Inspection on 09/05/05 for Redbank House Care Home

This inspection was carried out on 9th May 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 no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Redbank House Care Home 25/07/06

Redbank House Care Home 19/09/05

Redbank House Care Home 24/01/05

Redbank House Care Home 23/06/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Redbank House Care Home Town Street South Leverton Nottingham Nottinghamshire DN22 0BT Lead Inspector Jayne Hilton Unannounced 9 May 2005 10:00 am th 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Redbank House Care Home Address Town Street South Leverton Nottingham Nottinghamshire DN22 0BT 01427 880716 01427 884430 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Voyage Limited, 1st Floor Office Suite, Kelham Street, Doncaster DN1 3QZ Vacant -acting manager Christine Hamblyn Care Home (CRH) 7 Category(ies) of Learning Disability (LD) 7 registration, with number of places Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: NONE Date of last inspection 24/1/05 Brief Description of the Service: Redbank House is a large family home in a quiet village. The garage, has been converted into a second self-contained flat in order to provide independent living for a service user. A seperate bedroom is also accomodated in the garage building. A conservatory houses the pool table and is used as a games room.The drive provides ample parking for staff and visitors. The home provides transport enabling service users to access other towns and cities.Staff have contacts within the colleges around the Nottingham area and all service users are currently enrolled on various courses. Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out by the inspector spending time in the communal areas of the home and speaking with three service users who were at home at different intervals throughout the day. Two service users development plans were examined in detail and a sample of records kept in the home, were inspected. Much of the evidence gathered at the inspection is based on the service users comments and observations made by the inspector. Three service users rooms were inspected and three staff were spoken with as part of the four and a half hour inspection. The Inspector wishes to thank the service users for their helpful comments and in allowing her to have such insight into their specialist needs. What the service does well: What has improved since the last inspection? Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 6 The requirement set at the last inspection had been met, this was regarding the information within the statement of purpose being up to date. 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. Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 5 Service users are given clear information about the service, its specialism and regarding any structured daily routines, which the service users are consulted about and sign that they agree to. EVIDENCE: Although the statement of purpose was only briefly examined the requirement set at the previous inspection was now met. A welcome pack that is given to new service users was kept in the service users personal file. Two service users informed the inspector of why Redbank House was an appropriate placement for them, clearly explaining about their syndrome and how this needs to be managed by them with the assistance of staff. Needs assessments were in place in the two personal files examined and development plans had been devised from the individual assessed needs. Any restrictions on choice, freedom, services or facilities are documented and service users were very aware of these. Each service user had been issued with the terms and conditions of the home. When asked what the best thing is about the home, a service user stated that the small number of people living at the home means there is not too many people to get on with and when asked if they would like to change anything, replied “nothing”. The Inspector suggested that if there was nothing to change this makes the home perfect, the service user replied, “ well it is perfect” Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9,10, Service users are supported with decision making and in their daily lives through structured and appropriate development plans. The system for review evaluation and monitoring needs improving as does the documentation for the assessment of daily living skills, as the present system does not demonstrate the great achievements made regarding service users goals and aspirations. EVIDENCE: Two service users explained their lifestyles to the inspector and how their Prada Willis Syndrome effects this. Their daily lives were filled with structured programmes, which were varied in meaningful activity, leisure, and responsibilities. Although there needs to be structure within the lives of the service users who live at Redbank House, the staff team offer choice options within the structure. The development plans examined were detailed and appropriate however they had not been reviewed since July 2004. Consent forms were signed where limitations were placed, such as for locking away food, however service users confirmed that they are given a choice about food options within the structure needed for treatment programmes. Each service Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 10 user chooses the menu options for a particular day, however there are three alternatives offered should the service user not like the main menu item offered that day. Service users spoken with were aware of the development plans and had contributed comments within them. A service user and staff member told me about the advocate that visits the home periodically to discuss issues that that they may have. The group or individual meeting is called time to talk. Two service users informed me they had chosen the clothes they were wearing and one requested the inspector’s opinion as to how they looked for their days activities. A service user showed the inspector money in her purse and explained that she would be meeting her parents later that day for a family outing and would be treating them to a cup of tea and ice cream. Another service user showed the inspector the lockable facility provided for keeping money. Development plans covered the individual money management plans for service users. Each service user has a responsibility in the home, which is recorded in their development plan. One service user informed the inspector that her responsibility was vacuuming the house and is in charge of the utility room and explained about the health and safety aspects of this task. A House meeting is held regularly, a service user told the inspector that they talk about concerns and activities and all service users get a copy of the minutes and each service user takes turns to chair the meeting. A copy of the minutes was seen. The acting manager explained that service users are encouraged to be involved in recruitment of staff, when showing prospective candidates around the home and in giving their comments. There was no other evidence examined regarding this on the day of the inspection. Risk assessments were in place and from examination of these they appeared, generally, detailed and appropriate. One service user informed the inspector that they run the bath independently but there was no evidence that a risk assessment of the service users ability to do this safely, had been carried out. The acting manager explained that key workers and co-key workers are allocated, according to their skills and experience, which does cause conflict between some service users. On the day of the inspection this conflict was witnessed as two service users were in dispute about an outing with particular staff support. The manager explained the difficulties when staff unfortunately, have to let service users down through sickness or medical appointments etc. Through the observation of staff interaction in dealing with the escalating conflict of the two service users the inspector felt that staff were calm in approach, skilled in effective communication and demonstrated a good awareness of the individuals needs. Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 11 Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12, 13, 14,16,17 Service users are well integrated within their local and wider communities and are provided with varied opportunities and responsibilities within their daily lifestyles and individual preferences. The manager and staff team have been innovative and instrumental in enabling service users to gain meaningful activities and employment and have promoted an ethos of valued participation both within and outside the home environment and are commended for this. The management of the complex needs of service users is balanced with good promotion of individual rights. The current practice of using nicknames is not appropriate and this requires sensitive review. EVIDENCE: Documentation in the development plans and conversations with service users alongside observations made provided much evidence that service users have Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 13 opportunities to maintain and develop social emotional, communication and independent living skills. One service user informed the inspector that she had a little job dog walking in the village and had bought lots of new clothes recently. Development plans were full of certificate of achievement at local colleges, birds of prey group etc. The dog walking service for local people in the village is carried out by a number of service users who live at Redbank house and this has enabled service users to integrate into community life and maintain a neighbourly relationship with the community. It also provides earnings for the service users, responsibility and provides healthy exercise. One service user also has a paper round with staff support. Service users spoken with talked about going out to the local pub and community activities, including church and car boot sales. Many of the service users require 1: 1 support to achieve these tasks and which is provided. Service users rooms were full of personal items including videos, games, and music. Service users had been to the photographic museum in Bradford the day prior to the inspection and stated that they had really enjoyed this. One service user explained that she was going on holiday to Norfolk with her family and had previously been to Bridlington with staff support. Activities are planned within House meetings. The conservatory provide d a wide range of facilities and recreational equipment A service user confirmed that staff knocked, before entering bedrooms etc and that their privacy was respected within the constraints of their syndrome and development plans. Two service users showed me their rooms and used their own key to gain access. One service user asked a member of staff if the post had arrived and explained the routine for this. The service user informed the inspector that any mail for service users is distributed un- opened and staff assist with reading as required. The service users preferred term of address is documented on the service users personal information, however staff were observed to be using a shortened version of a service users name that wasn’t stated. There was a culture of “jokey” nicknames that had developed between staff and service users, which needs addressing as may be deemed not to be appropriate practice. A sensitive approach is needed to balance service users choice with appropriate good practice from staff and in the promotion of age appropriateness and mutual respect. The service users preferred term of address should be recorded in the development plan as specified in standard 16.5 of NMS. Because the home specialises in providing a service for people with Prada Willis Syndrome there are structured programmes for meeting the dietary needs of service users. Menus are planned with service users but within a calorie and nutritional value controlled framework. A service user showed the inspector the menu and the lunchtime mealtime observed. Night staff, pack up, lunch boxes with service users selected items of food. These are refrigerated until lunchtime and each service user has their own food pack. The lunchtime was Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 14 unhurried and staff were observed to give verbal support where needed. Some individuals are involved in the preparation of food within development plans depending on the individual’s circumstances. Service users were observed to eat at different times depending on their activities and routines. Weight records were clearly evident and staff are commended, in supporting service users with significant weight loss. Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18.19, 20, 21 Service users are provided with flexible personal support to maximise privacy, dignity, independence and control over their lives. There are inadequate systems in place for ensuring the healthcare needs of service users are met. There are examples of good practice within the area of medication, however, the systems in place for the management of medication in the home overall, require evaluation and review to improve practice. The wishes of service users at the end of life are obtained. EVIDENCE: Service users informed the inspector that they choose their own clothes when getting up in a morning and confirmed staff support for personal care as identified within the personal development plan. Service users were observed, to be dressed in varying styles, which reflected their personality. The bedrooms inspected were also personalised. Support from specialist professionals is documented in the development plan. Where service users present challenging behaviour this is covered within development plans and charts. Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 16 One service user had returned from a visit to the district nurse and was able to explain to the inspector of the reason for the visit. The visit outcomes were documented within the service users development plan. There was no evidence of other health care checks such as annual well person checks, chiropody, foot care, optician, dentist, routine smear tests, or GP visits. The manager and staff members spoken with stated that some of this information had been archived and that they use a diary for appointments. The manager and staff also reported that they had recently discussed improving the documentation systems for healthcare checks. A service user reported that when she is not well, staff support a GP appointment promptly. Medication is stored in a lockable cabinet in a locked store cupboard and keys are handed over each by Team Leaders or by the manager. A random check on the controlled drugs highlighted an error in recording and countdown of controlled drugs. A missing tablet was accounted for on auditing the Medication record. Staff must ensure that they balance the count of controlled drugs in the appropriate book as well as signing as administered on the medication chart. There was also a discrepancy of prescription information on the medicine label and the medication record sheet, which highlighted that the receipt and cross checking procedures are not working in practice or that staff are not following them. There are policies in place for medicine management, including for drug errors. A recent drug error was being investigated but had not been reported to CSCI as required by regulation. It is recommended that a copy of the drug error policy is placed where staff can easily access the information and that it prompts staff to report drug errors under regulation 37. Where service users are prescribed ‘as required medication ‘[PRN] for challenging behaviours, this is only administered after authorisation from a senior manager in the organisation, this system of good practice ensures that PRN medication is only dispensed to service users as a last resort in managing behaviour or at the service users request. There was good information about the prescribed medication of individuals on the two development plans examined, however this section could be improved by developing it into a medication profile for each individual, detailing medication reviews and any changes in medication and reasons why. The needs assessment should also indicate that service users are offered opportunity to self medicate unless a risk assessment defines otherwise. Where suitable, service users may wish to work towards a goal of achieving independence in managing their own medication and this should be part of the medication profile also. Signatures of staff who administer the medication were not evident and should be placed in the front of the chart folder. Prescriptions are processed and dispensed by the local surgery. The manager reported that the service provided by the local surgery was very good. Staff who administer medication undertake medicines management training by distance learning, Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 17 linked with the local college, however no competency assessments are undertaken and this should be implemented. The wishes of service users at the end of their life are documented within development plans. Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 Service users and staff overall have a good knowledge of dealing with concerns complaints and protection and are confident in dealing with any issues as they arise. EVIDENCE: A service user explained how to make a complaint should they have one. A complaint had been received from a service user, who had used a picture symbol format with staff assistance, this was currently being dealt with by the acting manager. This is the only recorded complaint since the last inspection. CSCI have not received any complaints about the home. A copy of the complaints procedure had been issued to those service users whose personal files were examined. The policy states that all complaints will be responded to within 5 days. The manager reported that she had recently followed the Protection Of Vulnerable Adults Procedures and was therefore confident in dealing with issues as they arise. All staff apart from newly recruited staff have attended training, records were seen as evidence to support this. A newly appointed staff member was able to discuss the confidentiality policy and when information needs to be passed on. She was not however familiar with the whistle blowing policy. Two service users confirmed that they felt safe, living in the home. Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27,28, 29, 30 Service users live in a homely, clean, comfortable and safe environment. Personal and communal space meets the needs of individuals residing in the home. EVIDENCE: A tour of the building was undertaken at the inspection and was led by a service user. Furnishings and fittings were in good order and were domestic and homely. One bedroom examined had en-suite facilities with a bath and another had no en suite facilities at all. A service users, self- contained flat, sited within the garage conversion was also inspected. All were personalised, spacious and appeared to meet the needs of the individual lifestyles. All bedrooms examined were furnished and equipped appropriately and service users had added extra items as required such as storage trolleys and chests. The wardrobe and drawer facilities provided were very good. All doors were lockable and lockable facilities are provided. The manager reported that one Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 20 service user has a risk assessment in place regarding a bedroom door lock, however this was not examined at this inspection. Toilet and bathroom facilities were sufficient. One central bathroom has sauna and juccusi facilities, which are not in working order. The manager reported that she wants to re-instate the sauna as a service user has requested this, however there are risk issues and the service users GP is to be involved. One service users room needs the ceiling redecorating due to water damage from a leak in the roof. Sleep in accommodation is provided but this was not examined on this occasion. All service users are independent in their mobility. There was lots of evidence around the home and in development plans of symbol and makaton communication. A games room has a large number of facilities, including a Pool table, dartboard, exercise bike, books, crafts, music and leisure facilities. Service users spoken with were obviously proud of their home, explaining that they like their home to be clean. The home was clean throughout. The utility room is cited adjacent to the garage conversion and has a washing machine, which meets sluicing and disinfecting standards and a dryer. There is a large garden and enclosed courtyard with pond. An area which has become overgrown, is not used by service users, however the manager reported she has plans to develop this area into a sensory garden. Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35, 36 There are good systems in place for staff support and a good level of training provision. Staff members are clearly skilled and confident in the work they perform. Service users needs are met, by competent, confident and skilled staff. EVIDENCE: Three staff members participated throughout the inspection and were observed demonstrating competency and skill when interacting with service users, this was particularly noted when conflict and challenging behaviours were presented on the day of the inspection. The staff spoken with, were clear about their roles and limitations. Staff confirmed they had a good level of training provided, such as health and safety, food hygiene, first aid, SCIP,[Strategies for Crisis Intervention and Prevention] care standards, nutrition, aggression management, abuse awareness, infection control, fires safety and medicines management. A new member of staff explained about the induction process of working with a mentor until confident in working un- supervised. The training records examined supported staff comments and identified that LDAF [Learning Disability Award Framework] training and NVQ’s [National Vocational Qualifications] were part of the training and development programme for staff. The rota was examined and this identified that five support staff are rostered on most daytime shifts but sometimes this is increased to six. The rota is Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 22 devised to meet the 1:1 staffing needs of service users. When trips or events are arranged staffing is increased as required. 1 staff sleeps in and 1 staff is awake for night- time arrangements. The home does have a couple of regular bank staff, this with overtime facilities means that staffing is consistent and agency use is minimilised. The manager works supernumery. A handyperson is reported to be a bonus to the home and is currently making great progress with the garden. The manager and staff members on duty confirmed that, formal supervision is part of the staff support structure. Staff spoken with praised the acting manager stating she was very good and that all of the service users love and respect her. Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 41, 42 Service users benefit from a well run home that generally promotes and protects their health and safety. There are identified issues around surface temperatures of radiators and water temperatures, which must be addressed to ensure the safety of service users. EVIDENCE: The acting manager is a long serving staff member, who hopes to be offered the post formally very soon. Interviews are to take place the week after the inspection. The acting manager is currently undertaking NVQ 4. An application for a registered manager should be submitted as soon as a decision is made as the home has been without a registered manager for some time The home also provides placement for nursing students undertaking RNLD training. Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 24 A sample of records was examined including accident records fire safety testing, Water outlet temperature records, service user plans, medication records, rotas, menus etc. All were found to be satisfactory apart from where the temperature of water is above 43 degrees, a comment needs to be added as to what action has been taken to remedy the situation and a record of a retest. Service user plans are kept secure. As stated there is a good level of staff training and observations made during the inspection provided evidence of a good level of health and safety practices take place. Radiator covers are not provided and there was no risk assessments regarding the risk of surface temperatures in the home. One service user’s en suite was noted to be a particular hazard and a radiator in the toilet next to the office. The acting manager was given advice in how to possibly remedy the issue where standard covers would not be suitable. There was also an issue of poor water pressure in one service users bath and a recorded water temperature of 47degrees, however this had been previously noted to be 54 degrees. The service user explained that when the temperature is regulated to 43 the water pressure in the tap is reduced, which she is not happy about as it takes a long time to fill her bath, she also prefers her bathing water warmer than 43 degrees. The situation appears to require a plumbing evaluation alongside, risk assessments and disclaimer from the service user should she prefer her water temperature to be regulated higher than 43 degrees. Window restrictors were observed to be in place. Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 4 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 4 4 3 x 3 4 Standard No 31 32 33 34 35 36 Score 3 3 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Redbank House Care Home Score 3 2 2 3 Standard No 37 38 39 40 41 42 43 Score 2 x x x 3 2 x C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 26 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard YA6 YA9 Regulation 14,15 Requirement Timescale for action 9/8/05 9/8/05 3. 4. YA19 YA20 5. 6. YA20, YA20 7. 8. 9. YA20 YA24 YA42 Ensure service user plans are approprately reviewed and evaluated. 12, 13, Ensure a detailed risk 14, 15 assessments is in place for service users bathing independently, particularly in relation to when running hot water 12,13, 14, Ensure the healthcare needs of 15 service users are fully detailed within their development plans Medicines Ensure that the balance of Act, 13 controlled drugs kept in the home equates with the record book and medication adminstration record 37 Ensure that all incidents relating to drug errors are notified to CSCI Medicines Ensure that all medicines Act, 13 received into the home are appropriatley checked and documented Medicines Ensure that all medication Act, 13 records are accurate and in accordance with the prescription. 23 Repair the damaged ceiling in a service users bedroom and redecorate 16, 23 Ensure the water pressure in C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc 9/8/05 9/8/05 9/8/05 9/8/05 9/8/05 9/9/05 9/9/05 Page 27 Redbank House Care Home Version 1.30 10. YA42 12, 13 11. YA42 12, 13 service users rooms is sufficient for use. Ensure that the surface 9/9/05 temperatures of radiators are risk assessed and covers fitted to priority areas. Where service users wish to 9/8/05 have their water regulated above 43 degrees that this is clearly documented and a signed disclaimer is in place 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. 2. 3. 4. 5. 6. Refer to Standard YA42 YA16 YA16 YA19 YA19 YA20 Good Practice Recommendations Development plans should indicate service users clear goals and achievements The practice of using nicknames should be reviewed as may be deemed to be inappropriate. Ensure that the service users prefered terms of address are documented within the care plan and staff use this term of address Service users should be encouraged to have an annual well person check Development plans should have a running record sheet for healthcare sheets, ie Chiropody, GP, dentist, optician etc A copy of the drug error policy should be posted on the drug cupboard door, and /or in medication record folder for easy access and should prompt staff to report under the regulations to CSCI Each service user should have a medication profile which contains a history of medication, medication reviews and any changes Service users should be offered the opportunity to self medicate or work towards this as part of their development plan Competency assessments should be carried out by the manager for staff who have undertaken medicines training and on an ad hoc basis. The assessment needs to be documented. Ensure new staff are familiar with the whistleblowing policy Establish with service users if the juccusi is to be repaired. C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 28 7. 8. 9. YA20 YA20 YA20 10. 11. YA23 YA24 Redbank House Care Home 12. YA42 Where water outlet temperatures exceed 43 degrees, an action comment should be recorded and the result of a retest. Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 29 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI Redbank House Care Home C53 C03 S8737 Redbank House V225954 090505 Stage 4.doc Version 1.30 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!