvement include covering all radiators in the next 12 months, this will provide a safer environment and reduce the risk of accidental burns. At this inspection the provider informed us that they have altered the shared rooms to provide single rooms and reduced the number of bathrooms by one. Red Rose Care Home DS0000024657.V361694.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 good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. The process of recruitment ensures that people that may be unsuitable to work with vulnerable adults are not employed. EVIDENCE: There is a sustained track record of meeting these standards. We looked at 2 staff files which identified an appropriate safe recruitment of staff and an induction linked to skills for care, a programme of training which reflected the needs of the service users and ensures they are in safe hands and protected from anyone that may be unsuitable to work with them. The records of staff training shows that there is a high level of importance on training and staff report that they are supported through training to meet the individual needs of service users. Red Rose Care Home DS0000024657.V361694.R01.S.doc Version 5.2 Page 20 From the homes own quality monitoring results and from speaking to service users during the inspection service users feel confident in the staff that care for them. Duty records show that trained nurses are on duty at all times and over 50 of the care staff team have National Vocational Qualifications in care. We observed good deployment of staff to both floors of the home ensuring that each area was supported by trained nurses and carers at all times. The AQAA tells us that there are high staff retention rates and we saw evidence of clear contingency plans to cover sickness or vacancies, which will support a consistant service in care delivery. Records of staff meetings show they focus on improving the outcomes for the service users and continually review how they provide services. Red Rose Care Home DS0000024657.V361694.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): 31-33-35-38 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based openness and respect, has effective quality assurance systems developed by a qualified, competent manager. EVIDENCE: There is a sustained track record since 2006 of meeting all these standards. The manager was not on duty during this inspection.
Red Rose Care Home DS0000024657.V361694.R01.S.doc Version 5.2 Page 22 The manager is registered with the Commission for Social Care Inspection. She has completed the Registered Managers Award and a course in risk assessment. We saw that a quality assurance and monitoring system is in place to work to continuously improve services. The AQAA shows us that the manager is aware of current developments both nationally and by the Commission, and plans to implement a more person centred care-planning system, which will focus on the elements of social and health care and consider the diverse needs of each service user. We talked to staff and service users, along with looking at the homes own quality assurance outcomes and found that the manager is highly respected, regularly checks that the service users are happy with the care they are receiving and works with staff on a daily basis providing nursing care. The last inspection identified that there is an efficient system to ensure effective safeguarding and management of residents’ money and valuables, including record keeping. All the working practices in the home are safe and there have been no preventable accidents reported to the Commission. On this occasion we examined the fire safety documents and these show that the equipment, emergency lighting and fire system are tested as required to ensure they are in working order. The home has a comprehensive range of policies and procedures to promote and protect service users’ and employees’ health and safety. Staff are trained, understand, and consistently follow these as demonstrated through record keeping and observation of working practices. Red Rose Care Home DS0000024657.V361694.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Red Rose Care Home DS0000024657.V361694.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations Look at ways to ensure that those service users who have the ability to participate in their care plans are consulted and see them whenever possible. Consider improving the management of risk during medicine administration by ensuring the telephone is not answered by the person administering medicines unless in emergency. Medicines that are no longer in use should be reviewed by the G.P. to prevent future over prescribing. Provide the Commission with the sizes of the new single room accommodation. 2. OP9 3. 4 OP9 OP23 Red Rose Care Home DS0000024657.V361694.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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
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