Inspection on 09/09/08 for Redcotts

This inspection was carried out on 9th September 2008.

CSCI 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 19/11/09

Redcotts 26/02/09

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 17/02/2009.

CARE HOMES FOR OLDER PEOPLE Redcotts 96 Wensleydale Road Hampton Middlesex TW12 2LY Lead Inspector Sandy Patrick Unannounced Inspection 9th September 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 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.V371792.R02.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 Stella Vuyiswa Brenda Lehola Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Redcotts DS0000017388.V371792.R02.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 23rd April 2008 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 £499 to £520 per week. Redcotts DS0000017388.V371792.R02.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 star. This means the people who use this service experience poor quality outcomes. We visited the home on the 9th September 2008 and this visit was unannounced. During the visit we met people who live at the home, the staff on duty and the Owner. We spoke to them all about their experiences. We looked at records kept at the home, the environment and observed how people were supported. The Registered Manager was not working at the home at the time of the inspection and had been away since July 2008. There was no one else managing the home in her absence. We visited the home for a key unannounced inspection in April 2008 and asked people living there, staff and visitors to complete surveys about the home. We therefore did not ask them to complete surveys again for this inspection. In April 9 people returned surveys to us. People told us that the staff were mostly kind and helpful but that they did not always have time to sit and talk to them. They told us that there was not always a lot for them to do. We looked at all the information we had received about the home since the last key inspection. This included records of accidents and incidents and information from the London Borough of Richmond, who have conducted an investigation into poor practice and have visited to make assessments of the care people are getting. The day after our visit we met with the Owner to talk about our findings and tell him the things he needed to do to make sure people living at the home are safe and well cared for. Nine people were living at the home when we visited this time. What the service does well: People told us that they were happy living at the home. The staff spoke about people living there with genuine fondness. The home has a relaxed atmosphere. Visitors are made welcome. Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: We are concerned about the number of National Minimum Standards this service has failed to meet and we are considering enforcement action where failure to meet Regulations puts people at risk. The Owner needs to make sure the service is appropriately managed and there must be a structured action plan for meeting the requirements made by the CSCI, Environmental Health and Fire Officer. There are a high number of required improvements and these include: Care plans and risk assessments must continue to improve and the staff must understand and follow these. There needs to be improvements to the way people are supported with medication. The staff need to be trained so that they can move people safely. The staff must make sure they meet people’s individual needs in all areas. There needs to be further improvements to activities. There needs to be improvements to the environment. Staff records must be improved. Thorough checks must be made on all staff as part of the recruitment. Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 7 The Owner must make sure there are sufficient staff on duty at all times to keep people safe. Someone needs to offer the staff support and guidance. The staff need training in different areas. There needs to be regular recorded checks on health and safety and action must be taken to keep people safe. Policies and procedures need updating and all staff must be given information on these. People living at the home must have access to their money at all times if they want to. 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. The summary of this inspection report can be made available in other formats on request. Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 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.V371792.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People have their needs assessed before they move to the home to make sure these needs can be met there. EVIDENCE: No one has moved to the home since we last visited. The consultant has started to write new aims and objectives and a philosophy of care. We saw that basic needs assessments are made before people move to the home. Copies of these assessments are kept on their files. There are copies of more detailed assessments made by the placing authorities. There is evidence that placing authorities review the needs of people after they have Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 10 stayed in the home for 6 weeks to make sure they are happy and their needs are being met. Local authorities have recently reviewed the majority of people living at the home and the London Borough of Richmond is visiting regularly to support the Owner to improve the quality of care at the home. Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There have been improvements to some care plans although this work has not been completed and the staff do not always adhere to new care plans so the changes have had little impact on people’s lives. There needs to be improvements to the way in which medication is managed to make sure people are safe. People’s basic personal care and health needs are met but they are put at risk from untrained staff. EVIDENCE: The consultant has started to improve the way in which people’s needs are recorded. She has introduced a new format for care plans. Only a small number of new care plans had been completed at the time of our visit. These were better organised and information was clearer. They included information Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 12 on strengths and needs, how to give people more control and choice in their lives and an action plan. Dates for reviews had been recorded. New care plans included information on personal, health, social, emotional and a variety of other needs. The care plans are good and if followed by staff and regularly updated could make a difference in the type of care people experience. Work needs to take place to create meaningful plans like these for everybody. The staff must follow these and take time to get to know about individual needs. Some of the older out of date information needs to be removed from people’s care plans and archived, to avoid confusion. The consultant has introduced a keywork system. Key staff should spend time with their allocated person to get to know them better and know what their needs are. The consultant has started to write risk assessments for each person. These are well presented and show how people can be supported to take risks and make choices. For example there were risk assessments which showed how people could be supported to make their own hot drinks and how they could stay safe while doing this. The work in this area is good and if these assessments are followed and regularly reviewed the people’s quality of life could improve. People are registered with local GPs and see other health care professionals as needed. At the beginning of September all staff received training in medication. Before this untrained staff were responsible for administering medication. We spoke to some of the staff about the training. The training included information on certain medicines and side effects. However, not all the staff have been assessed as being competent in administering medication and the training did not cover that. The medication procedure needs to be updated. The consultant has introduced some changes to recording and storage which are an improvement. However further improvements are needed. There is a medication cabinet and some medicines are stores appropriately. However, some of the storage of medication was unclear and tablets, creams and other medication were stored in bags, tubs or on top of these in the bottom of the medication cabinet. There is no clear organisation for unused medication waiting to be returned to the pharmacy. External and internal medication is stored together. We found some medicated creams and laxatives and in one bedroom. These were not locked away. Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 13 One person administers their own medication. The agreement and risk assessment for this arrangement need to be updated. There is no record of staff signatures and recently there was some confusion when staff could not identify who had administered some people’s medication. Some of the medication people are prescribed had specific instruction, eg to avoid certain foods or direct sunlight. This information was not recorded on care plans and should have been. Where someone had been prescribed a variable dose (eg 1 or 2 paracetamol) the amount administered was not recorded. Some administration records had gaps where people had not signed. Some people’s allergies were not recorded on the medication administration record. On the day of our visit two members of staff were administering medication. They said that they had received training but had not been assessed for competency. They took medication to people in open containers. The pots contained a number of different medicines and there could be confusion if some of the medication is dropped or refused. One person told us that the staff did not always remove their gloves when they had finished helping someone with personal care. They said that they were concerned about cross infection. A pair of someone’s glasses had been left on the piano in the lounge. They were not labelled and this might mean it was hard to identify who they belonged to. Some staff reported that people’s hearing aids had run out of batteries and no one had replaced these. Records of baths indicated that some people had long gaps between each bath. For example several people only had 1 or 2 baths each month. The staff told us that some people did not want to have baths and would prefer showers. There are no shower facilities at the home. Where people consistently refuse to have baths, the staff need to consult other professionals to agree the best way to support them to stay clean. We found that some people were not being supported at all with personal care because they did not want any support. However, their health and wellbeing and that of others living in the home are at risk if they do not receive this support and the staff must find appropriate ways to care for them. Accidents and incidents are recorded and the staff notify the CSCI of these. Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 14 There was no evidence that the staff have had training in helping to move people safely. Untrained staff put people at risk if they are supporting them to move. One person uses a Percutaneous Endoscopic Gastrostomy (PEG) feed. There was no evidence that staff had been trained to support them with this. One member of staff told us that they had needed to give the person support with this and they had not had any training. This puts the person at risk. Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are supported to take part in some activities and this is an improvement, however people do not have active, varied or stimulating opportunities throughout the day. People are not supported to use the local community although visitors are welcome at the home. People have a variety of well cooked food but are not given a choice about the food they are offered. EVIDENCE: The staff and some people living at the home told us that activities had improved over the last month. Some of the staff have been given extra responsibilities to provide some daily activities and an activities officer visits the home twice a week. There is a planned event for most days. These include, quizzes, arts and craft, games and a movie club. The people living at the home have requested a keep fit class which they used to have. The staff are trying to organise this. There have been some visiting entertainers and people told us that they had enjoyed these. Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 16 Having some organised activities is an improvement from the last inspection and people told us that they enjoyed these. However, there is limited resources and the Owner should consider purchasing a wider range of art and craft materials, games and other resources. There is a selection of books on cases in the lounge and hallway but these are not accessible as they are situated behind other furniture. The activities are limited to an hour or two each day and for the rest of the time there is no organised activities. We saw that the staff did not encourage or support people to do anything at all during the day. The care staff on duty hardly spoke to people living at the home and only did so as part of a task, eg giving out medication or helping someone to the lunch table. For the majority of the day people were sitting in the lounge with the TV on. No one was offered a choice of TV station and at one point the domestic started hovering in the lounge without warning people or asking their permission, therefore making it impossible for them to watch the television. One carer told us that their role was to get people up in the morning, give anyone allocated a bath and then to wait until dinner time to help them if needed. They had no awareness that their role also included supporting people with social, leisure or any other needs throughout the day. There needs to be evidence that people have been consulted about their individual interests and social needs and staff must support people to meet these. One member of staff said that some organised activities did not take place at the best time for people living at the home. The activity programme should be arranged so that it suits people in the best way. Visitors are welcome at any time. At the key inspection in April 2008 relatives told us that they were made welcome. We saw that staff were friendly and chatty to visitors. People living at the home are not supported to go out. There are not enough staff on duty at any time to make this possible. The consultant arranged for the people living at the home to have a meeting. We saw minutes of this and were told about it by one person. People were given the opportunity to discuss activities and the menu. People were also given information about changes, complaints and the CSCI. These meetings should continue on a regular basis. People told us that they enjoyed the food at the home. When we first arrived at the home the menu for the day was not on display. There is a typed menu which is repeated every three weeks. The print for this is rather small and although it was pinned to the dining room wall it is rather Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 17 hard for some people to read. Later in the day, before lunch the day’s menu was written on a board in larger print in the dining room. There is no choice at mealtimes. The weekday cook told us that she knows people’s likes and dislikes. People told us that the menus were not always followed at weekends and sometimes they did not know what food they were having. A jug of water was available in the hallway throughout the day we did not see staff offering people drinks or snacks throughout the day. None of the people living at the home helped themselves to a drink and were not encouraged to. Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People know what to do if they are unhappy with their care however do not always feel able to raise concerns. There are procedures to protect people, the staff have had training on these and know what action they should take if they suspect abuse. EVIDENCE: The complaints procedure was not on display at the home and people have not been given a copy of this. Although people told us that they knew who to complain to when we asked them in April 2008. There is no log for recording complaints or concerns. One person told us that they did not always feel that they could raise concerns because they were frightened of the consequences. The staff we spoke to said that they had been on protection of vulnerable adult training. The home has agreed to follow the local authority protection of vulnerable adults procedure and staff are trained by the local authority. The staff told us that they understand about whistle blowing. Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 25 & 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There have been some improvements to the environment, however further work needs to take place to make sure people are kept safe and live in a comfortable and pleasant home. EVIDENCE: Over the past few years there have been a lot of improvements to the environment. Some new equipment has been brought. However, there is still outstanding work. Some of this is cosmetic and improvements would make the home seem more pleasant and homely. Some changes would improve the quality of life for residents. And some improvements are necessary to make areas safe. Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 20 Improvements include creating a ramp from the lounge to the garden. The garden is nicely maintained, although the path around the garden is uneven and needs work to make it safe for people to use. There is some new garden furniture and the seating area for people in the garden has improved. The dining room has been rearranged. Some bedrooms are being redecorated. We looked around the environment including looking in some bedrooms. Bedrooms are personalised and people are able to bring their own furniture and belongings. There are a number things that must to be repaired or improved in the environment. These include: Damaged flooring around the utility room. Some radiator covers need to be repaired as they are coming away from the radiator. All radiator covers need to be painted. Old and broken furniture, rubbish, paint cans and old mattresses must be removed from the garden where they are a hazard. Some bathroom flooring was damaged and not secured. Some water pipes in bathrooms were coming away from their fixings. There is no handrail along the path to the front door. In some bedrooms electrical equipment was arranged so that electric cables were tangled or trailed across areas of the room. These must be rearranged so that people are not put at risk. Some call alarm bells were tied up so that people could not easily reach these. People must have access to their alarm bells at all times. Some bedrooms had exposed electrical wires where there had been alterations to equipment and wiring. These must be made safe. Other minor repairs should be attended to and these include: Damaged lampshades. There was no waste paper bin in one WC so used paper towels were piled up on a handwash basin. The stair carpet would benefit from replacement or deep cleaning as it is stained. Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 21 Some WCs and baths are stained with limescale and water marks. Some areas of the home would benefit from repainting. Carpet tiles in one room were mismatching. Some plaster work is damaged. Other areas that could be improved include: The furniture in communal areas is not matching. Tables in the lounge are hospital type tables on wheels. nicer if replaced by more appropriate coffee tables. These would look Some furniture, ornaments and pictures are old and do not match. At a recent meeting of the people living at the home, several people said that they would prefer showers to baths. There is currently no shower facilities at the home. The Owner should install a shower so that people can have a choice. The utility room is small and the washing and drying machines take up a lot of room. The housekeeper also uses this room to iron. When the ironing board is set up there is no room for staff to access machines, the outside door or the staff WC. The housekeeper said that the size of the room makes it difficult to iron or carry out other tasks. The Owner should consider relocating the staff WC in order to make the utility room larger and easier for staff to use. In general the house was clean and free from unpleasant odours. However, some areas of cleanliness must be attended to. These included: The plug holes in baths and sinks were encrusted and stained with limescale and some were clogged up with hair. Bars of soap were found on the sides of some baths and handwash basins. These carry a risk of cross contamination and infection. There was no soap in some WCs. Liquid soap should be used in these rooms. A member of staff told us that they were helping to clear out the shed. They said that there was an infestation of rats in the shed. The Owner must arrange for a pest control service to remove these and to make sure the area stays free from them. There were no window restrictors in three of the bedrooms we looked in and people may be at risk. Assessments must be made and restrictors which limit Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 22 the amount that windows can be opened must be put in place where people are at risk. Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are not protected as the staff have not been recruited safely, are not trained, are not appropriately supervised and not employed in sufficient numbers. EVIDENCE: The Owner told us that he had advertised for a Deputy Manager and that he was in the process of recruiting to this post. Two cooks are employed, weekends. The weekday Level 2 in cooking. Both Other staff who work in training. one who works during the week and one at the cook told us that she had just achieved her NVQ cooks need to renew their food hygiene training. the kitchens must also undertake food hygiene Three staff files contained evidence of some training. However, other files did not. There was no training audit and no central record so it was difficult to assess what training each staff member had had. Staff have not had manual handling training, fire safety training or dementia awareness. We looked at 10 staff files. We could not find any records for 2 members of staff. Other staff files varied in content. Some did not have any contracts of employment. No one had a job description. There was not evidence of Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 24 criminal record checks in all files. Five members of staff had only one reference and some of these were personal references or ‘to whom it may concern’. Some staff files did not have photographs or proof of ID. The work permit in one file had expired. There was no evidence of recruitment interviews in the majority of files seen. Some application forms indicated gaps in people’s employment history, but there was no evidence that these had been discussed as part of the recruitment. Two of the staff files we examined contained contracts which showed the person was employed for a different role than the one they were doing on the day of our visit. On the day of our visit the rota showed that 2 carers were on duty in the morning. One of these carers is employed as a cleaner and there is no evidence that their role has changed or of any training undertaken. The London Borough Richmond upon Thames has visited the home on several occasions in the past two months. They have found that one carer has been working alone on three occasions. This situation put people at serious risk. There is no period of overlap for staff between shifts and therefore insufficient handover of information. One member of staff told us that they were meant to arrive 10 minutes before the start of their shift but this is not on the rota and is unpaid. The staff member told us that hardly anyone did this. On the day of our visit none of the staff arrived before their shift was due to start and there was no overlap of staffing. This situation puts people at risk because staff do not have adequate information about each person when they start working with them. There must be allocated time, for which staff are paid, for a handover of information between each staff changeover. The consultant has set up a staff notice board and communication book to help give the staff better information. Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living at the home are at risk because the home is not appropriately managed. There has been insufficient action to put right failures to meet national minimum standards. People are put at risk through poor record keeping, poor health and safety, poor practice and systems. EVIDENCE: The Registered Manager was not at the home and had been away since July 2008, following an allegation. This has been investigated under the London Borough of Richmond safeguarding procedures. Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 26 The Owner has not put in place suitable arrangements to manage the home in her absence. There is no senior member of staff responsible for the day to day running of the home. Some staff have been given extra responsibilities, however, this is not properly recorded, and there is no clear information about who is responsible for what at the home. The Owner has spent more time at the home in the absence of the Manager, but is not managing the service. A part time consultant is visiting the home to help improve paperwork and some systems. Her influence has been important and is the main reason for improvements in some areas. However, there is no contract for this person and she is working fulltime somewhere else and therefore can only spend a small amount of time at the home. The Owner has not requested a criminal records check for this person, there is no job description or contract and no application form from this person. The Owner told us that he had references but there was no evidence of these at the home. Only a small number of the requirements we made at the last inspection have been met. The consultant is working towards meeting some of these requirements however, very little work had taken place to address any of the issues before she started work at the home. Staff commented that the management approach was intimidating and that they were not able to contribute their ideas and opinions. We looked for evidence of individual staff supervision meetings with the Manager. We saw that this had not taken place regularly for any member of staff and there was no record of supervision for some staff. There have been only two recorded staff meetings in the past year. There are no systems for the registered persons to assess the quality of the service, except for recorded monthly checks by the Owner. The home does not issue quality satisfaction surveys to people living there or their relatives. The consultant who has started work at the home has held a meeting for people living there and has started to review care plans, risk assessments and safety checks. She has also set up daily room checks. These quality checks did not take place before. We have told the Owner that he must employ someone to manage the home on a temporary basis while the Registered Manager is away from the home. There is no business plan or budget for the home. The staff do not have access to petty cash. On occasions the Owner has not been available to pay for something which is needed and the staff have paid from their own money and been reimbursed. This system is not acceptable. The Owner told us that he was starting up a petty cash system on the day of the visit. Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 27 The Manager keeps small amounts of cash for some of the people who live at the home to pay for toiletries, hairdressing, papers etc. However, when she was suspended the responsibility for keeping this money was not handed over and the Owner told us that he did not have access to people’s money or the records of this. We told the Owner that he had to get access to this money and records without delay and that he had to put a robust system in place to make sure this money was kept safe. The consultant has started to improve record keeping at the home and is starting to create some new policies and procedures. However, many of the policies and procedures are out of date. There is no evidence that staff have read or seen any of the policies or procedures. We saw that some procedures were not being followed. The consultant has started to introduce checks on fire safety. However, the staff have not had fire safety training and some do not know how to carry out checks on fire equipment. Some of the fire doors do not close properly and therefore do not adequately protect against fire. One fire exit was not labelled at all and was locked. The key to this door was stored in another room. Other fire exits needed clearer labelling. There is no fire risk assessment. There are no recorded checks on general health and safety or water temperatures. The Environmental Health Officer has made a number of visits to the home and has made requirements. Some of these have been met, however some requirements remain outstanding and must be met within the timescales set by the environmental health office. There is no evidence that electrical equipment has been tested for safety and this must be. The consultant has started to write a number of health and safety risk assessments. Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 13 14 15 2 X 3 X X X 2 2 STAFFING Standard No Score 27 1 28 3 29 1 30 2 2 3 2 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 1 2 2 1 2 2 2 Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulatio n 12 Requirement Timescale for action The Registered Person must 31/12/08 make sure residents (or their representatives) are involved in developing and reviewing their care plans. They should have a copy of these and information should be clear and accessible to them. They should sign their care plans as a record of their agreement. Previous requirement 30/06/08 (partly met) – 2 OP7 15 The Registered Person must 31/12/08 make sure all care plans are clear, accurate and appropriately detailed. Changes must be recorded and old information should be archived. Previous requirement– 30/06/08 (partly met) 3. Redcotts OP9 13 The Registered Person must 30/11/08 Version 5.2 Page 30 DS0000017388.V371792.R02.S.doc make sure the medication procedure is updated and reviewed. 4 OP9 13 The Registered Person must 24/10/08 make sure any staff administering medication have been assessed as competent to do so by a suitably qualified person. The Registered make sure: Person must 24/10/08 5 OP9 13 Instructions for administration of medication are clear. Medication appropriately. is stored Unused medication is returned to the pharmacist. Previous requirement 15/05/08 – (partly met) 6 OP9 13 The Registered Person must 24/10/08 make sure medication administration records are accurate, always completed, include a record of variable doses, include information on allergies and there is a record of staff signatures so that any person making an entry care be identified. The registered person must make 24/10/08 sure hearing aid batteries are replaced immediately if these run out. 7 OP10 12 Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 31 8 OP10 12 The registered person must make 24/10/08 sure people are offered regular baths and supported to be clean. The Registered make sure that: Person must 31/12/08 9 OP12 16(m) Detailed information on social needs and interests is in place for all residents. A wider range of activities and outings is available to residents. Staff encourage and support residents to meet their social and leisure needs throughout the day. Residents who have a disability have opportunities to participate in activities of their choice. This requirement has been made at previous inspections and was last made on 31/07/08. 10 OP14 12 The Registered Person must 30/11/08 make sure people are able to participate in decisions about their lives and the home, including care plans, menus, activities and events in the home, on a daily basis. Previous requirement 31/05/08 – partly met 11 OP15 16 The Registered make sure: Person must 31/10/08 The menu is displayed. People are able to make choices Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 32 at mealtimes. The food is always well prepared and good quality. Snacks and fruit are available at all times and that people are offered these. Previous requirement 31/05/08 – partly met 12 OP16 22 The registered person must make 31/12/08 sure everyone has a copy of the complaints procedure and that this is displayed. The Registered Person must: • Ensure all flooring in bathrooms and the utility room is secured and undamaged. Ensure all radiator covers are safely secured around each radiator. Ensure all water pipes in bathrooms are securely and safely fixed. Ensure the removal of any old or broken furniture, paint cans, old mattresses and any other rubbish from the garden. Ensure that there is a safe handrail from the path to the front door of the home. action is being 10/11/08 13 OP19 23 • • • • Enforcement considered. Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 33 14 OP19 13 The Registered Person must 31/10/08 makes sure electrical equipment is arranged so that cables do not present a risk to people. The registered person must make 31/10/08 sure people’s alarm call bells are accessible to them and are not tied up so that they cannot be reached. The registered person must make 31/10/08 electrical wiring is safely contained and people are not at risk from unfinished work. The Registered Person must 31/10/08 arrange for a pest control service to remove the rats in the shed and garden and to make sure the area stays free from them. The Registered Person must 10/11/08 ensure that suitable arrangements are made to prevent the spread of infection within bathrooms, toilets and washbasins in the care home. Previous requirement unmet from 31/05/08 Enforcement action is being considered. 15 OP25 12 13 16 OP19 13 17 OP19 13 18 OP26 13 19 OP19 13 The registered person must 31/10/08 makes sure assessments on windows are made and restrictors which limit the amount that windows can be opened must be put in place where people are at risk. Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 34 20 OP27 19 The Registered Person must: Ensure persons are not employed until such time as you have obtained all the relevant information and documents as required by regulation 19(1)(b) and paragraphs 1 to 9 of Schedule 2 of the Care Homes Regulations 2001. Enforcement considered action is being 10/11/08 21 OP27 19 The Registered Person must: Ensure that the relevant information and documents as required by regulation 19(1)(b) and paragraphs 1 to 9 of Schedule 2 of the Care Homes Regulations 2001 are in place and available for inspection for all staff employed. Enforcement considered action is being 10/11/08 22 OP27 19 The Registered Person must: Having regard to the size of the care home, the statement of purpose and the number and needs of service users, ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. Enforcement considered action is being 10/11/08 23 Redcotts OP29 19 The Registered Person must: DS0000017388.V371792.R02.S.doc 10/11/08 Page 35 Version 5.2 Ensure all employed staff have received training in moving and handling, food hygiene, first aid, and health and safety. Certificates to evidence training must be available for inspection. Enforcement considered 24 OP36 19 action is being The Registered Person must: Ensure all care staff have received training on dementia care and, if providing a service to people with their Percutaneous Endoscopic Gastrostomy (PEG), training on PEG. Certificates to evidence training must be available for inspection. Enforcement considered action is being 10/11/08 25 OP36 19 The registered person must: Put in place arrangements to ensure that all staff employed in the service receive appropriate supervision. Enforcement considered action is being 10/11/08 26 OP31 8 The registered person must 24/10/08 arrange for a temporary manager to run the home while the Registered Manager is not at work. The registered person must make 31/10/08 checks on the suitability of the DS0000017388.V371792.R02.S.doc Version 5.2 Page 36 27 OP31 9 Redcotts consultant and must agree a contract and job description with her. 28 OP32 12 The registered person must make 31/10/08 sure the management approach is open and inclusive and that people living at the home and staff are not intimidated or scare. The registered person must make 31/03/09 sure there is a business plan and budget for the home and that someone on duty has access to small amounts of cash for purchases if they need to. The registered person must 31/03/09 introduce a quality assurance system and look at how people who live at the home and their relatives can contribute to this. The Registered Person must 24/10/08 make sure people can access their own money whenever they wish to. previous requirement 15/05/08 – unmet 29 OP34 25 30 OP33 24 31 OP35 12 20 32 OP37 24 The registered person must make 31/03/09 sure there are up to date policies and procedures for the home and that these are followed by staff and regularly updated. The Registered Person must 31/10/08 make sure staff disciplinary issues are dealt with appropriately following the DS0000017388.V371792.R02.S.doc Version 5.2 Page 37 33. OP36 34 Redcotts disciplinary procedure. Previous requirement 31/05/08 unmet. 34 OP38 13 The Registered Person must 31/10/08 make sure all areas of health and safety, including first aid supplies, water temperatures, general health and safety and portable appliance testing are carried out regularly and are recorded. Previous requirement 15/05/08 unmet. 35 OP38 13 The registered person must make 24/10/08 sure all fire doors close fully. The registered person must make 24/10/08 sure fire exits are appropriately labelled, free from obstruction and unlocked. The registered person must make 30/11/08 sure there is a full fire risk assessment on the building, that staff are trained and understand how to carry out tests and that all fire equipment is in good working order. 36 OP38 13 37 OP38 13 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 38 No. 1 Refer to Standard OP10 Good Practice Recommendations Staff must remove gloves and dispose of gloves when they have finished supporting someone with personal care to avoid risks of spreading infection. The staff should make sure people’s glasses can be identified if left in communal places. People should be supported so that feel confident that they can raise concerns and make a complaint without fear of negative consequences. 2 OP10 OP16 3 4 OP19 The Owner should attend to: Damaged lampshades. There was no waste paper bin in one WC so used paper towels were piled up on a handwash basin. The stair carpet would benefit from replacement or deep cleaning as it is stained. Some WCs and baths are stained with limescale and water marks. Some areas of the home would benefit from repainting. Carpet tiles in one room were mismatching. Some plaster work is damaged. 5 6. OP19 OP9 The Owner should consider relocating the staff WC in order to make the utility room larger and easier for staff to use. The Manager should review the risk assessment for the person who manages their own medication. OP10 7 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. DS0000017388.V371792.R02.S.doc Version 5.2 Page 39 Redcotts 8 OP27 The registered person must make sure there is sufficient allocated time for the staff to handover information to each other when there is a changeover of staffing. The Manager should consider organising training for staff on how to support people at mealtimes. OP10 9 OP11 10 The staff should make sure individual wishes about death, dying and burial are recorded. OP12 11 There should be a range of resources which people can use to pursue leisure interests and these should be accessible to everyone. 12 OP21 The Registered Person must ensure that accessible bath and shower facilities are available to residents. The Registered Person must support staff to undertake and achieve NVQ Level 2 or above. The registered person must make sure the staff have contracts of employment and job descriptions which describe their terms and conditions of employment, roles and responsibilities. The Manager should make sure the staff can understand and communicate effectively with residents. 13 OP28 14 OP27 15 OP27 Redcotts DS0000017388.V371792.R02.S.doc Version 5.2 Page 40 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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