Inspection on 02/02/06 for Red Rose Care Home

This inspection was carried out on 2nd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 Rose Care Home 02/04/08

Red Rose Care Home 03/04/07

Red Rose Care Home 06/03/06

Red Rose Care Home 22/03/05

Red Rose Care Home 21/09/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Red Rose Care Home Brockton Avenue Farndon Newark Nottinghamshire NG24 4TH Lead Inspector Karmon Hawley Unannounced Inspection 2nd February 2006 10:00 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.V281822.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Red Rose Care Home DS0000024657.V281822.R01.S.doc Version 5.1 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.V281822.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Named Service user to be accommodated for TI category. There after the home’s registration reverts back to accommodate up to 44 service users within the OP category. Service users shall be within category OP Date of last inspection 30th August 2005 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. There are 36 single rooms, 10 of which have en-suite facilities; there are also 4 double rooms. 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. Red Rose Care Home DS0000024657.V281822.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place in four and three quarter hours and was performed by one inspector. The main method of inspection was case tracking, this is a method of sampling the records of four randomly selected service users to ascertain if the needs of service users are appropriately assessed and identified needs are being catered for by the home to maintain optimum health and wellbeing of the service user. Four service users were spoken with so as to give the inspectors an insight into the conditions and standards within the home. Those spoken with were happy with the staff, care received and the standards within the home. The registered manager assisted in the inspection process and two members of staff were spoken with. Staff were able to demonstrate a good understanding of service users needs and the core values and principles in relation to their job role. The focus of this inspection was to concentrate on the remaining core standards not assessed and the requirements made at the previous inspection, however during the inspection a concern with regards to criminal records bureau checks was observed, therefore a considerable time was spent in dealing with this. What the service does well: Service users spoken with expressed they were happy with care received, staff were kind and thoughtful and respected them as individuals. Staff spoken with were able to hold discussions with regards to service users needs, the core values and principles and adult protection at a high standard with thought and consideration to service users whole person needs. A kind and caring ethos was prevalent throughout the home and staff were welcoming and helpful towards the inspector. Care plans observed covered all identified needs and in depth records were maintained with regards to significant events and care received, thus enhancing continuity of care. Red Rose Care Home DS0000024657.V281822.R01.S.doc Version 5.1 Page 6 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. Red Rose Care Home DS0000024657.V281822.R01.S.doc Version 5.1 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 Rose Care Home DS0000024657.V281822.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Not assessed during this inspection. Red Rose Care Home DS0000024657.V281822.R01.S.doc Version 5.1 Page 9 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): 7,8,10 Service users individual 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 feel they are treated with respect and their right to privacy is upheld. EVIDENCE: Service users undergo various assessments with regards to the daily activities of living, manual handling, infection, dependency, nutrition and continence. Information gained forms the basis of the plan of care. Plans of care in place were personalised, reflected choices and preferences and covered needs highlighted. Daily communication records were maintained and were in depth and reflected significant events and changes. Appropriate risk assessments were in place. Service users spoken with stated they were happy with care received and their needs were met. Staff were able to discuss holistic needs and how rights, choices and preferences are maintained. There was evidence to demonstrate the multidisciplinary team and specialist services are accessed and relevant aids and adaptations are in place, which were observed during the tour of the building. The induction programme covers maintaining privacy and dignity of service users and staff were able to discuss these issues. All consultations are received Red Rose Care Home DS0000024657.V281822.R01.S.doc Version 5.1 Page 10 in private and in addition to service users rooms there are various quieter areas around the home, which may be used. Service users have access to a telephone and there is the optional of having their own telephone should they wish. Screening is available in double rooms. Service users spoken with stated staff were respectful and they felt their privacy and dignity is maintained. Red Rose Care Home DS0000024657.V281822.R01.S.doc Version 5.1 Page 11 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): 12,15 Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their need. Service users receive a wholesome appealing, balanced diet in pleasing surrounding. EVIDENCE: The routine of the home is stated to be flexible and service users are able to make the decision as to when they rise and retire and how and where they spend their day. Service users spoken with were able to substantiate this. Due to the activities coordinator being off work at present activities are not as structured as previous, however staff are spending time as able with service users and outside entertainment continues to visit the home, staff expressed there was sufficient for service users to do, service users spoken with were happy with life within the home and stated they felt settled and able to do as they wish. The kitchen on the day of inspection was clean, tidy and hygienic. Appropriate records were in place. There was evidence of a wholesome and nutritional diet being offered. The menu is due to be changed to reflect more choice in the near future, however alternatives are currently offered should a service user dislike anything on the menu. Service users spoken with stated food was at a good standard and choices were offered. Staff substantiated that specialist Red Rose Care Home DS0000024657.V281822.R01.S.doc Version 5.1 Page 12 diets were catered for; there was evidence of service users requirement on display in the kitchen. Red Rose Care Home DS0000024657.V281822.R01.S.doc Version 5.1 Page 13 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): 18 Further consideration is required with regards to recruitment practices to ensure service users are fully protected. EVIDENCE: Appropriate policies and procedures with regards to adult protection are in place. Staff spoken with were able to discuss these issues to a high standard. An ongoing training programme is in place to ensure all staff are trained in this area. There were major concerns with regards to Criminal Record Bureau Checks as discussed in standard 29. Red Rose Care Home DS0000024657.V281822.R01.S.doc Version 5.1 Page 14 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): 26 The home is clean, pleasant and hygienic. EVIDENCE: There are sufficient domestic staff employed to ensure the home remains clean pleasant and hygienic. Hand wash facilities are available around the home and the majority of staff have been trained in infection control. The laundry room was organised and relevant equipment was noted to be in place. Red Rose Care Home DS0000024657.V281822.R01.S.doc Version 5.1 Page 15 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): 28,29 Staff are working towards ensuring service users are in safe hands. Service users are currently not supported and protected by the homes recruitment policies and practices. EVIDENCE: One member of staff has completed the national vocational qualification (NVQ) level 3 and one member of staff is working towards level 3. Eight members of staff are currently working towards the level 2 and two have completed level 2. Two members of staff are waiting to commence level 2 and two are waiting to start level 3. Five staff files were observed, relevant references and applications were in place. Not all files contained photographic identification. Files observed contained satisfactory criminal records bureau checks (CRB’s), however on checking the status of other members of staff it was discovered that 29 staff members had current CRB checks in place whereas 33 members of staff had no CRB check in place. The registered provider who is countersignatory for CRB checks is currently out of the country and was therefore unavailable during the inspection. The manager stated that the administrator had been given the task to oversee CRB checks, addressed outstanding checks and several CRB’s had been received; however there had been difficulties. The duty regulation manager was contacted for further advice and an action plan was immediately put into place to protect service users. A staff meeting was held and staff were addressed with regards to the importance of attaining CRB’s. A policy with regards to supervisory practice was implemented and the duty Red Rose Care Home DS0000024657.V281822.R01.S.doc Version 5.1 Page 16 rotas were examined and altered accordingly to ensure sufficient ratios were achieved and all staff without CRB’s were supervised as appropriate to their job role. All staff members without CRB checks are being instructed to complete this process immediately. The city and county social services commissioning and contracting team were notified of this situation. Red Rose Care Home DS0000024657.V281822.R01.S.doc Version 5.1 Page 17 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): 31,38 Service users live in a home which is run and managed by a person fit to be in charge, of good character and able to discharge her responsibilities. The health safety and welfare of service users and staff are promoted however further attention and evidence is required to ensure they are fully protected. EVIDENCE: The manager is a registered nurse with relevant experience in managing a care home. She has completed her registered managers award and is awaiting certification. She ensures she remains up to date with mandatory training and also cascades her learning to the staff team. Staff spoken with spoke highly of the manager and stated they felt supported in their job role. Service users spoken with also expressed satisfaction of the way the home is run and stated the manager was approachable. Red Rose Care Home DS0000024657.V281822.R01.S.doc Version 5.1 Page 18 Relevant maintenance certificate and maintenance checks were observed with the exception of the gas certificate, portable appliance testing and waste disposal contract, the manager stated these are in place but due to the provider being unavailable these were not accessible and would therefore forward these to the commission. The fire logbook was observed and was satisfactory with the exception of emergency light testing. Appropriate accident records were maintained and evidence of audits taking place were apparent. Red Rose Care Home DS0000024657.V281822.R01.S.doc Version 5.1 Page 19 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 1 X X X X X X X 3 STAFFING Standard No Score 27 X 28 3 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 1 Red Rose Care Home DS0000024657.V281822.R01.S.doc Version 5.1 Page 20 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 OP38 Regulation 19(1) Requirement The responsible individual is required to review the recruitment and selection procedures and systems in place for remaining up to date with current practices and legislation The responsible individual is required to review the recruitment and selection procedures and systems in place for remaining up to date with current practices and legislation The responsible individual is required to review the recruitment and selection procedures and systems in place for remaining up to date with current practices and legislation All staff employed are required to have criminal records bureau checks in place. The action plan implemented is to be followed and the manager is to remain in contact with the commission for social care inspection on a frequent basis until this situation is resolved. Timescale for action 02/02/06 2 OP29 19(1) 02/02/06 3 OP18 19(1) 02/02/06 4 OP38 19(1) 02/02/06 Red Rose Care Home DS0000024657.V281822.R01.S.doc Version 5.1 Page 21 5 OP29 19(1) 6 OP18 19(1) 7 8 9 OP29 OP33 OP38 19(1) 24 23(4) 10 OP38 18(c,i) 11 OP38 23(2) All staff employed are required to have criminal records bureau checks in place. The action plan implemented is to be followed and the manager is to remain in contact with the commission for social care inspection on a frequent basis until this situation is resolved. All staff employed are required to have criminal records bureau checks in place. The action plan implemented is to be followed and the manager is to remain in contact with the commission for social care inspection on a frequent basis until this situation is resolved. All staff employed are required to have photographic identification in place. Quality assurance documentation is to be available for inspection Evidence of appropriate emergency light testing is to be available after consulting with the fire authority to demonstrate compliance with legislation. The responsible individual is required to ensure staff are appropriately trained to maintain the health safety and welfare of service users, this requirement has been partly met and a rolling plan is in place to ensure all staff are trained. Evidence that all staff have completed training is now required. The responsible individual is to forward evidence of gas certification, portable appliance testing and waste disposal contracts to the commission to demonstrate compliance. 02/02/06 02/02/06 02/04/06 02/04/06 02/03/06 02/04/06 10/02/06 Red Rose Care Home DS0000024657.V281822.R01.S.doc Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Red Rose Care Home DS0000024657.V281822.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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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