CARE HOMES FOR OLDER PEOPLE
Redcot Three Gates Lane, Haslemere, Surrey, GU27 2LL Lead Inspector
Fiona Cole Unannounced 19 July 2005 10:00 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 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. Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Redcot Address Three Gates Lane, Haslemere, Surrey, GU27 2LL 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) 01428 644637 Friends of the Elderly Mrs Lorraine Miller CRH Care Home 32 Category(ies) of OP Old age, 32 registration, with number of places Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Redcot is a substantial property set in its own landscaped grounds. It is situated in a quiet rural area a short distance from Haslemere town centre There are 32 single rooms situated on the ground first and second floors. All bedrooms have en-suite facilities. The upper floors are accessible by means of a lift shaft. There is a lounge dining room and chapel on the ground floor. In addition to the main kitchen there are small kitchenette areas on each floor, close to the bedroom accommodation, which give the service users access to prepare snacks and hot drinks. Redcot is operated by Friends of the Elderly which is a charity providing care and support to older people. The home has a clear focus on service users who enjoy relatively good levels of independence. Date of last inspection 11th and 19th January 2005. Brief Description of the Service: Redcot is situated in a rural location a short distance from Haslemere town, which offers a good range of small shops a library and a museum. Redcot is a large detached property set in its own substantial grounds. There are limited parking facilities at the front and at the side of the building. Service users bedrroms are provided at ground first and second floor levels and all have en-suite facilities. The home has a wide variety of communal spaces including outdoor areas to enjoy views across to the South Downs. The standard of presentation decoration and furnshings are to be noted and this was reflected in the inspectors conversations with the service users. The home has a terrace with plenty of seating and shade from the sun and very extensive landscaped gardens designed by Gertrude Jekyll. Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection of Redcot in the CSCI year 2005/2006, which began on April 1st 2005. It was an unannounced inspection, which meant that staff and service users were unaware of the visit planned by the inspector. The inspector began the inspection with the manager spending time looking at the requirements made from the last inspection to ensure that they had all been met. The inspector then made a tour of the building, and spent time talking with staff and service users. The rest of the time was spent looking at records, care plans, staffing schedules and an update on how the home was operating. Staff and service users were happy to assist with the inspection by talking to the inspector and were very encouraging about life at Redcot. What the service does well:
The home provides a very high standard of accommodation, and this was very much of major importance to two of the service users spoken to. Other comments made were about the running of the home, which service users felt in the main was run very efficiently by the manager. The staff were all described as kind and caring helpful and supportive. One service user said the staff encouraged their independence, but were happy to assist if they were unwell or unable to carry out a particular task. All of the service users spoken to were happy with the service provided. They all recommended the food and said they always had a choice and if these were not of their choosing then the chef was happy to prepare a light snack instead. The chef is always present at lunchtimes to speak with the service users about any likes or dislikes. In the main the service users felt in control of their lives but some found the adjustment to life in the home a little more difficult to get used to than others.
Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 6 One service user said her reduced mobility and therefore the reliance on others for support was her reason for coming to Redcot. All of the service users spoken to liked their rooms and the en-suite facility, in particular, as they had the option of staying in their rooms or enjoying the company of others. Activities in the home have in the past been a criticism by one service user but recently they have a lot more in the way of outings and now a member of staff has been appointed to co-ordinate these outings. What has improved since the last inspection? The general practice of administration recording and storage of medication was much improved since the last inspection and was evidenced to be in line with good practice. It showed that all medication was checked on receipt and recorded. The inspector saw accurate records of medication received and returned to the pharmacy. A documented risk assessment is now in place for all those service users that self-medicate. Complete and accurate records were seen by the inspector of all medication administered or not administered together with the reasons for nonadministration to service users. Where variable doses of medication are prescribed a record is now kept of the actual dose administered to the service user. Clear and comprehensive procedures for the receipt, recording, storage and safe handling, administration self administration and disposal of medicines specific to the home are in place and being followed and monitored by the manager. A controlled drugs cupboard has been fitted which complies with the Misuse of drugs (safe custody) regulations 1973 is provided for the storage of any controlled drugs including Temezepam, which are prescribed for service users. Staff have undergone in house competency assessments in safe medication handling. Each member of the care team, now has a copy of the General Social Care Council of conduct Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 7 The service user guide and statement of purpose had been updated in line with Care Homes regulations 2001. All Criminal Record Bureau forms are now kept in the home in a separate file. And were checked by the inspector. The manager has checked that the hairdresser and chiropodist have appropriate insurance cover and comply with The Care Homes Regulations 2001 2.9. The Registered Manager showed the inspector much improved care plans recording factually assessment of need as well as risk. These also reflected service user involvement and signed by them. These are being reviewed monthly clearly documented and review dates identified. Robust risk assessments and management of that process continues to be implemented and are now under periodic review with dated clearly defined to ensure the safety and welfare of all persons in the home. All extractor fans are now working and most windows have been fitted with safety devices, the outstanding ones being 3 where windows are both plastic and metal and require a specialist lock, which is on order. The building has recently been risk assessed internally and externally to ensure The home is free of hazards. Extra handrails have been put in on the slopes where the area can become slippery in the winter months. The safe practice of Control of Substances Hazardous to Health storage regulations are being closely monitored by the manager and within the District Nurses Room soap is available for hand washing. The clinical waste is being regularly disposed of and the bin kept in good working order. The Commission For Social Care and Inspection are now receiving regular notification of any accidents or incidents in the home either by service users or staff. What they could do better:
Staff files needed to be reviewed as some had very limited information in them and the inspector was unable to track staff members from the files. It was required that where possible the manager provides two referees, an application
Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 8 form or CV. Work permits where applicable, and a copy of the members passport. The manager needs to perform supervision on a monthly basis, or ask her deputy to carry this function once she has been trained. Care plans were much improved but failed to make any reference to the expressed wishes of a service user in respect of death and dying. The inspector will make this a requirement. One service user who spoke with the inspector mentioned that staff in the mornings are sometimes too busy to spend time with them. 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. Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 9 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 Standards Statutory Requirements Identified During the Inspection Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 10 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 standard(s) 1 2 3 The homes statement of purpose and service users guide now provide service users with the information they need to make an informed decision about admission to the home. Service users are only admitted to the home following a full needs assessment. The service users have written contracts, which are signed by them or by a member of their family. EVIDENCE: The care plans sampled by the inspector all contained detailed assessments of the service users needs and included information regarding their preferences likes and dislikes. Two service users spoken to stated ‘ I am very happy here and I have made some new friends’, another said he had been actively encouraged to learn to use a computer and has been helped a great deal by staff members’ The inspector was shown a recent assessment of a prospective service user.
Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 8 9 10 Personal care and healthcare support and assistance is planned and was seen to be provided, where needed, in a respectful and sensitive manner. Policies procedures and practices are now in place to ensure the safe handling and administration of medication. EVIDENCE: Care plans inspected were comprehensive and clearly set out actions which need to be taken by care staff to ensure that all aspects of the health and personal care needs of the service user are met. The inspector noted that no record of service users wishes had been documented in the care plans regarding death and dying. It was discussed with the manager and will be a made a requirement. During the tour of the home the staff were observed to always knock before entering the service users rooms and all interactions between staff and service users were seen to be caring and respectful. Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 12 All of the service users spoken to during the inspection were complimentary regarding the care they receive at the home, with one service user stating that the staff are always ready to help. Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 13 14 15 The evidence gathered indicated that these standards were fully met and therefore the home was supporting residents to maintain control and autonomy over their lives as far as it was possible to do so. Catering arrangements were commended based on the very positive comments made by the service users. The recent employment and training of an activities co-ordinator is a positive step towards ensuring that activities provided will meet the preferences, expectations and needs of all service users. EVIDENCE: In the main the service users felt in control of their lives, but some found it difficult having reduced mobility and reliant on others for support and going out. All service users without exception said they enjoyed the food and some explained that they were always offered an alternative if they didn’t like the main meal choices. Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 14 Service users spoken to said they were pleased an activities co-coordinator had been appointed as they though they would see more choice of things to do. The activities person has been meeting with service users on a one to one basis to gather information regarding their previous hobbies and interests. The inspector was advised that once the process was completed the coordinator would be looking to expand the activity programme and draw up weekly plans with each service user. The inspector congratulates the home on the very positive steps they have taken so far in working toward ensuring the social care and activity needs of the service users are met. Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home has a clear and accessible complaints procedure, which includes timescales for the process. EVIDENCE: The home has not had any complaints or vulnerable adults concerns. The home has a copy of the latest Surrey Multi-agency Procedure for the protection of vulnerable adults. It is readily accessible and staff are aware of their responsibilities. Two service users spoken to said they knew precisely how to complain and would have no difficulty doing so when the need arose. Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 16 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 standard(s) 19 26 The location and layout of the home and gardens are suitable for their stated purpose. An ongoing maintenance and redecoration programme provides the service users with clean, pleasant and homely surroundings in which to live. EVIDENCE: During the tour of the home the premises were seen to be well maintained with service users able to access all areas of the home and grounds. Most of the work on the window security has been completed. On the day of inspection the home was found to be warm and bright with a homely atmosphere and a high standard of housekeeping apparent. The gardens are well established and very well kept offering plenty of seating. One service user commented on how much she enjoyed the view from her room and going into the garden in the summer months. Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 29 30 Since the last inspection positive action has been taken to ensure all the required checks have been made and this is evident in the staff files. Staff are continuing to receive training and updates from an in-house trainer and Guildford College is providing updated medication training for all care staff. Staff on duty appeared to be enthusiastic and committed to supporting residents, with training and development being given a high priority. EVIDENCE: All of the service users who spoke to the inspector were happy with the service provided. They said they found the staff kind and helpful. They also said the home was run efficiently by the manager who had and ensured high standards are maintained particularly in housekeeping and menus. Staff Criminal Record Bureau checks were seen at this inspection. Since the last inspection the manager has worked very hard to obtain all the correct information on the files and with a few exceptions this had been completed. A requirement will be made for the remainder to be completed before the next inspection. Since the last inspection the manager has completed her RMA registered managers Award.
Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 18 Three members of staff are undertaking their NVQ 2 training and four staff members already have NVQ 2. Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 34. The home meets each of the assessed standards and was seen to be well run with sound management and accountable support. The home has a comprehensive quality assurance and monitoring system in place. Policies and procedures and practices are in place to ensure, so far as is reasonably practicable, the health and safety and welfare of the service users and staff. EVIDENCE: All of the service users spoken to on the day of inspection were happy with the way the home was run and with the service provided. The inspector acknowledged that the Manager in particular and the staff have worked hard since the last inspection, and a number of significant improvements have been made.
Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 20 The home has had an Environmental health inspection very recently, and no requirements have been made. Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 N/A N/A N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 N/A N/A N/A N/A N/A N/A 4 STAFFING Standard No Score 27 3 28 N/A 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 N/A N/A 3 N/A N/A 3 N/A 3 N/A N/A Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 11 Regulation 16 Requirement The manager must consult with service users (and or families if appropriate) to determine the wishes of the service user in respect of death and dying. Staff files are reviewed and updated with information accordingly. The registered manager must ensure that supervision of staff takes place no less than at six weekly intervals. Timescale for action 30/11/05 2. 3. 29.1 36 19 18.2 31/10/05 31/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Redcot H58 s13756 Redcot v217346 190705 stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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