Inspection on 19/11/09 for Redcotts

This inspection was carried out on 19th November 2009.

CQC found this care home to be providing an Poor service.

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 26/02/09

Redcotts 09/09/08

Redcotts 24/04/08

Redcotts 02/05/07

Redcotts 16/05/06

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 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Redcotts 96 Wensleydale Road Hampton Middlesex TW12 2LY Lead Inspector Sandy Patrick Key Unannounced Inspection 09:30 19th November 2009 DS0000017388.V377655.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Redcotts DS0000017388.V377655.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Redcotts DS0000017388.V377655.R01.S.doc Version 5.2 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 020 8979 5491 redcottshome@aol.com Mr Sajjad Hassan Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Redcotts DS0000017388.V377655.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 18 26th February 2009 Date of last inspection Brief Description of the Service: Redcotts is a privately owned residential care home registered for up to 18 older people. The owner visits the home on a regular basis and a manager is employed to oversee the day-to-day operation of the home. The home is situated in a residential road in Hampton, close to local shops, community facilities and public transport networks. Communal rooms include a lounge and separate dining room. The home has a large rear garden. Residents’ rooms are on the ground and first floor of the home. The home is staffed 24 hours a day. Information about the home is available in a Service User Guide, which includes information on the aims and objectives of the service. The home’s charges range from £520 - £700 per week. Redcotts DS0000017388.V377655.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. The service has failed to comply with regulations. Therefore to ensure future compliance and secure better outcomes for people who use the service the commission is taking enforcement action. The inspection included an unannounced visit to the home on 19th November 2009. We met the owner, people who live at the home, their visitors and staff on duty. We looked at records, the environment and how people were being cared for. There is no registered manager at the home. leave at the time of the inspection. The acting manager was on We wrote to the owner and asked him to complete a quality self assessment. This was not completed at the time of the inspection. We wrote to the owner and asked him to distribute surveys to people who live at the home, their representatives and staff. Unfortunately people were not given these. The local authority recently visited the home and they gave us some information about what they found. Most people we spoke to at the time of the inspection told us that they liked Redcotts. One person said, ‘it is a lovely home’ and another person said, ‘they do everything for us’. What the service does well: People told us that they were happy living at the home. They told us that the staff did everything for them. People are able to see their friends and family whenever they want and visitors are made welcome at the home. The owner visits the home every day and has a good relationship with the people who live there and visitors. The building is generally well maintained. Redcotts DS0000017388.V377655.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Redcotts DS0000017388.V377655.R01.S.doc Version 5.2 Page 7 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who move to the home have not had their needs assessed to make sure the home is suitable for them. The staff who support people have not been given information about their individual and specific needs. EVIDENCE: Some of the people who had recently moved to the home told us that they had found it hard to settle. One person told us that they liked it better than their previous home. One person told us that the staff had not taken the time to get to know them. Since August 2009 five new people have moved to the home. We found that there was no evidence that anyone from Redcotts had assessed their needs to make sure these needs could be met at the home. Three of these people Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 10 moved to Redcotts at very short notice as they could not continue to live in their current home, therefore a pre-admission assessment was not possible. However, Redcotts failed to assess their needs when they moved to the home or since then. We found that information from each person’s previous home or hospital was minimal and there was not enough information for staff to be able to support people with their specific individual needs. There was no evidence that any of these people’s care and support had been reviewed since they moved to the home. Some of the information from hospitals and previous homes indicated high needs and risks to people’s well being. There was no evidence that staff had been given information about these needs or risks. There was no evidence that people who had recently moved to the home had been given a copy of the terms and conditions of the home or a contract. The owner confirmed that assessments and contracts for the people who had recently moved to the home were not in place. The service has failed to comply with regulations. Therefore to ensure future compliance and secure better outcomes for people who use the service the commission is taking enforcement action. Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s individual needs are not being met and the staff do not know what they are. People are not given all the support they need to stay healthy. The way in which medication is managed means that people may be at risk. EVIDENCE: Eight of the thirteen people who were living at the home at the time of the inspection had their needs recorded in a care plan. There was no care plan or guidelines for staff about how to care for the other five people. Six of the eight care plans had not been reviewed since May 2009 and two had not been reviewed since June 2009. Therefore any changes in need which people had experienced were not recorded and there was no information about these for staff to be able to care for them. Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 12 There was very limited information for five of the people who live at the home. Information for each person included a basic list of key personal and health needs which had been provided by the person’s previous home or hospital. There was no evidence that staff at the home had seen this information and there was no plan of care to tell the staff what they should to do to meet these needs. Some of the information indicated that people were at risk or had serious health concerns. For example, one person’s information stated that they were at high risk of falls. Another person’s information highlighted health conditions which could be serious. The fact that there was not even a basic care plan for these people means that they are at risk because the staff do not know how to care for them and their specific needs. The risks that people experience or areas where they might be at risk had not been assessed. We saw that one person’s file said that they were at high risk of falls, another person’s said that they needed support when walking. There was no risk assessment for either of these people and no action plan to state how the staff should support them to reduce the risks. One person’s file indicated that they were at risk because they were underweight. There was no assessment or plan to help make sure the risks this person faced were reduced. The owner confirmed that care plans and risk assessments were not in place for the 5 people who had recently moved to the home and that there was no other information about how staff should care for these people. The staff keep a record of the care and support they have given each person and their general well being every morning, afternoon and night. Everyone is registered with a GP and we saw that some people had support from other health care professionals. On the day of our visit someone was visited by a dietician and we saw that the staff spoke to this professional about this person’s needs. However, we saw that some of the people who had recently moved to the home had specific health needs. There was no evidence that these people had seen other health professionals as needed. One person’s information identified that they were at risk because they were very underweight, another person’s information stated they had a catheter in situ. There was no evidence that either of these health concerns had assessed, and no evidence that the staff had consulted with health professionals about the best way to meet these needs. There was no evidence that any of the people who had moved to the home since August 2009 had seen health care professionals. The owner told us that he felt the staff worked really hard to make sure people’s personal care needs were met. Most people who live at the home told us that they felt they were well cared for. One person told us that the staff Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 13 had failed to answer a call bell when they had required assistance and that their personal care needs had not always been met. One person told us that they were not provided with a call bell for the first three days of their stay at the home. There is a medication procedure and all the staff who administer medication have been trained to do so. Medication was stored securely. There were no photographs for people who had recently moved to the home. These people required support with medication. We felt that photographs to help the staff to identify them would reduce risks of errors when administering medication. There is a list showing the signatures of the staff who administer medication. We found that one person who was not on this list had administered medication. We saw that they had been trained to do so. Their name should be added to the list as this is good practice. We saw that one three people’s medication records the staff had entered a symbol which indicated that the medication had not been administered and the reason for this would be recorded. We found that the reason was not always recorded. We looked at the amount of medication held at the home and compared this to the amount of medication records said should there should be. We found that there were 9 doses too many of one medicine, 1 dose too many for another medicine and 3 too many for two medicines and 2 doses too many for a fifth medicine. We did not check all of the medicine supplies in the home. The allergies section had not been completed on 3 medication charts we looked at. We found a medicine for one person which had been dispensed earlier in the month but had not been administered. There was no record of why this had not been administered on their medication chart. This person did not have a care plan. We found that the staff handover book stated that the GP had visited and discontinued this medication. However, there was no other record of this. We found another medication for one person which had been dispensed in October 2009. None of these tablets had been administered and the medication was not included on the chart. The instructions on the bottle stated that the medication should be given three times a day until the course was complete. We could not find reference to this medication in the communication book, staff handover book or the person’s diary. The person did not have a care plan so we could not check details against this. Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 14 We found an unlabelled tube of mouth ulcer gel in the medication cabinet. We found that where people were prescribed a variable dose of paracetamol (one or two tablets as required), the staff had not recorded the amount of tablets they had given. We saw that one person had been prescribed food supplements in the past and that these had recently been stopped by the GP. The person was underweight and the staff at the person’s previous home had highlighted that they did not know why the GP had stopped these supplements. There was no evidence that staff at Redcotts had investigated this. One person’s medication chart did not state the dosage or time that their medication was to be administered. The service has failed to comply with regulations. Therefore to ensure future compliance and secure better outcomes for people who use the service the commission is taking enforcement action. Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not always given the opportunity to participate in activities of their choice nor do they have full, active and varied lives. People are able to see visitors. Family and friends are valued as an important part of daily life at the home. People are given fresh, nutritious and varied food but are not always able to choose what they eat. EVIDENCE: People’s individual social needs, likes, wishes and interests have not been recorded. The amount of staff who work at the home mean that they do not have the time to give people individual support to pursue their interests. There is a plan of organised activities on display however this is not followed. A part time activities coordinator works for two hours, three days a week. She supports people to take part in a variety of activities in the lounge. These include games, quizzes and bingo. She records what she has done and who has participated in these. Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 16 Entertainers visit the home about once a month for a singing session. Another person visits the home weekly to provide support with gentle exercise. Some people told us that they enjoyed the activities at the home. However, some people do not join in with the activities provided and we felt they should be given more support to do the things that they want to do. One person told us that they had enjoyed gardening in the past and another person told us that they liked going to the shops. We felt that the staff should provide people more support to participate in the things that they want to do and to meet their individual needs. There are no organised activities at the weekends or in the evenings and the mornings. We saw that people spent the morning in their bedrooms or sitting in the lounge with the TV on. Although this may be some people’s choice, there is no evidence that they are offered an alternative to this. Some people told us that they were happy at the home and enjoyed being there. Other people said that they would like more things to do. One person who was unable to leave their bedroom told us that the staff did not visit them for a chat or for any social activity and at times this was boring. Visitors are welcome at the home and are able to visit whenever they want. We met some visitors on the day of our inspection and they told us that they were happy with the home. The atmosphere at the home was relaxed and visitors were included in conversations and activities in the main lounge. People told us that generally liked the food. Some people said that the food was very good. The food is freshly prepared each day from a set menu. The menu is displayed in the main dining room, but people who spent time in their rooms and ate their meals there told us that they did not know what the planned menu was. The staff should make sure everyone has the opportunity to see the planned menu in advance. We saw that there was only one option for the main meal at the home. Some people told us that they did not have a choice about what they were served. The staff should make sure people are able to make a choice about what they eat in advance. We saw that people were not given a choice of cold drinks to accompany their meal. We saw that some people were given their dessert (a hot pudding and custard) before they had finished their main meal and this meant that it had gone cold before they got the chance to eat it. We saw that the staff on duty were kind and supportive towards people and listened to what they said. The activities coordinator told us that she had recently asked people who live at the home what they wanted to do on Christmas Day and she had recorded their choices about this. However, the routines of the home mean that people have limited choices about when and Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 17 what they eat, the daily activities they participate in and when they receive some care. There are no meetings for people who live at the home and we saw no evidence that their care was reviewed and that they had an opportunity to comment on the care and support they received. Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to make a complaint about the service and procedures designed to protect them are in place. EVIDENCE: People who live at the home told us that they knew how to make a complaint and who to speak to if they were unhappy about anything. There is a complaints procedure which was reviewed in 2008. There are procedures about abuse and whistle blowing and copies of the local authority safeguarding procedure at the home. There was no evidence that staff who have been employed in the last six months have had training in this area. This must be organised so that they know how to recognise abuse and what action to take if they suspect people are at risk. Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and well maintained environment. EVIDENCE: The building is generally well maintained and some areas of the building were being redecorated at the time of the inspection. The carpet in one bedroom was not securely fitted to the floor and there was a large ridge where it had risen up. This could put people at risk if they tripped and the carpet should be secured and smooth. A housekeeper is employed throughout the week. Her role involves some cleaning but also laundry work. There was no cleaner at the time of the Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 20 inspection and care staff were responsible for attending to some of the cleaning. We found that the home was generally clean and tidy although records of cleaning checks on bathrooms and toilets indicated that these had not been checked for 13 days. One bathroom did not have any soap in and we saw that one bathroom was dirty on our arrival, but these problems were resolved during our visit. The home smelt and appeared fresh throughout. Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some of the staff who support people have not been appropriately recruited or trained and therefore people may be at risk. There are not always enough staff to support people and meet their needs. EVIDENCE: There was no list of staff employed at the home and the only evidence that people were working there was the staff rota. There was a photograph board of staff in the main foyer to help people to identify them. This had photographs of staff who had left and did not have photographs of some new staff. The staff rota showed that a maximum of 2 care staff were employed at any one time, throughout the day and night. There was no information on the assessed staffing needs of people who live at the home so we were unable to judge whether these staffing levels were adequate. However, some information on people’s needs indicated that they needed at least 2 carers at times. This would mean that there was no other care staff available to help anyone else at these times. The owner needs to base staffing levels on the assessed needs of the people who live at the home and keep this under review Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 22 if people move to the home or their needs change. We saw that some people did were only offered baths once a week. We also saw that people were not getting opportunities to meet their individual social needs and this would indicate that the staffing levels at the home may not be enough to meet everyone’s needs. The staff sign a record to state when they have arrived at work and when they leave each day. We saw that there were a high number of days when the home was left with only one carer for up to 10 minutes and on one occasion in November when the home was left with only one carer for 20 minutes. The owner needs to make sure the staff leaving work do not do so until their replacement has arrived so that the home is not left with one carer, because people living at the home may be at risk if there are not enough care staff on duty. There is no period for handover of information when the staff changeover. For the majority of changeovers there was hardly any or no overlap of staff. There is no paid period of handover and the overlap of staffing had only taken place when staff had arrived early or stayed late. The staffing rota should include a period of overlap so that staff have an opportunity to discuss important things about the people who live there and the home. There was evidence that the staff employed before February 2009 had been trained in safeguarding adults, basic first aid, infection control, management of medication, manual handling and supporting people with some health equipment. However, they had not received any training in food hygiene, dementia or specific health conditions. Three of the staff who had been employed since February 2009 had no training records and no evidence of any training in any areas. There was no record of an induction for any of the four staff who had been employed at the home in 2009. We looked at staff recruitment files for the four new members of staff. There was no records for one member of staff. One recruitment file showed that appropriate checks had taken place. One staff file had only one reference as part of their recruitment. There was no evidence that a second reference had been requested. Another staff file had two references but one of these was not appropriate as it was written in 2003 by someone who had only known the candidate for a week. The member of staff had provided the owner with three people who would be willing to provide a reference but there was no evidence that these had been requested. There were no contracts of employment for new staff. Their job application forms did not state what post they had applied for at the home. There was no record of when the staff had started work at the home. Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 23 The Owner confirmed that there were no other records of the staff who were employed at the home elsewhere. The service has failed to comply with regulations. Therefore to ensure future compliance and secure better outcomes for people who use the service the commission is taking enforcement action. Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 & 38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is not being managed and the people who live there are being put at risk from poor practice. People who live at the home and their representatives are not able to contribute their ideas and opinions to the running of the home. The staff are not given the supervision they need to make sure they care caring for people appropriately. Checks on the health and safety are not taking place which means people may be put at risk. EVIDENCE: The registered manager left the home in August 2008. An acting manager has worked at the home during 2009, but recently left for a period of extended Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 25 leave. The staff on duty and owner could not give a clear answer to when the acting manager stopped working at the home. The owner was not clear about whether the acting manager would be returning or not. There was no contract of employment for the acting manager and no information about their period of leave in her staff file. The staff on duty told us that they did not know who was managing the home. We asked the owner to complete an annual quality self assessment for us. He did not do this within the time we asked him to and told us that he was not aware that he should have done this. The owner visits the home each day but does not provide supervisions or guidance for staff and has not kept records up to date. The staff on duty told us that, ‘he just pops in with the shopping or anything we ask him for’. The staff told us that they had not had any individual supervision meetings. There was no evidence that supervision meetings take place for any staff who work at the home. People make their own private arrangements for managing their finances. However they are able to leave small amounts of cash with the owner for safekeeping. He keeps accurate records of this and all expenditure and receipts of all purchases. During 2008, a lot of records at the home were updated. This included updating and reviewing policies and procedures and care plans for the people who lived there at the time. A person employed to help update records set up systems for monitoring health and safety and reviewing records. However some records were not updated and remain inaccurate. These include the admissions and discharge book which should state the names of everyone who has lived at the home, when they moved in and the date of them moving out or dying. This record has not been kept up to date and we could not tell who was actually living at the home at the time of the inspection. We found that some records were not in place, these included care plans and staff files. We found that old records were mixed with newer information and it was sometimes hard to see what was current and what was no longer applicable. We saw that some records had not been reviewed and updated in the past few months. These included some health and safety checks and care plans. There are systems for making regular checks on health and safety at the home, and the staff make some checks. However the hot and cold water delivery temperatures had not been checked since August 2009, and if these temperatures exceed recommended safety levels then people could be at risk of scalding or from water borne diseases. Regular checks could help reduce the risks to people. Checks on fire safety equipment had not taken place since December 2008. People may be at risk if fire safety equipment is faulty and regular checks may help to reduce this risk. There had not been a fire drill Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 26 evacuation since August 2008. There was no evidence of staff training in fire safety. The fire risk assessment had not been updated since new people have moved to the home. We saw that one fire door was wedged open with a magazine. The key to a cupboard, which was labelled to be kept locked shut and which contained cleaning products, was left in the door of the cupboard throughout the day of our inspection. The last recorded check of fire safety equipment by a professional was in September 2008 and this was due for rechecking. The service has failed to comply with regulations. Therefore to ensure future compliance and secure better outcomes for people who use the service the commission is taking enforcement action. Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 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 X 2 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 3 1 2 2 Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 28 Are there any outstanding requirements from the last inspection? Yes Numbers 1 - 4 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 OP33 Regulation 24 The Registered Person must 31/03/11 introduce a quality assurance system and look at how people who live at the home and their relatives can contribute to this. Requirement 31/10/09 2. OP7 13 The Registered Person must 05/01/10 make sure risk assessments are made for the risks each person experiences and these are reviewed and updated regularly and following a change in need. Requirement 30/04/09 OP30 3. 18 The Registered Person must 31/01/10 make sure all staff are trained in food hygiene, supporting people with dementia, use of health care equipment and supporting people with specific health care needs they have. DS0000017388.V377655.R01.S.doc Version 5.3 Page 29 Requirement Timescale for action not met not met Redcotts Requirement 30/06/09 OP38 4. 13 not met The Registered Person must 05/01/10 make sure regular checks on health and safety take place and are recorded. The Registered Person must make sure action is taken wherever a problem with health and safety is identified. Requirement 31/03/09 not met 5. OP3 14 The registered person must: Ensure that no service user is accommodated unless an assessment of need has been obtained or is undertaken by a suitably qualified person and the service has confirmed in writing to the service user that the service is a suitable establishment to meet his health and welfare needs. Statutory Requirement Notice 05/01/10 6. OP3 14 The registered person must: Ensure that for all service users accommodated in the home there is an assessment of need that clearly identifies each service users’ health and welfare needs Statutory Requirement Notice 05/01/10 7 OP2 5 The registered person make sure everybody DS0000017388.V377655.R01.S.doc must 28/02/10 who Version 5.3 Page 30 Redcotts moves to the home, or their representatives, has a copy of the home’s terms and conditions and a contract which they have agreed to. 8 OP7 15 The registered person must: Ensure a system is put into place that ensures, unless it is impractical, that service users and/or their representatives are consulted about the arrangements to be put in place to meet their health and welfare needs. Statutory Requirement Notice 9 OP7 15 The registered person must: Have a system is in place to ensure that care plans for service users are kept under review and updated when necessary to reflect the changing and current needs of individuals. Statutory Requirement Notice 10 OP7 15 The registered person must: Ensure that all service users care needs are fully identified and documented in a care plan, which contains sufficient detailed information on their care needs and guidance necessary for staff to support service users and minimise risk and fully meet their needs. Statutory Requirement Notice 05/01/10 05/01/10 05/01/10 Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 31 11 OP7 13 The registered person must 05/01/10 make sure any risks or restrictions in people’s lives are fully assessed and recorded. Assessments should indicate the action required to reduce risks and to support people. Risk assessments must be regularly reviewed. The registered person must 05/01/10 make sure everyone is able to access a call bell in case they need support when the staff are not with them. The registered person must 05/01/10 make sure staff answer call bells in a timely fashion. The registered person must: Ensure all medications received into the home are properly recorded, handled and administered safely. Statutory Requirement Notice 05/01/10 12 OP10 12 13 OP10 12 14 OP9 13 15 OP9 13 The registered person must: Ensure the allergy section on medication administration records is completed. Statutory Requirement Notice 05/01/10 16 OP9 13 The registered person must: Ensure there is a system in place to ensure that medication is only signed for as given after the 05/01/10 Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 32 medication has been administered and should the same be refused or not given for some reason then the reason for non administration is also documented on the medication administration record. Statutory Requirement Notice 17 OP9 12(1) The registered person must: Ensure there is proper provision of care and where appropriate the treatment of service users. Statutory Requirement Notice 05/01/10 18 OP12 16 The registered person must 31/01/10 make sure there is a full and varied activities programme and that the advertised activities take place. The registered person must 31/01/10 make sure people are supported with their individual interests. The registered person must 05/01/10 make sure everyone is given the opportunity to make choices about what they eat and drink. The registered person must 05/01/10 make sure there are opportunities for people who live at the home to make choices about the care they receive and their daily lives. The registered person must 31/01/10 Version 5.3 Page 33 19 OP12 16 20 OP14 12 21 OP14 12 22 OP18 13 Redcotts DS0000017388.V377655.R01.S.doc make sure all staff have had training in safeguarding people and protecting them from abuse. 23 OP19 13 The registered person must 05/01/10 make sure carpets are well fitted and do not present a risk. The registered person must: Maintain in respect of each service user a record which includes the information and documents detailed in Schedule 3. Statutory Requirement Notice 25 OP27 17 The registered person must: Ensure all records as detailed in Schedule 3 are kept securely within the care home. Statutory Requirement Notice 26 OP27 17 The registered person must: Ensure that records as detailed in Schedule 4 are maintained in the care home. Statutory Requirement Notice OP27 27 17 The registered person must: Ensure that all records as detailed in Schedule 3 and Schedule 4 are kept up-to-date and available for inspection by any person authorised by the Commission. Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 34 24 OP27 17 05/01/10 05/01/10 05/01/10 05/01/10 Statutory Requirement Notice 28 OP27 18 The registered person must 05/01/10 assess the staffing needs of the people who live at the home and make sure he employs enough staff to meet these needs at all times. The registered person must 05/01/10 make sure there is a period of time when the staff coming on shift and the staff leaving shift over lap so that they can discuss the home and the people living there and handover any important information. The registered person must 28/02/10 make sure all staff are trained in manual handling techniques, food hygiene, first aid and fire safety and that this training is renewed as needed. The registered person must 31/01/10 make sure all new staff have a full induction into working at the home and that this recorded. The registered person must: Ensure a system is in place to ensure that full and satisfactory information is obtained and is available in respect of each of the matters specified in Schedule 2 of the Care Homes Regulations 2001 prior to employing staff in the care home. Statutory Requirement Notice Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 35 29 OP27 18 30 OP30 18 31 OP30 18 32 OP29 19 05/01/10 33 OP29 19 The registered person must: Ensure that full and satisfactory information is obtained and is available in respect of each of the matters specified in Schedule 2 of the Care Homes regulations 2001 for all existing staff employed by the service. Statutory Requirement Notice 05/01/10 34 OP31 8 The registered person must 31/01/10 employ a suitably qualified person to manage the home and they must make an application to be registered with the Care Quality Commission. The registered person must 31/01/10 make sure all staff are given the supervision and support they need to do their jobs, including at least 6 formal supervision meetings with a manager a year. The registered person must 05/01/10 make sure there are regular recorded checks on all aspects of health and safety and equipment at the home. The registered person must 05/01/10 make sure there are regular recorded checks on fire safety and equipment. The registered person must 05/01/10 Ensure that you are fully compliant with the Regulation Reform DS0000017388.V377655.R01.S.doc Version 5.3 Page 36 35 OP36 18 36 OP38 13 37 OP38 13 38 OP38 23 Redcotts (Fire Safety) Order 2005 in accordance with regulation 23 (4A) Statutory Requirement Notice 39 OP38 13 The registered person must 05/01/10 make sure cupboards containing potentially harmful materials cannot be accessed by people living at the home. 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 OP19 Good Practice Recommendations The Owner should consider relocating the staff WC in order to make the utility room larger and easier for staff to use. People living at the home should be given a choice about how they want their room identified. Pictures, name plates and other symbols should be attractive and meaningful to the person occupying the room. The Manager should consider organising training for staff on how to support people at mealtimes. There should be a range of resources which people can use to pursue leisure interests and these should be accessible to everyone. The Registered Person must ensure that accessible bath and shower facilities are available to residents. 2. OP10 3. OP10 4. OP12 5. OP21 Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 37 6. OP12 The staff should consider working with people and their families to create a detailed picture of their lives, interests and experiences. 7 OP9 There should be a photograph of each person so that the staff administering medication can recognise them and check they are giving this to the right person. All staff who are responsible for administering medication should add their signature to the sample signature list. The staff should make sure they spend time with people who are not able to or do not want to go to the main lounge so that some of their social and leisure needs are also met. The staff should make sure people are served their meals and desserts at a time when they are ready for these. There should be regular meetings for people who live at the home so that they are well informed and have the opportunity to voice their views and opinions. The board of staff photographs should be updated to reflect the staff who actually work at the home. The registered person should consider archiving old information and records so that these do not get confused with newer records. 8 OP9 9 OP12 10 OP15 11 OP14 12 OP27 13 OP37 Redcotts DS0000017388.V377655.R01.S.doc Version 5.3 Page 38 Care Quality Commission Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.london@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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