Inspection on 16/05/06 for Redcotts

This inspection was carried out on 16th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Redcotts 24/02/10

Redcotts 21/01/10

Redcotts 19/11/09

Redcotts 26/02/09

Redcotts 09/09/08

Redcotts 24/04/08

Redcotts 02/05/07

Redcotts 24/11/05

Redcotts 07/04/05

Redcotts 03/11/04

Redcotts 14/07/04

Redcotts 14/01/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Redcotts 96 Wensleydale Road Hampton Middlesex TW12 2LY Lead Inspector Sandy Patrick Unannounced Inspection 10:00 16th May 2006 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 Redcotts DS0000017388.V289510.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. Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Redcotts Address 96 Wensleydale Road Hampton Middlesex TW12 2LY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8979 5477 02089795491 Mr Sajjad Hassan Ms Amanda Draper Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th November 2005 Brief Description of the Service: Redcotts is a residential care home registered for up to eighteen people. The home is privately owned. The Owner visits the home on a regular basis. A Manager is employed to oversee the day-to-day operations of the home. The home is situated in a residential road in Hampton, close to local shops, facilities and public transport routes. Accommodation is provided on two floors, accessed by a stairway and passenger lift. The home is staffed twenty-four hours a day. The Registered Persons have produced a Service User Guide, which includes information on the aims and objectives of the service. The charges for the service are £499 - £520 per week. Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection included two visits to the service on the 16th and 25th May 2006. Both visits were unannounced. The Inspection Team included a Pharmacist Inspector. A report of his findings are recorded within Section 2 of this report. The Inspectors were made welcome by everyone at the home and the Lead Inspector was invited to share a midday meal with the residents on the first day of the inspection. The Inspectors met with the majority of residents, the Manager and staff on duty. The last inspection visit was in November 2005. Following this, both the Lead Inspector and the Pharmacy Inspector visited the home in December 2005 and January 2006 to check compliance with requirements. A separate report was not generated from these visits but a letter was written to the Registered Person and Manager. The CSCI met with the Registered Person and Manager in February 2006 to discuss non compliance with some requirements and to discuss the running of the home. The Lead Inspector spoke with a number of residents during this inspection visit. Most of them spoke positively about the home, staff and food. One resident said that they liked their room and the food and that staff were very kind. One resident said that they did not always know what was going on and whether there were any planned activities. The CSCI sent out surveys asking residents, their relatives and professionals involved with the home to comment on their experiences of the service. Six residents, three relatives and five professionals returned surveys. All six residents said that the home was clean and fresh and that they usually liked the food. Some residents liked the activities. They generally felt that staff were available but not always able to meet all their wishes and some felt that staff did not always listen to them or act on what they said. Most of the residents said that they got the care and support they needed. None of the residents who returned surveys had received a contract for their stay at the home. One resident said, ‘I am quite happy at Redcotts. I enjoy the privacy of my own room. I am free to go out when I wish’. All three relatives said that they were welcomed at the home by staff and that the Manager and staff kept them informed about the care of their relative. One relative wrote, ‘there is a homely environment and staff treat the residents with dignity’. Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 6 Another relative wrote, ‘the staff have got to know my relative well and give them the attention and care they need in a way that they can keep their independence and respect’. One relative wrote about their relative, ‘I feel that when I am not there he still feels that he is with people that care about him’ The professionals who completed surveys all said that the staff communicate well and work in partnership with them. They felt that staff had a good understanding of needs and acted on specialist advice that they gave. The professionals felt that residents were generally happy. One person wrote, ‘Redcotts is a pleasant home and everybody is helpful’. Another person wrote, ‘the home has improved 100 since the arrival of the new manager, I feel there is more care for the service users and that staff are properly motivated and encouraged and their work has greatly improved’. Another professional wrote, ‘Since the appointment of the new Manager there has been a marked improvement in the care of the Redcotts’ residents’. What the service does well: What has improved since the last inspection? Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 7 Over the past year and since the employment of the new Manager the service has improved a great deal. There have been difficulties and some of the changes have been slow. However, the Inspectors felt that at this inspection visit the general atmosphere had improved. Staff spent more time with residents chatting and asking for their opinions. The staff are now offering more choices to residents and supporting them to keep their independence. There have been improvements to activities and supporting residents to go out of the home. The health and abilities of some residents have improved due to care programmes introduced at the home. This is particularly commendable and shows how a dedicated, caring approach can make a difference to someone’s life. There have been some improvements to the environment. There have been improvements to records and the systems of staff communication and support. Staff have attended a range of training. There have been improvements to medication practices. What they could do better: At the unannounced inspection of April 2005, the home failed to meet twentyfive of the twenty-nine standards assessed. There were concerns about almost every aspect of the service, including care, staff support and health and safety. The new Manager was employed in July 2005 and has worked hard to address the majority of concerns. Most importantly the home is now a more pleasant place to live in and the care needs of residents are better assessed, monitored and met. Work to improve some areas still continues and further work to improve activities and some staff support and areas of the environment is needed. The Manager should also make sure all residents have a contract. Further work to make the environment safe and more accessible is needed. In particular the garden must be made safe so that residents feel free to use this whenever they wish. Further staff training is needed in some areas. The Manager needs to complete her application to be registered with the CSCI and must continue with her NVQ Level 4 when she is able to. Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 8 The Owner must make sure he offers the supervision and financial support so that the Manager feels supported and the home can run efficiently. The Manager should start to look at how the views of residents and relatives can be used for quality monitoring and to look at further improvements. The work which has started to make electrical wiring and windows safe must be completed. 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. Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 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 the following standard(s): 1, 2, 3, 4 & 5 Quality in the Choice of Home Section is good. This judgement has been based on information received from the home and seen during a visit to the service. There is information about the home for prospective residents but this needs updating. Residents and their relatives feel that they were supported with making a decision to move to the home. Assessments have improved and are more thorough these help the staff have a better understanding of the needs of residents. Not all residents have a copy of their terms and conditions. EVIDENCE: There is a Statement of Purpose and Service User Guide for the home. However these have not been reviewed or updated for some time and not since the new Manager has been appointed. The Manager should review these documents and make sure information is clear and accessible. Copies of these Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 11 documents should be given to prospective residents to help them make a decision about whether they want to live at the home. All of the residents who had completed questionnaires for the CSCI said that they had not received a contract from the home, or could not remember whether they had. The Manager said that she was in the process of reviewing contracts and was going to issue these to all residents. The Inspector saw an example of the proposed contracts. These were suitable but should also include details of the room number to be occupied, state who is paying the fees, give information on trial stays and should refer to the CSCI not the NCSC. The contracts should be issued to all residents as soon as possible and a signed copy should be held by the home. Over the past year the Manager has worked hard to improve the assessment process. The Manager hopes that a more thorough assessment will make sure that the needs of residents can be met at the home. Copies of assessments were seen on file. Prospective residents and their families are able to visit the home before they make a decision about whether to move in. The Manager said that she wants people to feel that they can visit the home at any time. At the time of the inspection one person was staying at the home for a short period with a view to possibly moving there at a later time. All residents are admitted for a six week trial stay. After six weeks they meet with their representatives and the Manager and together they decide if they want to continue to live at the home and if the home can meet their needs. One person completing a survey wrote that the staff at the home were very good at helping their relative settle in when they moved to the home. They said, ‘their care, kindness and attention has made what could have been a traumatic move, a calm and happy one.’ Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in the Health and Personal Care section is generally good and has improved. This judgement is based on information from residents, health care professionals, families and staff and also from records seen during a visit to the home. Individual care plans give clear information on the residents’ needs and how staff should meet these. Future development of care plans should be based on person centred planning. The health and personal care needs of residents are met, however lack of equipment and clear guidance around manual handling could put residents and staff at risk. The overall quality of the medication standard is adequate. Minor omissions in record keeping and inadequate storage areas were found. These did not put the health or welfare of residents at risk. EVIDENCE: The Manager has created a care plan for each resident. These care plans give a good range of detail on meeting individual needs. Care plans include Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 13 information on giving residents choices and on maintaining independence where possible. Some staff have started to put information into care plans. Updating all care plans has been a priority for the Manager and she has worked hard to complete this. Once staff have become familiar with the new care plans, and when they have had appropriate training, they should be involved in creating and reviewing these where possible. The Manager said that she has started introducing staff meetings where the needs of individual residents are discussed. This is good practice and will help staff to have a consistent approach. The Manager should look at ways to work towards person centred planning, in particularly looking at ways to involve the residents in developing care plans which reflect their wishes and opinions. Risk assessments are in place for all residents. assessments have been regularly reviewed. Care plans and risk Health care professionals who completed surveys for the CSCI said that the staff worked well with them and listened to their advice. All residents are registered with local GPs and are visited by other health care professionals as needed. The health and mobility of some of the residents has improved. The hard work of staff to support residents and meet their needs has contributed towards this improved health and mobility. This is very positive and the staff should see how valuable changes in practice have been to improve the quality of individual lives. There is no hoist at the home. Storage and transportation of a hoist in the home could be difficult. In particular there is only a chair lift, so a hoist could not be transported from one floor to another easily. Some of the residents have mobility needs and some cannot be lifted without a hoist. The Manager said that she hopes to seek expert advice on this. The home and needs of the residents should be assessed by an appropriately qualified health care professional. This assessment should look at what type of equipment could be used safely within the home. The Statement of Purpose should clearly state how the problems with using some manual handling equipment in the house may mean that some residents would not be able to live at the home. An appropriately qualified person should have input into the development and review of risk assessments for residents and for staff regarding manual handling practices. All staff must have up to date manual handling training. The staff team have started undertaking a range of training regarding some health care needs. At the time of the inspection the staff had just completed a course in infection control. The Manager is also looking at training around continence needs. Residents are offered regular baths and the Manager has improved the staff routines to make sure all personal care needs are met, respecting privacy and Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 14 dignity. The lack of useable bath and shower facilities at the home does present difficulties. Refer to the Environment Section. The home has arrangements for the safe storage, recording, administration and disposal of medication. The recording, auditing and administration of medication have improved since the previous inspection by a Pharmacist Inspector. Medication is given correctly and residents can manage their own medication. All staff giving medication have received training. The storage areas and records need to be improved. All records relating to receipt, storage, administration and disposal of current medication were examined. The Manager, and senior staff member were interviewed. A sample of the current medication in stock was compared to the current records and medication not supplied in the monitored dosage system was counted and compared to the records. This was to check that medication was being given as directed. One resident was self-medicating. Risk assessments and appropriate monitoring were in place. All the medication in stock agreed with the list of medications on the administration records except in two instances. A medication for one resident was found in the cupboard. The medication had not been given. No current administration record was available. Staff stated that the resident was in hospital and it had just been confirmed that they would not be returning to the home. The records must indicate this. The medication and current records for one resident were not in the home. The care plan and staff indicated that the medication and records had been given to a relative to be given at home. Normally a copy of the record is given when medication leaves the home and the original is kept in the home. One resident had not had the amount of medication given recorded accurately on two instances. All other current administration records had all been completed. Staff were all aware of the procedure for checking and handling medication and have been trained by a pharmacist. Certificates of training were seen. Most medication is given from a monitored dosage container. Staff are able to check if medication has been given or not. When medication is not supplied in the MDS there is a clear audit trail to check whether medication has been given correctly. The amount of medication currently in stock agreed with the records. In one instance the amount of medication carried over from one month to next had not been recorded on the current administration record. The audit records showed that the correct medication had been given. This indicated that medication had been given to the resident as prescribed unless otherwise recorded. Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 15 All medication was stored securely and in the correct conditions. The medication cupboard has been moved to another room. The cupboard is not attached to the wall. It is not practical to secure the cupboard to the wall at present. The room is locked when no staff member is present. No work surfaces are available in the room where medication is stored making it difficult for staff to handle medication appropriately when it arrives in the home. Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in the Daily Life and Social Activities section is good and has improved. This judgement is based on information from residents, families and staff and also from records seen during a visit to the home. Activity provision has improved but further work in this area would enhance the quality of life for residents. Residents are able to make some choices about their lives, however the staff need to consider how residents can be given more choices and take more control of their own lives. EVIDENCE: There have been improvements to the way in which activities are organised and run at the home. One of the staff has become a part time Activities Coordinator. This person organises an activity for each day for the group. These include bingo, reminiscence and sing-a-longs. The Activities Coordinator works three days a week and said that she spends some time talking with individual residents in their rooms if they are not in the communal lounge. The Inspector saw that this person had a good rapport with residents and helped initiate stimulating conversations, which the residents were interested in. The residents clearly liked the Activities Coordinator and felt at ease with her. There is also a weekly keep fit class run at the home. Many residents have Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 17 said that they enjoy this. The Manager said that more residents had been able to go out of the house on short walks or to local shops and they had enjoyed this. However, staffing levels mean that this cannot always happen as there is sometimes not enough staff left in the house. The Inspector noted that there have been significant improvements in activity provision. However, this is an area which would benefit from further improvement. The information on social needs and personal histories is very basic for some residents and this could be improved. The staff should be proactive in seeking information from the resident themselves and their families, if appropriate. Consideration should be given to increasing staffing levels or changing staffing rotas so that more residents have the opportunity to go out. Organised activity sessions are for a short period of time and the Manager should also look at how residents are supported to meet their social needs when there is no organised activities. Activity resources, such as books, jigsaws, games and craft materials should be purchased and made available for residents to use at any time. Staff should actively encourage residents to pursue activities of their choice on their own and in groups. One resident said that they were unable to participate in activities because they could not see well. The Manager should consider how best residents who are visually impaired can be supported to participate in activities. Residents are supported to make some choices about their lives and the Manager said that she encourages staff to help residents to be as independent as they are able. The staff should continue to look at ways in which they can support residents to have more controls of their own lives. Residents who spoke to the Inspector said that they did not get a choice of meals, although they were given alternatives if they had a known dislike. Residents should be given a choice at mealtimes. One resident said that they never knew what was happening at the home. The Manager should look at ways in which she can keep residents informed. A church service is held at the home on a regular basis and residents are able to attend this if they wish. One resident said that they felt the services were rather sombre and enjoyed a more lively service. The Manager should look at the individual cultural and religious needs of residents and consider how best the home could meet these. Visitors are welcome at the home at any time. The two relatives who met with the Inspector and the three who completed surveys all said that they were made welcome at the home and that staff were approachable. One visitor arrived at lunch time and sat with their relative whilst they ate lunch. The Inspector was invited to join the residents for their midday meal on the first day of the inspection. This was well prepared using fresh food. The residents said that the food was usually good and enjoyed their meal on the Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 18 day of the inspection. The Manager said that she is currently reviewing the menus with the cook. The Manager should consult with residents and if possible, have the input of a dietician. Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18 Quality in the Complaints and Protection section is good. This judgement is based on evidence received before and during the visit to the service. There are appropriate procedures regarding complaints and protection of vulnerable adults. The staff team have been trained in protection of vulnerable adults. EVIDENCE: There is an appropriate complaints procedure. Residents who completed surveys said that they knew who to speak to if they were unhappy with their care. The Manager spoke about how she had addressed complaints that had been made. These had been appropriately dealt with. The Manager said that all residents were on the electoral register and those who wanted to had voted at the recent election. The home has adopted the London Borough of Richmond protection of vulnerable adults procedure. Staff have undertaken training in protection of vulnerable adults in the past year. The Manager must make sure new staff are also trained in this area. Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Quality in the Environment section is poor. evidence seen during a visit to the service. This judgement is based on Some improvements to the environment have been made. However, some areas of repair and maintenance are outstanding and put residents at risk. EVIDENCE: The home is a converted two storey house. All rooms are single and there is a stair lift between floors. Bedrooms are personalised by residents. There is a large lounge and separate dining room. There is a large front and back garden. However areas of these are unsafe. There are steep steps leading from the patio to the garden and no handrail. The garden path and the path to the house are uneven and there is no rail. These hazards mean that residents are at risk and cannot safely use the garden or walk down the front path alone. This has been discussed at several previous inspections and the Manager has said that she is anxious for work on the garden and pathway to be completed. The Manager said that paramedics who recently visited the home commented Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 21 on how dangerous they felt the front path was. The Owner must prioritise this work. Some of the maintenance work identified at previous inspections has been attended to and some work has commenced but has not been completed. All radiators are now covered and all first floor windows have been equipped with restricting devices. Work to the electrical wiring has started but needs to be completed. The carpet in the hallway and stairs is wrinkled and unsafe. replaced with a suitable and safe floor covering. This must be Some work in the bathrooms has taken place but many of the residents are restricted to the use of one bath, because it is the only one with a bath chair. There is no shower facilities at the home and the Manager reported that some residents have requested a shower. The changes in need for some service users has meant that they find accessing the bath difficult. The Registered Person should consider the installation of a walk in shower which would be easier for service users to access. There is no hoist at the home. The size and layout of the home would mean that storage of and moving a hoist would be difficult. However, some of the residents cannot be lifted without a hoist. The Registered Person should seek the advice of an occupational therapist, or suitably qualified person, to look at the equipment needs of the residents. Suitable equipment must be obtained if the home is to continue to meet the needs of each resident. Residents and their families said that they found the home clean and fresh. One resident said that cleaning had improved recently. Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in the Staffing section is adequate. This judgement has been based on evidence gathered during the visit to the service. Staffing levels are adequate but only allow for a basic level of service. Staffing levels should be reviewed to support a more person centred approach. Training and supervision for staff has improved and this will benefit the residents. However, further training is needed in some areas. Improvements to staff records and records of disciplinary action need to be made. EVIDENCE: Since the last inspection the Manager has recruited a new senior carer. There is now a team of senior staff who work throughout the week and weekends. The Manager said that she feels supported by the senior staff team who meet regularly and have worked together to support staff to make changes to the way they work. The staff team is fairly stable and staffing levels are acceptable. However, there is little opportunity for additional activities, such as trips out of the home, to be organised. Consideration should be given to increasing staffing or rearranging staff rotas to allow for more individual activities. Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 23 The Manager has introduced new systems of communication for staff and these have helped improve practice and consistency. Some staff meetings have been held and the Manager said that she hopes to increase the frequency of these. Regular supervision sessions have been arranged for staff, however some staff have not been able to keep their supervision appointments. It is important that all staff receive regular formal supervision particularly when new systems and changes are being introduced. Each staff member should be reminded of their responsibilities and both the Manager and staff should make sure regular supervision takes place for all. Two new staff members have been employed since the last inspection. There recruitment records were examined. One file did not contain copies of the staff member’s ID. Other staff files were examined and these needed to be sorted out as information was not clearly filed and some information was old and could be archived. Where disciplinary action had been taken evidence of this was not altogether clear. The Manager must make sure all disciplinary records are appropriately maintained and that the disciplinary procedure is followed appropriately. Over the past year the staff team have had a variety of training opportunities. Some of these external and some in house. This has been really positive. More training is planned in some areas. The Manager must make sure all staff are trained in manual handling, food hygiene and basic first aid. Some of the residents have different health care conditions and staff should be trained in these, such as epilepsy and dementia. The Manager has started to develop training profiles for individual staff. These must be completed for all the staff. The Manager said that she hopes two staff will start their skills for care induction training and two staff will start their NVQ Level 2 later in the year. All staff should be given the opportunity to work towards this qualification and the Manager should work towards supporting at least 50 of staff to achieve NVQ Level 2. Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 24 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, 32, 33, 34, 35, 36, 37 & 38 Some of the quality in the Manager section is good, however some is poor. This judgement is based on evidence gathered before and during the inspection visit. The Manager has introduced positive changes at the home and improved the quality of the service. She does not always receive the support she needs. There have been improvements to checks on health and safety. EVIDENCE: The Manager has been in post since July 2005. In April 2005 the home failed to meet the majority of National Minimum Standards and the outcomes for residents were poor. The Manager has worked hard to improve the quality of the service and has achieved this on many levels. Residents are now better cared for and have a better quality of life. The residents have more control and choice. The staff work in a more professional way and have a better Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 25 understanding of their roles and how they should support and care for residents. Families and professional contacts now have more faith in the management and staff of the home. There have also been improvements to health and safety. These changes have been lead by the Manager and have been difficult to implement at times. The work of the Manager is commendable as the changes introduced by her have directly benefited the residents. The Manager has a good knowledge of the residents and was able to speak about individual needs. The Deputy Manager spoke with the Inspector and said that she felt changes introduced at the home were very good. The Deputy Manager and senior staff have been supportive of changes and have also worked to make sure the quality of the service improved. Some staff were initially resistant to change and found it hard to change the way they worked. However, they have looked at their own practice and worked hard to improve this. The changes to continue to improve the quality of the life of residents and to run the service in a professional manner must continue and the commitment of all staff is important. The Manager started to undertake her NVQ Level 4 but took a break from this due to the volume of work she was undertaking at the home. Now that there is more senior support in place the Manager should restart her qualification. The Manager must complete her application to be registered with the Commission for Social Care Inspection. The Owner must make sure he offers appropriate support to the Manager. There have been times when the situation at the home has been very stressful and the Manager has been faced with a series of challenges. At times the Owner hasn’t been available or has not been able to offer the practical support needed. The Owner must recognise that the Manager needs regular access to professional support and he should arrange for a suitably qualified person to offer this if he is unable to. The Manager does not control the home’s budget and has a limited amount of petty cash. At times non payment of bills has created problems for the home with suppliers refusing to continue business until they have been paid. This directly effects the staff and residents. In addition some of the building and environmental work has remained outstanding or incomplete for long periods of time. At the last inspection the CSCI requested a copy of the homes budget and business plan. This has not yet been received and should be forwarded as soon as possible. The Owner must make sure the finance of the business is managed appropriately and non payment of bills does not adversely effect the service. The home does not manage the finances of any residents although residents are able to leave small amounts of cash with the Manager for safe keeping. Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 26 Accurate records of these are kept and were examined by the Inspector. The Manager has started to review some of the policies and procedures at the home. This work should continue and priority given to looking at staffing procedures. The Manager should consider how best to introduce quality monitoring, which takes into account the views of residents, their representatives and staff. Regular checks on health and safety were seen, including checks on fire safety, water temperatures, food storage and cooking temperatures. A newly purchased fridge was malfunctioning and running at a high temperature. This must be repaired or replaced as food cannot be safely stored within it. Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 27 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 3 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 2 3 2 3 2 Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 28 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. OP2 5 The Registered Person must 31/07/06 issue all residents with a statement of terms and conditions and a contract if they are funding their own placement. These terms and conditions must include details of the room number to be occupied, state who is paying the fees, give information on trial stays and should refer to the CSCI not the NCSC. A signed copy should be held by the home. 2. OP22 12 13 23(2) The Registered Person must 31/08/06 arrange for the manual handling needs of the residents to be assessed by an appropriately qualified health care professional. This assessment should look at what type of equipment could be used safely within the home. The Redcotts Standard Regulation Requirement Timescale for action Registered Person must Version 5.1 Page 29 DS0000017388.V289510.R01.S.doc make needed moving users is sure that equipment to support the safe and handling of service in place. – Previous requirement timescale 31/01/06 3. OP9 13 (2) The Registered Person must 01/07/06 make sure that accurate records of all administration/nonadministration of medication are retained in the home. The Registered Person must ensure that sufficient work surfaces are available in the medicine room. 4. OP12 16(m) The Registered Person should 31/07/06 make sure detailed information on social needs and interests is in place for all residents. A wider selection of activity resources is available for residents and staff encourage and support residents to meet their social and leisure needs throughout the day. The Registered Person must make sure all residents who have a disability have opportunities to participate in activities of their choice. 5. OP19 13 23(2) The Registered Person must 31/07/06 make sure the garden and pathway to the front of the home are safe and accessible. The Registered make Person must 31/08/06 sure: 6. OP19 13(4)(6) 23(2) Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 30 1. All maintenance needs identified at this and previous inspections are attended to. 2. Regular checks on the condition of the building and gardens are made and needs attended to as required. (Previous requirement made 28/02/06, 14/07/04, 03/11/04 & 07/04/05) 7. OP29 13 19 The Registered Person must 30/09/06 make sure staff files are complete and are well ordered. The Registered Person must 31/07/06 make sure disciplinary procedures are clearly followed and this is evidenced within staff files. The Registered Person must 31/12/06 support staff to undertake and achieve NVQ Level 2 or above. (Previous requirement made 28/02/06 & 07/04/05) 11. OP30 18(1)(a) & (c) The Registered Person must 31/12/06 make sure all staff are appropriately trained in first aid, food hygiene, health and safety and fire safety. (Previous requirement made 28/02/06 & 14/07/04 & 03/11/04 & 07/04/06) Staff should also have training in dementia, epilepsy and other conditions which may affect the residents. Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 31 9. OP36 18 19 10. OP28 18(1)(a) 12. OP31 9 The Registered Person must 31/07/06 make sure the Manager applies to be registered with the CSCI. Previous requirement 15/01/06 13. OP31 14. OP36 12(5) 18(2) The Registered Person must 31/07/06 make sure the Manager has access to regular support and professional supervision. The Registered Person must 31/07/06 forward a copy of the home’s budget and business plan to the CSCI. Previous requirement 31/01/06 16. OP34 25 The Registered Person must 31/07/06 make sure the finance of the business is managed appropriately and non payment of bills does not adversely effect the service. The Registered Person must 30/06/06 make sure the broken fridge is repaired or replaced. The Registered Person must 31/08/06 make sure work to make safe the electrical wiring is completed. (Previous requirement made 31/12/05, 14/07/04 & 03/11/04 & 07/04/05) Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 32 10(3) The Manager must recommence 31/12/06 her NVQ Level 4. 15. OP34 25 17. OP38 13 16(2) 18. OP38 13(4)(6) 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. OP1 The Manager should make sure the Statement of Purpose and Service User Guide are reviewed. Information should be up to date, clear and accessible. Copies of these documents should be given to all existing and prospective residents. The Manager should look at ways to work towards person centred planning, in particularly looking at ways to involve the residents in developing care plans which reflect their wishes and opinions. It is recommended that the quantity of medication carried over from one month to the next be recorded on the current administration record. The Manager should consider how best the cultural and religious needs of different residents can be met. The Manager should look at ways to make sure residents are informed and can make choices about food, activities and other areas of their lives. The Manager should consult with residents and a dietician when reviewing the menu. Residents must be given a choice at mealtimes. The Registered Person should consider the installation of a shower which would meet the needs of service users. Refer to Standard Good Practice Recommendations 2. OP7 3. OP9 4. OP12 5. OP14 6. OP15 7. OP21 Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 33 8. OP27 9. OP33 10. OP33 The Manager should consider how best to introduce quality monitoring, which takes into account the views of residents, their representatives and staff. The Manager should continue to review policies and procedures at the house. The Manager should review staffing levels giving consideration to how individual activities can be met. Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 34 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Redcotts DS0000017388.V289510.R01.S.doc Version 5.1 Page 35 - 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!