Inspection on 15/07/08 for Redcroft

This inspection was carried out on 15th July 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Redcroft 06/07/07

Redcroft 04/08/06

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

CARE HOME ADULTS 18-65 Redcroft 255 Belle Vue Road Southbourne Bournemouth Dorset BH6 3BD Lead Inspector Heidi Banks Unannounced Inspection 15th July 2008 10:25 Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 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 Redcroft DS0000065720.V370634.R01.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 Adults 18-65. 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. Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Redcroft Address 255 Belle Vue Road Southbourne Bournemouth Dorset BH6 3BD 01202 428158 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) info@applehouse.co.uk Apple House Limited Mrs Romaine Estelle Lawson Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Redcroft DS0000065720.V370634.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 - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning Disability (Code LD) The maximum number of service users who can be accommodated is 8. Date of last inspection 6th July 2007 Brief Description of the Service: Redcroft opened as a residential care home in December 2005. It is one of two homes run by Apple House Limited. It is a detached house situated in the Southbourne area of Bournemouth. The property is in-keeping with the neighbourhood. The home is registered to provide accommodation and support for up to eight adults who have a learning disability. There is a lounge, kitchen / dining room, a small utility area and a large garden to the rear of the house. Accommodation is provided on three floors. There are currently two bedrooms on the ground floor and five bedrooms on the first floor, two of which have an en-suite facility. The second floor of the home comprises a studio flat with ‘kitchenette’ facility suitable for a person who wishes to gain more independence. Five people who use the service share bathroom facilities in the home. The home is staffed on a 24-hour basis. There is an area for parking at the front of the property. Local shops are within walking distance and a bus route into the neighbouring towns of Christchurch, Boscombe and Bournemouth is close by. At the time of the inspection the basic fee for the service was £735 per week. General guidance on fees and fair terms in care homes contracts may be obtained from the Office of Fair Trading whose website can be found at www.oft.gov.uk . Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 5 Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection of the service. The inspection took place over approximately fifteen hours on three days in July 2008. The aim of the inspection was to evaluate the home against the key National Minimum Standards for adults and to follow up on the requirement made at the last key inspection in July 2007. At the time of the inspection there were seven people living at Redcroft aged between 18-61. For part of the inspection process the inspector was accompanied by an Expert by Experience from Bristol and South Gloucestershire People First. Experts by Experience is a project that involves people who use services in the inspection of those services. Their role as part of the inspection team is help us get a picture of the service from the viewpoint of people who use it. The Expert by Experience, Hayley Hughes, who was accompanied by her supporter, Lesley Doherty, spent time looking around the premises and talking to service users and staff. During the inspection we were able to meet some of the people who use the service and observe interaction between them and staff. Discussion took place with the Registered Manager, Romaine Lawson, and some members of staff in the home. A sample of records was examined including some policies and procedures, medication administration records, health and safety records, staff recruitment and training records and information about people who live at the home. Surveys were given to the home before the inspection for distribution among people who live in the home and those who have contact with the service. We received three surveys from people who use the service, two surveys from care workers, two surveys from care professionals and a comment card from a general practitioner who has contact with the home. We received the home’s Annual Quality Assurance Assessment when we requested it which gives us some written information and numerical data about the service. A total of twenty-two standards were assessed at this inspection. What the service does well: The provider has told us in their Annual Quality Assurance Assessment that their philosophy is that of ‘home living in a supported environment’. Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 7 The Expert by Experience told us ‘the house is in a nice street. The house is very clean and the decoration is nice’. They also noted that the atmosphere in the home was ‘really friendly and homely…all the residents I talked to liked being there’. We observed that there was a person-centred approach to care at the home that recognises people’s individuality and promotes their independence. We were told by a care professional that the home embraced the challenge of meeting individuals’ diverse needs and responded well to this. People we met in the home told us that they enjoyed the activities and opportunities offered to them. People who use the service are listened to by their care workers and there is a concerns and complaints procedure in place that enables people to express their point of view and receive a response to the issues they raise. The provider ensures that the home’s development is based on the needs and wishes of the people who live there and we saw some positive outcomes for individuals with regards to this. Safety checks are carried out in the home to ensure the welfare of the people who live there is promoted. We received some very positive comments from care professionals who have contact with the home; ‘Very person-centred. Individuals are involved in their care and support’ ‘I feel they are meeting all of our service users’ needs’ What has improved since the last inspection? The home has responded to most of the recommendations made at the last inspection. We noted that people’s care plans had been reviewed in order to make them into one document. Care plans showed consideration of individuals’ goals. The home has implemented some total communication approaches, for example, using symbols to simplify documents and pictures on kitchen cupboards so that people who use the service know where to find things. Health care appointments are now documented more effectively so there is a clearer record of outcomes. We also noted that people’s medication needs had been referred to in their care plans giving care workers some information about how individuals prefer their medicines to be administered. Some staff in the home have received instruction in stoma care from a health care Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 8 professional since the last inspection and are now responsible for cascading this down to other staff. Record-keeping in relation to complaints and concerns has improved with correspondence kept on file so it was clear how the management of the home had responded to issues raised to achieve good outcomes. The home has implemented a ‘first day induction’ for care workers who are new to the home which offers them an introduction to policies and procedures. As recommended at the last inspection, the ‘Home Manager’, who takes responsibility for some aspects of day-to-day management of the home, is being given appropriate training to develop her knowledge and skills in this area. What they could do better: As a result of this inspection we have made four requirements. Requirements are law and must be addressed by the registered provider. Three of the four requirements are in relation to the recruitment and training of care workers. One of these requirements, in relation to recruitment procedures, is repeated from the last inspection. We have also made nine recommendations. Recommendations should be given serious consideration by the provider to ensure that best outcomes for people who use the service are achieved. The home employs care workers through an agency who undertake preemployment checks on their behalf. However, the registered provider of the home remains responsible for ensuring that they have written confirmation that these checks have been carried out. There was not enough evidence on the first day of the inspection to show that the registered provider could be fully confident that all checks had been carried out on all care workers. The Registered Manager acted promptly to obtain more information about each care worker. However, we are repeating this requirement because the provider had not ensured this system was in place before we visited them. The home has told us that they are liaising closely with the agency to ensure that they are supplied with enough information to be able to meet this regulation in full. Although we were told that every care worker who comes to work in the home has received induction training from the agency this was not always clearly documented on their individual profiles. Records need to be clearer to show evidence that each person has received a full induction that meets the Common Induction Standards and has the appropriate basic knowledge and skills to work with people with learning disabilities. The provision of specialist training to all care workers, not just the people who work there most regularly, is required to ensure that everyone employed in the home has the necessary skills to meet the specific needs of people who live Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 9 there. The home needs to design a training programme for all staff who work in the home to ensure that they are appropriately trained to understand and meet people’s needs, for example in relation to epilepsy and total communication. The Expert by Experience told us that the only thing they did not like about the home was that staff were wearing T-shirts with the ‘Apple House’ logo on them. The Expert by Experience thought that this looked rather like a nurses’ uniform. We have suggested to the home that they review this to ensure that people who use the service are not accompanied in the community by a care worker who is recognisable by a ‘uniform’. We have told them that the wearing of such items potentially makes people who use the service identifiable as care home residents. We have also suggested that the home reviews the logo on the home’s vehicle as again it further emphasises that people are from a care home rather than promoting integration. 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. Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the home experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are provided with appropriate information to make an informed choice before moving in. Detailed assessments are completed prior to people moving in, to ensure that staff are able to meet people’s needs. EVIDENCE: The three people who use the service who completed surveys told us that they received enough information about the home before they moved in and had been consulted in the process. There have been three new admissions to the home since the last inspection. We looked at the records for two people which showed evidence that their needs had been assessed prior to them moving to Redcroft. Documentation from the local authority about their needs was on file and there was evidence that the home had also carried out their own assessment. Areas covered by the assessment included personal care, eating and drinking, behaviour, medication, health care, community access, social needs, literacy and safety. Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are given opportunities to be independent, make choices and decisions about their lives and achieve their goals. Some aspects of record-keeping could be improved to fully evidence this. EVIDENCE: Two care workers who responded to the survey told us that they were always given up-to-date information about the needs of the people they support. We looked at a sample of care plans. We saw some good, detailed information about people’s morning routines, for example; ‘I usually get up around 8.30am. I can get myself washed and dressed without any support. If I should require a bath / shower then you must test the water temperature in order to keep me safe.’ Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 13 An Essential Lifestyle Plan for one person showed consideration of their background, preferences and communication needs. The individual’s goals had also been identified as part of their plan. However, written information about progress made in relation to these goals was sometimes limited. Discussion with the service user and staff indicated that they were making very good progress in this area but this had not always been recorded in their plan. For example, goals in relation to trampolining and going to the gym had not been followed up in the record so we were unable to see what action had been taken by staff and the service user to meet them. The service user concerned told us in a survey that their care workers ‘are looking into it’. For another person, we noted that a goal had been set regarding their wish to attend Church. Their care plan showed that they had been supported to do this on one occasion. We have recommended that goal-setting processes are made more specific so that it is very clear from the record the actions being taken by staff to ensure that goals are met consistently and within a limited time-frame. There was evidence that the home is making efforts to implement a total communication approach in the home with regards to using pictures and symbols. The Expert by Experience said ‘There are pictures on all the cupboards of what is in them. I thought this was good to help residents do things for themselves in the kitchen’. The home has told us in their Annual Quality Assurance Assessment that they have purchased a package for the computer to enable staff to convert text into symbols. We saw evidence in the home that some care plans and other documents have been converted into symbols in order to be more accessible to people. We discussed with the home that they need to make sure that the people who live there are able to understand this format and to ensure that they are responsive to different needs where some individuals may prefer an alternative communication approach. We saw evidence of residents’ meetings taking place in the home. Minutes of meetings showed that people had been enabled to discuss activity and holiday choices. The home had also involved people in a recent recruitment campaign, requesting service users’ involvement on the interview panel and in thinking of questions they would like asked. People’s care plans showed that some relevant risks to each person had been assessed, for example in relation to cooking, use of sharp instruments, using the stairs, going out in the community and money-handling. An environmental risk assessment had been completed for one person who moved to the first floor from a ground floor bedroom. It was identified that the banister height should be increased to reduce the risk of them falling during an epileptic fit. The registered provides advised that additional staffing was put in place during the four week period until this work could be completed. Risk assessments offered some guidance to staff about the action they need to take to minimise Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 14 risks, for example, to avoid certain crowded places if they are likely to raise service users’ anxiety levels. It was evident from observing people in the home and talking to them about their lives that their independence is promoted and that the home enables people to take risks in order for them to lead an ordinary life. The home has been proactive in supporting one person in increasing their skills and being able to go out in their local community independently. A care professional told us that the home had undertaken some ‘wonderful work’ in this area, enabling them to move onto a more independent living setting. Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are enabled to lead a lifestyle that is positive, gives them opportunities to develop skills and independence and have the support of their family and friends. They are supported to lead an ordinary life. EVIDENCE: People who use the service told us in surveys that they could do what they wanted to do during the day, in the evenings and at weekends. We noted from records and from talking to people who use the service and staff that they are enabled to engage in activities that are meaningful to them as individuals. For example, one person does voluntary work, others attend day services in the community while others attend college or school. A service user told us that they had wanted to go to a concert and had been supported to do so at the Bournemouth International Centre. Another service user who Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 16 enjoys reading was supported to go to a local store to purchase a book of their choice during the inspection. Two care professionals who responded to the survey indicated that the home always provides support to individuals to live the life they choose, one adding that people receive ‘full support in accessing the community’. The Expert by Experience noted on her visit to the home that there were pictures in the hall of people who live in the home doing various activities. She also said that in discussion with service users she had found that, those who have family see them regularly and some go to stay. The home’s Annual Quality Assurance Assessment confirms that people who use the service have regular contact with their families via home visits, telephone calls and e-mails. Observation during the inspection showed that people are able to access all communal areas of the home as they wish. People also have access to their own bedrooms at all times. We observed that, where appropriate, people are enabled to make themselves drinks and snacks using the kitchen facility and help with cooking. The home has told us in their Annual Quality Assurance Assessment that meal times in the home are generally taken communally as historically this has been people’s preference. They have indicated that as new people move in this should be revisited to ensure that it is still people’s preference. The Expert by Experience observed ‘When we got there they were making pizzas for lunch. One of the residents had chosen the toppings and we were invited to have some…they were delicious. The staff all ate with the residents and everyone was chatting’. The Expert by Experience also noted that there were bowls of fruit out which people could help themselves to although biscuits were kept in the office area of the home. The Home Manager explained to the Expert by Experience that staff are trying to promote healthy eating in the home and they were aware that some residents would not be able to manage their intake if biscuits were freely available in the main kitchen. Records showed that people are offered a variety of meals each week. Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has established links with health and social care professionals in order to meet people’s different needs. However, some aspects of care planning, record-keeping and training are not robust enough to demonstrate that care workers are given all the information they need to be able to meet people’s requirements fully. EVIDENCE: We looked at a sample of care plans to see if there was enough information about people’s personal care requirements to ensure their needs are met. There was some good detail about how staff could help people with their needs. For example, for one person who has a tendency to become anxious the plan stated that while helping them with personal care staff could ‘tell jokes…or talk to X about cars as this could help with keeping X calm’. The plan also made clear that the individual concerned ‘wears glasses and special insoles in his shoes’ and that staff would need to ensure that their glasses are kept clean and their insoles are in place. Another part of the plan was rather Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 18 vague, however; ‘X needs help to get in the bath’. This does not tell the reader exactly what help is needed and should be expanded on to ensure that the person always receives the support they need. Two people who use the service told us in surveys that staff at the home always treated them well, one person indicating that this was sometimes the case. Both care professionals responding to the survey told us that the service always respected people’s privacy and dignity. We examined a sample of care plans in relation to information about people’s health care needs. People’s appointment records that we looked at indicated the home liaises with various health care professionals to meet their individual needs. However, one record we looked at indicated that the person had attended their dentist in February 2007 but there was no evidence on the record of an appointment taking place since this time. There was no information about arrangements to provide foot care to people who use service. The provider has told us they will take appropriate action to address this. We saw on one record that there was extensive involvement from the multidisciplinary team in relation to one person’s care. This was confirmed by care professionals involved who told us that they liaise closely with the home. One care professional told us that the home was ‘exemplary’ in their communication with them and were supporting a service user’s needs remarkably well, managing difficult situations with a ‘positive, proactive approach’. We were also told that the home were providing very detailed and factual reports to care professionals on the person’s behaviour and needs. Another care professional also told us that reports submitted by the home in relation to another person’s behaviour were very good although they were concerned that they had not been advised about two incidents that had occurred. They told us they would take this up directly with the home to ensure all incidents are being reported. This is important so that care professionals can take prompt action to support individuals with their behaviour and work collaboratively with the home in doing so. Information about people’s health care needs in their support plans was not always clear enough to ensure that care workers know how to respond. A risk assessment was in place for one person with regards to ‘hitting staff’. The ‘staff action’ that had been identified for this was ‘X may have to be restrained by safe holding techniques’. There was no further information about this to say exactly what techniques are used and what the procedures are around using such interventions. Discussion with the Home Manager indicated that safe holding techniques were not being used and the records we looked at showed no evidence that such interventions were being employed. Therefore, it should not have been written in the care plan as it is misleading for staff and could result in inappropriate intervention. Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 19 We looked at the support plan in place in relation to the person’s epilepsy. This gave instructions to care workers about how to respond to witnessing a seizure; ‘Stay calm; Call on-call; Call Registered Manager; Call GP; Dial 999’. However, it was not clearly specified at which stage the care worker should take each action. For example, the plan said that the service user’s breathing may be impeded when having a seizure but did not specifically say that if this happened care workers must dial 999 immediately. Records we looked at indicated that a member of staff had opened the person’s airway to help them breathe when they were having a seizure. Again, there was no specific information in the care plan to say that this was an agreed action or the circumstances in which this action should be taken. For one person who suffers from food allergies we saw some information about ‘Yes’ and ‘No foods’ and the care plan informed staff that they must read food labels to ensure that the person can eat them. For another person who wanted to lose weight, we saw limited information in the care plan about how staff were to support this. The Home Manager gave us a verbal update saying that they had been seen by a dietician and had been given a food chart about eating a low-fat diet. The dietician had given this to the individual concerned who was keeping it in her bedroom. The home did not have a copy of the chart on file to ensure that staff also have this information and are in a position to support the service user in the event of her requesting advice. We were advised that a follow-up appointment with the dietician had been arranged. We looked at medication practices in the home. Medication is currently stored in a metal cabinet that is fixed to the wall of the office area of the home. Medication is supplied to the home by a local pharmacy who also produce printed medication administration record (MAR) charts for staff to record administration. We noted that people’s allergies had been documented on the MAR chart. Handwritten instructions on one person’s MAR chart had been double-signed appropriately. The date of opening of one box of medication had been recorded on the box but this had not been done on another box. The Home Manager told us that she puts a ‘dot’ on the MAR chart which indicates when new boxes have been opened. Records we looked at showed that medication is checked at every handover to ensure that it has been given as prescribed. The home tells us that this system works well for them. The Home Manager told us that all staff come to the home with basic medication training from the agency. We saw that one person had been prescribed olive oil ear drops. We asked if the current training provided to staff included administration of ear drops and were told that it does not. We have recommended that staff receive instruction from a suitably qualified professional so that they are competent in administering ear drops. We were told that staff with no experience of administering medication shadow experienced staff in doing so when they come to work in the home. Staff with previous experience were reported to be supervised on their first shift but not Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 20 all were reported to do ‘shadowing training’. The process of shadowing and supervision for each care worker had not been documented. The home has told us in their Annual Quality Assurance Assessment that ‘the House Manager oversees the in-house medication training’. The Registered Provider has advised that medication training has been provided by an external company. We discussed with the Home Manager the possibility of using photos in people’s medication administration records to aid with identification of people who use the service. We also discussed that, given the home’s philosophy is to promote people’s independence as far as practicable, they may wish to review their systems to make it more individualised, for example, enabling people to have their own medication cabinets in their bedrooms where this has been risk assessed as safe. People’s care plans gave care workers some information on how to administer individuals’ medication; for example, ‘Please bring my medication to the table in a pot. I will take it myself in my own time’. However, this should be more specific to identify whether staff then observe the individual taking their medication or whether the service user has been risk assessed as able to do so without observation, bearing in mind the presence of other service users. Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are listened to and systems are in place to respond to their concerns and complaints. Procedures are in place to protect people from harm. EVIDENCE: All the people who use the service who responded to the survey told us that they knew who to speak to if they were not happy, one adding; ‘I talk to a member of staff and they deal with it’. All three service users also told us that they knew how to make a complaint, two people saying that carers always listened to what they say and one person saying this was sometimes the case. Both care workers who filled in a survey indicated that they knew what to do if a service user had concerns about the home. During the inspection, the Expert by Experience observed ‘Staff were chatting to residents and really seemed interested in what residents had to say’. A copy of the home’s complaints procedure was on display in the hallway. This gives contact details for the managers of the home and the timescales by which complaints will be responded to. The contact details for the Commission were also seen to be on the procedure. The home’s Annual Quality Assurance Assessment states that the home addresses ‘all complaints and concerns at the earliest opportunity…no longer than 28 days’. We looked at the complaints record for the home and saw that Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 22 three concerns had been documented. There was evidence in each case that the person raising a concern had been contacted promptly and correspondence was on file detailing the action being taken to respond to the issues raised. For example, one relative had raised a concern about the condition of their family member’s room during building works. A memo had been sent to staff to inform them of the issues raised and the home has since employed cleaners in the home. At the time of the inspection there was one safeguarding issue arising in the home in the past twelve months. The Commission was notified of the issue and updated accordingly. The home has told us in their Annual Quality Assurance Assessment that they have a policy on disclosure of abuse and bad practice. We were told by the Home Manager that all staff undertake training in abuse awareness as part of their induction training with the agency who supplies them to the home. We were also advised that people who work in the home are introduced to the home’s safeguarding policy on their first day and we checked a sample of records which showed evidence of this. Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Redcroft provides a homely, comfortable and clean environment for people to live in. EVIDENCE: In the past year the home has undertaken building works to increase the accommodation available from six to eight people. This includes a studio flat including en-suite facilities on the second floor which has been designed for people who wish to work towards greater independence. The Expert by Experience visited the flat with the service user who lives there. They said that the flat was ‘small but light and bright’ and noted that the service user had chosen the cushions and bedding. However, it was also observed that the person was unable to use their own bathroom due to a plumbing installation problem. The home should ensure that this repair is undertaken promptly so that the service user can gain the full benefit of living in her new flat. Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 24 The home’s Annual Quality Assurance Assessment indicates that there has been extensive refurbishment of the property in the last twelve months. This is reported to have included new carpets in the hallway, stairs and landing and a new bathroom on the first floor. The home has stated in their Annual Quality Assurance Assessment that their future plans are to resurface the driveway of the home and also install a decking area in the rear garden for use by residents. The communal kitchen and lounge are spacious. The Expert by Experience noted that there was a big table in the kitchen where everyone sits to eat. She said that this made it ‘feel like a family home’. The Expert by Experience took a tour of the premises. She observed that the home was clean. This was echoed by people who live in the home who told us that the home is always fresh and clean. She also observed that when a service user spilt some tea on the floor a member of staff cleaned it up straight away. The home employs a cleaner three times a week for communal areas. Staff are reported to support service users with cleaning their individual rooms. The Expert by Experience noted some old stains on the lounge carpet which needed a good clean. We were told by the managers in the home that the lounge carpet was next to be replaced in the ongoing refurbishment of the home. Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home’s recruitment monitoring systems are not always robust enough to ensure that there is sufficient evidence to demonstrate that people are fully protected. Although care workers receive some training, improvements are needed to ensure that all care workers have all the training they require to respond to individual needs and to ensure that full and accurate records are maintained to evidence this. EVIDENCE: Apart from the Registered Manager the home directly employs one other member of staff (the Home Manager). At the time of the inspection a second member of staff had also been appointed as a permanent Senior Support Worker although the home were awaiting confirmation of pre-employment checks. Remaining members of the staff team at Redcroft are supplied by an agency who provide them with induction training before supplying them to the home. Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 26 We made a requirement at the last inspection that the provider must be able to satisfy themselves that appropriate and satisfactory checks have been carried out on all care workers before they come to work at the home and have written evidence of this. To the question in the Annual Quality Assurance Assessment ‘Have all the people who have worked in your home in the past twelve months had satisfactory checks?’ the home had answered ‘Yes’. On the first day of the inspection, we asked to see a sample of records to check that this had been addressed. The home had evidence of a Criminal Records Bureau (CRB) check for all care workers but in some cases there was no further evidence to demonstrate that all information required by Regulation 19 of the Care Homes Regulations had been obtained. We drew the Registered Manager’s attention to Regulation 19 and Schedule 2 of the Regulations which lists the evidence that is required in respect of each care worker. The Registered Manager told us that where agency workers were regularly employed at Apple House they had obtained more information about them but there were some workers who only worked the occasional shift in which case written confirmation of all checks had not been obtained from the agency. The Registered Manager took prompt action and by the second day of the inspection, had obtained a profile of each care worker from the agency who supplies them. Although this was a significant improvement from the first day’s records we remain concerned about some gaps in information. For example, we noted that for one person the references obtained by the agency were testimonials. We also noted that individuals’ training profiles did not always specify that they had attended the full induction programme organised by the agency. Therefore, the home did not have written confirmation that each individual had met the Common Induction Standards. The provider has told us that they are working closely with the agency to ensure that the information they are provided with is robust and meets the Regulations. They were reminded that it is their responsibility to satisfy themselves that appropriate pre-employment checks have been carried out on all care workers and to have written confirmation of this. Since the last inspection the home has implemented a ’first day induction’ for all staff to orientate them to Redcroft and ensure they are aware of the home’s policies and procedures. The Home Manager confirmed that people are always supervised by an experienced member of staff on their first day. Records indicated that all staff who come to work in the home have done this orientation. Two staff who responded to surveys told us that their induction covered everything they needed to know to do the job before they started and indicated that they were being given training relevant to their role. We noted that the home has kept records to show that staff have received instruction on using the hoist (used for two service users in an emergency) and supporting one service user with their stoma. The most regular care workers Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 27 in the home have received this instruction from a health care professional and are responsible for cascading it down to other staff. From the sample of records we looked at, the majority of staff were recorded as receiving this instruction – two staff that had not were very new to the service. The Home Manager confirmed that they would not have been left alone or expected to undertake the task without the specific training to do so. The home has told us in their Annual Quality Assurance Assessment that ‘a recent training course on epilepsy was delivered for the team’. Records we looked at showed that six staff across both of the provider’s homes had received this training in March 2008. However, looking at the current rota for Redcroft (July 2008) only three of these staff were working in the home. Out of a sample of care worker’s records we looked at only one was recorded as having done training in epilepsy with a previous employer. This means that the majority of care workers employed in the home during July 2008 had no record of undertaking training in epilepsy. Four people who use the service have a diagnosis of epilepsy. The sample of training records we looked at for agency workers indicated that only one person had received training in total communication approaches although there are people in the home who use non-verbal means of communication who would benefit from care workers having an understanding of this. Two care workers who responded to the survey told us that they usually felt they had the right support, experience and knowledge to meet the different needs of people who use the service. A care professional who has contact with the home told us that they felt staffing in the home could improve with them recruiting ‘staff who are highly motivated and able to develop in areas of new competencies’. The home’s Annual Quality Assurance Assessment tells us that three staff are currently working towards their National Vocational Qualification (NVQ) at Level 3 and one has completed their NVQ Level 2. Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure health and safety checks are carried out in the home and that the home’s development is based on the views and needs of people who live there. However, an outstanding requirement from the last inspection means that the home has not taken enough action to address a breach of regulation that was identified. EVIDENCE: The Responsible Individual for the home is Mrs Jane Montrose who is one of the Directors of Apple House Limited. The Registered Manager of the home is Mrs Romaine Lawson who is also a Director of the company. Mrs Montrose and Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 29 Mrs Lawson have appointed a ‘Home Manager’. Mrs Lawson told us that they intend to support the Home Manager in applying to the Commission for registration as manager. The Home Manager is currently working towards her NVQ Level 4 in Care and Registered Managers’ Award. One requirement was made at the last inspection of the service in July 2007. This was for the registered provider to ensure they have written evidence to demonstrate that appropriate and satisfactory checks have been carried out on all care workers before they come to work at the home. Although, when we spoke to the Registered Manager she was confident that the agency who supplies their staff had carried out all appropriate checks there was a lack of written evidence to support this on the first day of the inspection. The Registered Manager took prompt action to liaise with the agency to ensure that written profiles were received for each care worker by the second day of the inspection. However, we remain concerned that the provider did not have this written evidence on the first day of our visit. The regulations are law and in place to protect people who use the service. It is the provider’s responsibility to ensure that they have enough evidence to fully meet the regulations. The provider has told us that they are committed to improving the service and ensuring that they meet the Regulations and National Minimum Standards. Mrs Montrose and Mrs Lawson supplied us with the home’s Annual Quality Assurance Assessment when we asked for this information to be sent to us. The home has a quality assurance process in place and we were given a copy of the outcomes for the 2008 survey they have undertaken. Mrs Lawson told us that this year they decided to focus on outcomes for people who use the service with regards to their activities, independent living skills and outcomes in relation to privacy and dignity. Mrs Lawson advised us that it is their intention to ensure that the next quality assurance process incorporates the views of other people who have contact with the service. An annual development plan has also been drawn up for this year. Discussion with people who use the service and care professionals who have contact with them indicated that the service is very person-centred in its care delivery. Where it has been identified that individuals have a wish to move towards greater independence the home has been responsive to this and ensured that plans are put in place to meet these needs. A care professional commented that the home embraces challenges and ensures that achieving best outcomes for individuals, whatever their circumstances and needs, is central to its philosophy. We looked at a sample of health and safety records in the home to evidence whether people’s welfare is safeguarded in this respect. We saw that systems are in place to record refrigerator and freezer temperatures on a daily basis. The home has been proactive in establishing a system to check their water supply for legionella. A system is also in place to record bath temperatures on Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 30 a daily basis. There is a fire risk assessment in place, completed in the last year, which has been undertaken by an external agency. Records showed that monthly fire evacuations have been undertaken and recorded. As stated in the ‘Staffing’ section of this report the provider needs to have more robust evidence to show that each care worker has undertaken their mandatory training before they start work at the home as training profiles were not always consistent in the information they contained. The home has an emergency plan that includes information about the action to be taken in the event of a utilities disruption, heatwave, outbreak of infection or extreme staff shortage. The telephone number of the Commission needs to be updated in this document to show that of the Regional Contact Team. Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 3 X X 2 X Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 32 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 YA19 Regulation 15(1) Requirement People’s care plans must contain accurate information about people’s health care needs and the specific interventions that are needed to respond to this. This ensures that care workers are confident about the action they need to take to support people with their health and respond to their needs safely and effectively. 2. YA34 19(4)(b) Sch.2 The registered provider must be able to satisfy themselves that appropriate and satisfactory checks have been carried out on all care workers before they come to work at the home and have written evidence of this. This will help ensure that people who use the service are fully protected. This requirement is repeated from the last inspection of the service as the previous timescale of 01/10/07 has not been fully met. 31/10/08 Timescale for action 31/10/08 Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 33 3. YA35 17(2) Sch.4 The registered provider must have sufficient evidence to demonstrate that each care worker employed in the home has undertaken induction training that meets the Common Induction Standards. People who work in the home must receive the specialist training required for them to understand and respond to the needs of people who use the service. 31/10/08 4. YA35 18(1)(c) 30/11/08 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 YA6 Good Practice Recommendations Goal-setting processes should be very clearly documented so that there is a record of how progress will be measured and progress that has been made to date. Care plans should be more specific so that they give clear instructions to care workers about the action they need to take to support people in their personal care. The home should ensure that all relevant information is shared with health care professionals so that they have the right evidence on which to base their interventions. Where there is an identified need for people who use the service to have eardrops administered to them by staff, care workers should be deemed competent to undertake this task. The registered persons should be clear about the competencies needed by all staff in relation to administering medication at Apple House and develop a training and assessment programme to ensure that they Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 34 2. YA18 3. YA19 4. YA20 meet these competencies before they are required to administer medication. Assessment of people’s competence should include observation and assessment of their practice. Instructions in people’s care plans about how they need to be supported in relation to administration of medication should be sufficiently detailed so that care workers know exactly what action to take. 5. YA24 The toilet of the studio flat on the second floor should be repaired promptly so that it can be used by the person who lives there. All care workers at the home should have achieved, or be working towards an NVQ in Care of at least Level 2 standard. The registered persons should ensure that regular audits of records and procedures in the home against the regulations and national minimum standards take place so that they identify for themselves any shortfalls and put systems in place to rectify these. 6. YA32 7. YA37 Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. Extracts may not be used or reproduced without the express permission of CSCI Redcroft DS0000065720.V370634.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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