Inspection on 04/08/06 for Redcroft

This inspection was carried out on 4th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Redcroft 15/07/08

Redcroft 06/07/07

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 09/07/2008.

CARE HOME ADULTS 18-65 Redcroft 255 Belle Vue Road Southbourne Bournemouth Dorset BH6 3BD Lead Inspector Heidi Banks Key Unannounced Inspection 4 & 8th August 2006 10:30 th Redcroft DS0000065720.V307162.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.V307162.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.V307162.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 429093 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) Apple House Limited Mrs Romaine Estelle Lawson Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Rooms may provide accommodation without en suites where it has been agreed with CSCI that it would not be in the interests of named individuals to have such facilities. (This condition will not apply where a named individual vacates the property). En suites are to be provided in all rooms (excepting those referred to in Condition 1) over an agreed timescale which shall not exceed 12 months from the date of registration. This was the first inspection of the service. 2. Date of last inspection 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 six adults who have a learning disability. It is a family-style home. 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 two floors. There are currently two bedrooms downstairs, one of which has a bathroom adjacent to it. There are four bedrooms on the first floor, one of which has an en-suite facility. The remaining bedrooms share bathroom facilities. It is a condition of the home’s registration that en-suite facilities will be provided in a further two bedrooms by December 2006. There is an area for parking at the front of the property. The property has a second floor which is currently used as office space. Local shops are within walking distance and a bus route into the neighbouring towns of Christchurch, Boscombe and Bournemouth is close by. Fees for individual service users at Redcroft are variable depending on their level of need and, from information provided on 12th August 2006, currently range from £710 to £1100 per week. Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection taking place over 9.5 hours on two weekdays. There are five permanent residents living at Redcroft at the present time. At the time of inspection one bedroom was being used as an ‘assessment bed’ for a service user staying at the home temporarily. During the course of the inspection the inspector was able to meet all six service users and four members of the care staff team. The inspector was assisted by the Registered Manager of the home, Romaine Lawson, during the first day of the inspection and by both Romaine Lawson and Jane Montrose, the Responsible Individual, on the second day. The inspector was also given a guided tour of the home. A sample of records was examined including some policies and procedures, medication administration records, health and safety records and service user and staff files. Three completed service user surveys, comment cards from four relatives and a comment card from a social care professional were received prior to the inspection. A pre-inspection questionnaire completed by the Registered Manager was also supplied. Information from these sources is reflected throughout the report. Twenty-three standards were assessed during this inspection. What the service does well: There was sufficient evidence that assessments are carried out for individual service users prior to their admission to the home which enables their needs to be identified and plans put in place to meet their requirements. Service users are encouraged to make decisions and choices about their lives through their participation at house meetings, the provision of individual time for activities and participation in reviews. The home achieves positive lifestyle outcomes for service users with evidence that support is tailored to the needs of the individual. Plans are in place to support service users with a range of educational activities in the new academic term including attendance at college and employment projects that will enable service users to pursue their chosen interests and develop their skills. Home-based and community leisure activities are also offered to service users on a daily basis. Service users’ rights are clearly recognised with service users having access to all communal areas of the home and their ability to make decisions about the way they spend their time respected by staff. Two Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 6 service users spoken with during the inspection commented ‘I like it here’ and ‘I don’t want to leave’. Service users are offered adequate support in their personal care to meet their needs and ensure that their privacy and dignity is maintained. Liaison with health services is also maintained to ensure service users’ physical and emotional health care needs are met and reviewed as necessary. A policy is in place on the prevention of abuse and staff files demonstrated that they are accessing certificated training in abuse awareness to ensure that they can recognise signs of abuse and know how to respond in line with local procedures. Systems are in place to promote good hygiene in the home with policies on infection control and hand-washing in place and staff accessing relevant training in this area. The home has a management structure that provides clear lines of accountability to service users and staff. The registered persons present as committed to providing a service that is run to the benefit of service users and to meeting the Regulations and National Minimum Standards. What has improved since the last inspection? What they could do better: As a result of this inspection five requirements and nine recommendations have been made. Attention is needed to the recording of food provided for individual service users to ensure they are sufficiently detailed so that anyone reading the record would be able to determine whether the diet is satisfactory. Shortfalls were identified in relation to recruitment procedures in the home and action is required to ensure that appropriate checks are carried out on all staff prior to their employment in the home to ensure the safety of service users in their care. Health and safety practices must be reviewed to ensure that regular monitoring of water temperatures and refrigerator temperatures are carried out and that risks to service users in relation to these are minimised. All staff must also receive training and regular updates in first aid, food hygiene and fire safety to ensure that they are fully aware of safe practices. Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 7 Service user plans should be developed further to include more detail about service users’ individual needs and goals and the support required from staff to meet these needs. The format of the Plans should also be considered so that they are meaningful to service users. Risk assessments should be dated so that it is clear when they were written and when they should be reviewed. Further accredited training in medication administration should be provided to ensure staff have the necessary knowledge to undertake this task. Patient information leaflets for medicines used in the home should be kept on file for the information of staff and the homely remedies list be adapted to suit the needs of service users. A recommendation has been made for the home’s complaints procedure to be expanded to ensure concerns are appropriately recorded and responded to. Awareness of the home’s complaints procedure should be raised among relatives to ensure that they are all aware of the process by which they can raise concerns about the service. The home’s training programme should be developed to ensure that staff undertake an induction programme that meets Skills for Care standards and are able to access NVQ and specialist training that meets the requirements of service users. Staffing levels should be reviewed at regular intervals to ensure that the numbers within the staff team are adequate to meet service users’ individual needs. The home has started to implement its quality assurance process by obtaining the views of service users, their relatives and representatives. An annual development plan should now be produced to ensure that service users’ views contribute to the ongoing development of the home. The recording of fire drills should be expanded so that the names of those taking part are recorded on each occasion. Fire drills should be carried out at variable times of day including those times when there are reduced staffing levels. Individual fire training and drill records are recommended for staff to make it clear where gaps exist. 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. Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 8 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.V307162.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ needs are assessed prior to their admission to the home which means that the home is able to make adequate preparations to meet their requirements and accommodate their wishes. EVIDENCE: A sample of a service user assessment was seen. This had been undertaken prior to the admission of the service user to the home and included information on the service user’s daily routine, religious and cultural needs, medical and health history, eating and drinking, night-time support requirements, independent living skills, activities and personal care needs. The service user’s preferences had been considered in the assessment and there was evidence that the document had been signed by both the service user and the member of staff responsible for its compilation. Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service user plans would benefit from further expansion to ensure that there is sufficient detail about their needs, personal goals and how these are to be met. Service user plans need to be in a format that is meaningful for them. The home offers service users opportunities to make decisions about their everyday lives promoting their autonomy and ability to make choices. Risk assessments are in place for individual service users which balance the need to keep service users safe with their need for independence. EVIDENCE: One service user’s support plan was seen. This contained a one page ‘personal profile’ of the service user’s needs and preferences in relation to her daily routine, health care needs, communication, personal care and eating and drinking. Information about the service user’s diagnosis had been included in her support plan for the information of staff. A Care Plan written by the Local Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 11 Authority was also on file. An assessment of the service user’s coping skills had been completed in June 2006 by her key worker. Discussion with a senior member of staff in the home indicated that he was planning to develop the support plans with service users to include more information about their needs including the setting of goals. This will help identify service user’s personal objectives and the support they need to achieve them. Service user plans are not currently in a format that is accessible to service users. There was evidence on file that a review had taken place since the service user moved into the home involving the service user, their family and Care Manager. Observation of staff interaction with service users indicated that they are given opportunities to make decisions about their everyday lives. One service user who did not want to go out with the group that day was able to stay at home and occupy herself with knitting and having an afternoon nap. On the second day of the inspection, another service user who was feeling unwell was seen to be making herself a cup of tea before returning to her room for some quiet time. The home employs a part-time Activities Co-ordinator who spends individual time with each service user on a regular basis, this time being used to do whatever is the service user’s choice – for example, engaging in a hobby or accessing the community. This offers service users the opportunity for some spontaneity in their lives as they can decide on the day what they choose to do. The Registered Manager reported that house meetings are held approximately every six weeks with service users chairing the meeting. The home is looking towards using an independent advocate to chair the meetings in the future. Records of individual service user review meetings in the home showed evidence of their participation in the process. A sample of risk assessments was seen. These contained information on the identified risk, the likelihood, impact and action to be taken by staff to minimise risks. Risks to the individual service user in terms of their mobility, personal care, assisting in the kitchen, managing finances and accessing a local club had been assessed. In the sample inspected, these emphasised the need for the service user to receive supervision at all times in order for her safety to be maintained. There was evidence that the importance of the service user’s independence being promoted had also been carefully considered, that is to say the need to balance risk with social and psychological benefits. It was noted that not all risk assessments had been dated. Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ programmes are tailored to their individual needs which enable them to pursue interests that are meaningful to them. Service users are supported to access their community on a regular basis and thus lead ordinary lives. Service users’ contact with their families and friends is encouraged which enables them to maintain a circle of support outside of the home. Daily routines in the home protect the rights of service users and promote their independence. Improved recording of service users’ food intake is needed to evidence that each individual is having an adequate and balanced intake that meets their needs. Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 13 EVIDENCE: Jane Montrose reported that service users are offered the opportunity to go out every day if this is their choice. The home has individual ‘Activities Logs’ for service users in order to monitor this. These indicated that service users had accessed a range of places in their leisure time including Poole Park, Poole Quay, the New Forest, PHAB Club, a local shopping centre, leisure centre and the supermarket. A variety of home-based activities are also offered including cooking and art and craft. Service users at the home had joined residents from Apple House’s other home on a holiday to ‘Butlins’ in June. Colour photographs from the holiday had been included in service user plans. One service user spoken with stated that she was able to make decisions about what she did each day. On the first day of the inspection four service users were going bowling accompanied by two members of staff and on their return reported that they had also gone out for lunch and spent some time enjoying the warm weather in Bournemouth Gardens. There was sufficient evidence to demonstrate that service users’ individual needs with regards to their education and / or occupation are considered. One service user will be continuing her full-time education at a local school in the new term. There are plans for another service user to be attend a local college for three sessions each week in the new academic term. Courses planned included Snack Cookery, Pottery and Skills for Life. Staff are also supporting her in applying for a place at the ‘Crumbs’ project – a local charity which offers training and personal development to people with mental illness, head injury or learning disability wishing to access employment. Referral documentation for Poole Supported Employment Service was also seen on file. Another service user who regularly declines opportunities to go out is interested in animal care and to pursue this, she is being supported to consider voluntary work with a cat’s protection charity. At the time of inspection a senior member of staff had accompanied a service user’s relative in visiting local day service opportunities with the aim of choosing one that will meet his needs. The majority of relatives responding to comment cards indicated that they felt welcomed in the home. There was evidence that service users are encouraged to maintain contact with their relatives. On the first day of inspection one service user was visiting her family for the weekend. There was evidence that service users’ families had been invited to their reviews. In addition the Responsible Individual stated that all service users have personal e-mail accounts and staff support them with accessing the computer in order to correspond with their family. Evidence of this correspondence was seen on file. The Registered Manager reported that the home is looking towards Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 14 recruiting volunteers to provide a further means of social contact for service users outside of the home. Service users were seen to have access to all communal areas of the home, be able to help themselves to drinks as they wished and choose how they occupied their leisure time. Service users have the option of having a key to their bedroom and observation of staff interaction with service users demonstrated that their rights were respected in terms of their dignity and independence. The pre-inspection questionnaire indicated that menus are not planned ahead of time, this being to maximise opportunities for service users to choose what they want to eat on the day. The Registered Manager also stated that timings of meals are flexible in order to accommodate individual activities. One service user spoken with reported that the food offered at the home was ‘good’ and that she was able to eat her favourite meal of fish, chips and peas once a week which she was happy about. Food eaten by service users is recorded in their personal diary but not always in sufficient detail to provide an accurate account of the amount that was eaten by individuals. Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ personal care is delivered in accordance with their needs and wishes with attention given to their privacy and dignity. Service users are supported to access generic and specialist health care services as appropriate to ensure that their health care needs are met. Some recommendations have been made in relation to the home’s medication practices to ensure service users are fully protected. EVIDENCE: The personal profile in the support plan examined showed that individual needs, likes and dislikes had been considered. This was written in the first person, for example ‘Tell me what you are doing before you start doing it’. As indicated in Standard 6 the support plans would benefit from expansion to include more detail about service user’s personal care requirements and how they are to be met. Discussion with the Registered Manager demonstrated that service users receive personal care that is individualised to their needs. For example, one Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 16 service user has a colostomy and needs support to change the bag at regular intervals. This is clearly stated in the service user’s personal profile; ‘staff must know how to change my bag’ and risks in relation to this procedure have been assessed. Staff receive instruction from a District Nurse on stoma care before they are allowed to attend to the service user’s colostomy bag. Issues such as maintaining the service user’s privacy and dignity have also been considered in the personal profile. All service users responding to the survey indicated that staff treated them well. One social care professional commented in a survey that ‘Redcroft provides excellent standards of care and support using person-centred approaches and enabling people to have a good quality of life’. Medical appointments for service users were seen to be recorded. One service user had attended appointments with his GP, chiropodist, nurse, psychologist and hospital since admission. Specific guidelines for supporting one service user with managing her anger and aggression had been transferred from her previous residential placement to Redcroft when she moved in June 2006 and had been put on file providing information for staff on her support needs; Redcroft staff will need to develop their own set of guidelines based on their own experience of working with the service user. Two relatives of a service user indicated in comment cards that their relative presents as ‘far less stressed and more relaxed’ than he was prior to moving to Redcroft which is evidence that his emotional needs are being met. On the second day of the inspection a member of staff alerted Jane Montrose that one service user had sustained a bruise on her head and had vomited. Appropriate action was taken by staff to contact the service user’s GP for an urgent home visit while monitoring her symptoms. Redcroft has a policy on the handling and storage of medication which covers recording, administration, self-administration, over-the-counter remedies, ordering medication and training. This is accompanied by a Drug Error Policy which states the procedure to be followed in the event of a drug error being made by a staff member. Medication is stored securely in a medication cabinet fixed to the wall of an area adjacent to the kitchen. Medicines are dispensed from a local pharmacy and the home uses the Medication Administration Records (MAR) charts provided by the pharmacy. The home uses a monitored dosage system for most of the medication although some medicines are boxed. The home’s Deputy Manager takes responsibility for booking medication in when it arrives from the pharmacy. She had undertaken accredited training in the Safe Handling of Medicines prior to joining the staff team at Redcroft. All staff take responsibility for administering medicines to service users once they have done the pharmacy’s one day training course on the use of the monitored dosage system. There is no further accredited training in place for staff at the present time. Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 17 A sample of records were checked and three gaps were found where staff administering medication had not signed to indicate they had done so. There is some information available for staff on various medicines used for epilepsy but it is recommended that patient information leaflets are kept for all medicines used by service users for staff reference. The home has attached a general example of a homely remedies list to the inside of the medication cabinet but this should be adapted to meet the requirements of the home and service users. Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Further development of the home’s practices around handling complaints and concerns will ensure that relatives of service users are fully aware of the home’s complaints procedure and issues raised are appropriately documented and dealt with. Policies and training around abuse are in place but shortfalls in the home’s recruitment procedures need to be addressed in order for service users to be fully protected. EVIDENCE: Of the three service users responding to the survey, one indicated they felt their carers ‘always’ listen to them while two indicated that they ‘usually’ felt listened to by staff. All three service users indicated that they knew how to make a complaint. Of the four relatives responding to the survey, only one indicated that they were aware of the home’s complaints procedure. A copy of the procedure is on display on the hallway of the home. This states that any complaints about the service should be directed to the Home Manager in the first instance but that if it cannot be resolved at this stage it should be passed to the home’s Registered Manager and Responsible Individual. The contact details of the Commission for Social Care Inspection are on the procedure. The pre-inspection questionnaire supplied by the Registered Manager of the home indicates that no complaints had been received by the service since it’s opening in December 2005. Discussion with a senior member of the staff team demonstrated that at times, however, relatives of service users may raise Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 19 issues that are responded to informally but not documented. In addition, review of one service user’s file showed that a concern had been raised by a social care professional in relation to one service user. There was evidence on file that the concern had been responded to promptly in the form of a letter by Jane Montrose and that action had been taken to ensure the issue was addressed. This had not been recorded in the home’s complaints record. The home has a policy on adult protection and the prevention of abuse. A flowchart has been developed to show the action that must be taken in the event of abuse being witnessed or suspected. A procedure on whistle blowing is also in place. These procedures are introduced to staff at induction and there was evidence to demonstrate that the home is introducing an improved system by which staff sign to indicate that they have read and understand the policy. Risk assessments in place for individual service users also take account of their risk of abuse and exploitation. Procedures around money handling have been reviewed since the home’s opening to promote the protection of service users. Recruitment procedures in the home are not currently robust enough to ensure service users are fully protected. Two staff files examined showed evidence that staff have recently accessed introductory training on adult protection with the Local Authority. Those staff who have not yet accessed the training have been allocated to training courses taking place in the next few months. Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a good standard of accommodation but en-suite facilities must be installed as per the conditions of registration in order for this standard to be considered fully met. Procedures and systems are in place to ensure that good standards of hygiene are promoted in the home. EVIDENCE: Redcroft is a detached, family-style home offering accommodation for six service users. The home presents in good decorative order although staining to the carpet in the lounge was noted. Discussion with Jane Montrose indicated that this has been caused by service users spilling drinks as they walk from the kitchen to the lounge as service users’ independence in this area is encouraged. Since the inspection the provider has hired a carpet cleaning machine in order to address this issue. Furnishings throughout the home are domestic and unobtrusive. A guided tour of the home showed that service users are encouraged to personalise their bedrooms as they wish. For one service user who particularly likes the beach, Jane Montrose had purchased a Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 21 picture of the coast for his room prior to him moving to the home to help him settle in. Redcroft does not currently provide en-suite accommodation for all service users and conditions of registration have been placed on the home with regards to this issue. At the time of inspection the home presented as clean. One out of three service users responding to the survey indicated that they felt the home was ‘always’ fresh and clean with two service users stating that this was ‘usually’ the case. One relative commented via a comment card that they felt the home was not always very clean. Discussion with the provider demonstrated a commitment to maintaining good hygiene throughout the home. At present staff undertake cleaning duties in the home with a checklist being in place to monitor this. The Responsible Individual stated that she would consider employing a cleaner in the event of standards not being maintained. An infection control policy is in place and there was evidence in risk assessments for individual service users that issues around hand washing and infection control had been considered. Aprons and gloves are accessible to staff who support service users with personal care tasks. Following the inspection Jane Montrose has confirmed that the home has taken delivery of regular and anti-bacterial soap dispensers and paper towels for each sink in the home in order to minimise the risk of cross-infection. Clinical waste is placed in yellow bags and locked in a separate bin for collection by a specialist clinical waste company. Two members of the staff team have undertaken training in infection control and places have been booked on courses for remaining staff over the next three months. Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is making appropriate links with local initiatives to ensure that all staff are competent to undertake their role with service users. Staffing levels should be reviewed on an ongoing basis to ensure that there are sufficient staff on duty to meet the individual needs of service users. Recruitment procedures are not sufficiently robust to fully protect service users although the provider is taking appropriate steps to address this issue. Further development of the home’s training programme is needed to ensure that staff are able to meet the general and specific needs of service users. EVIDENCE: Of five care workers employed at the home, one has a dual learning disability nursing / social work qualification while two have qualifications to NVQ Level 2 or above. There was evidence on file to show that the home is establishing links with Partners in Care regarding training opportunities in the area. On the first day of the inspection four staff were on duty at the home which included the Registered Manager, the Home Manager and two Support Workers. The Home Manager was visiting day services in the local area with Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 23 the relative of a service user. On the second day of the inspection the Home Manager was on duty with a Support Worker. Romaine Lawson and Jane Montrose were also on the premises. One service user commented in a survey ‘When is XXX going to employ some new staff’ and the relative of one service user stated that, in her view, there were ‘not enough staff on duty at any time’. Romaine Lawson and Jane Montrose stated that they work hard to ensure that adequate numbers of staff are on duty to meet service users’ needs but that the presence of staff may not always be obvious to visitors as they may be supporting service users with activities or personal care. A parttime Activities Co-ordinator is also employed by the home to support service users with their individual interests. The recruitment records of two members of staff were examined. Both were well-organised and showed proof of identity. The references for one member of staff were both from an employer for whom he had worked until June 2001 but there was no reference from his most recent employers. For the second member of staff, one reference had been provided by her most recent employer but the second reference was a photocopy of a personal testimonial written in the year 2000. As the person providing the testimonial had died this could not be followed up by Apple House Limited. Enhanced disclosures from the Criminal Records Bureau were on record for both staff but one of these was from a previous employer and dated September 2005 which was seven months’ prior to the date employment with Apple House had commenced. Jane Montrose confirmed that she is in the process of obtaining up-to-date disclosures for all staff employed at Redcroft using a new umbrella body. Failure to meet this standard has resulted in the overall rating for this outcome group to be assessed as ‘poor’. A copy of the guidance ‘Safe and Sound’ produced by the Commission has been given to the Registered Manager to ensure that practices in the home meet the Regulations. The home is making some progress in developing access to relevant training for all staff which will meet the general needs of the service user group. An induction programme which meets the objectives of the Learning Disability Award Framework (LDAF) has been purchased from the British Institute for Learning Disabilities (BILD) with a Trainer’s Guide and is to be implemented for all staff. Jane Montrose stated that she is planning to purchase a similar foundation training package. Some training has been delivered by community nursing staff on stoma care and epilepsy to meet the individual needs of service users although these were not certificated courses. The home has yet to develop its training programme so that it meets specific needs, for example total communication, mental health awareness, autism or challenging behaviour. It is advised that the registered persons familiarise themselves with the new Common Induction Standards to be launched in September 2006, information about which can be found on the Skills for Care website. Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there have been some changes in the management of the service since its opening a stable management structure is now in place to ensure consistency and continuity of care to the benefit of service users. The home has started to implement a quality assurance process which will ensure that the home’s development is centred on the views of service users, their relatives and representatives. Some shortfalls in health and safety practices in the home were identified at inspection but prompt action by the provider has been taken to ensure that these are addressed and that service users are protected by procedures. Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 25 EVIDENCE: There have been some changes in the day-to-day management of the home since it’s opening in December 2005. The Responsible Individual has been conscious of this and has provided increased input to ensure some continuity. She has updated the Commission with information about any changes that have taken place on a regular basis. The management structure of the home, at present, is at four levels with a Deputy Manager, Home Manager, Registered Manager and Responsible Individual. This provides clear lines of accountability for service users and staff. Discussion with one member of staff indicated that communication between all levels is good with supervision taking place on a monthly basis and regular management meetings being arranged. The staff duty rota also evidenced this. The member of staff spoken to stated that the skills of Jane Montrose and Romaine Lawson complement each other and were relevant to their respective roles. Both of the registered persons present as committed to ensuring the home is run well and to the benefit of service users. The home has started to implement its quality assurance process with questionnaires being distributed to service users, relatives and health / social care professionals in June 2006 to obtain feedback. It was noted that feedback was generally very positive. Views expressed have been collated and Jane Montrose will be responsible for producing an annual development plan for the home based on these responses. Jane Montrose and Romaine Lawson discussed the possibility of setting up a Forum for the Relatives and Friends of service users which would contribute to the overall process. A fire risk assessment of the home was undertaken by a fire safety consultant in April 2006. Jane Montrose has confirmed that the home is making progress in implementing recommendations made in the risk assessment. Formal fire training by the fire safety consultant was arranged for staff at Redcroft in March 2006. The content of this training is documented on file and covers legal obligations, fire routine, evacuation techniques and portable fire fighting equipment. Two staff training files were examined. Both staff had undertaken the first module of fire training. Since the inspection, the second module of fire training has been undertaken by the majority of staff at the home. A record of fire drills is in place and showed that since May 2006 there has been a monthly drill at the home recording the time of evacuation, nature of drill and any observations. Where observations had been made, for example, that a zone in the fire panel was not functioning, there was evidence to show that this had been reported to a fire safety company immediately. Emergency lighting checks had been undertaken at the home prior to its opening and again in May 2006. The fire alarm system was serviced in May 2006. Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 26 Water temperatures were checked during the inspection using a scald warning triangle as used by the home. Three water outlets were tested including the bath and sink of a communal bathroom and the en-suite sink of a service user. In all cases the triangle turned pink which indicated that the water was too hot and that service users may be at risk of scalding. There was no evidence at the home that water temperatures are checked and recorded on a regular basis to ensure temperatures remain constant. There was evidence on record that due to staff concerns about the water temperatures in the home a new thermostat had been installed in June 2006. Following the inspection a letter was sent to the provider to require urgent action on this issue. The provider has since contacted the Commission to advise that arrangements have been made for thermostatic valves to be fitted on all hot water outlets to ensure that water is of a safe temperature. Although a system is in place for staff to record refrigerator temperatures on a daily basis these had not always been completed. Of the two staff files examined, both showed evidence of them undertaking moving and handling training and one staff member had a food hygiene certificate. Neither file showed evidence of the staff having undertaken first Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 27 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 2 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 2 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 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 1 X Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? N/A 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. Standard Regulation Requirement Records of the food provided for service users must be in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory in relation to nutrition and otherwise. The registered provider must ensure that there is full and satisfactory information available in relation to all persons working in the care home in accordance with Schedule 2 of the Regulations. The registered provider must take appropriate action to ensure that the risks of scalding to service users in the home are minimised. The registered provider must ensure that refrigerator temperatures are recorded and monitored in line with guidance from the local Environmental Health Department. The registered provider must ensure that all staff undertake training in food hygiene, first aid and fire safety including updates as appropriate. DS0000065720.V307162.R01.S.doc Timescale for action 1. YA17 17(2) Sch. 4 01/11/06 2. YA34 19 01/11/06 3. YA42 13 06/09/06 4. YA42 13 01/10/06 5. YA42 13 01/11/06 Redcroft Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Service user plans should contain more detail about their personal care needs so that the support they require with each task is clearly specified. 1. YA6 Personal goals should be identified in the plan with reference to the support needed for these to be met. Service user plans should be in a format that is meaningful for the individual. Risk assessments should be dated so that it is clear when they were written and evaluated. Guidance from the Royal Pharmaceutical Society should be followed with regards to the receipt, recording, storage, handling, administration and disposal of medicines. All staff with responsibility for administering medication to service users should undertake accredited training. 3. YA20 Patient information leaflets regarding service users’ medication should be included in their records to provide information for staff. The homely remedies list should be adapted to contain details of all over-the-counter medicines used at the home. This should include information about the dosage, indications and contra-indications for each medicine. The provider should ensure that a copy of the home’s complaints procedure is given to all relatives / representatives of service users so that they are aware how to raise concerns about the service. 4. YA22 The complaints procedure should be expanded to include the reporting and recording of concerns. All records of concerns should be kept together with complaints in a specific file for that purpose. 2. YA9 Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 30 5. 6. YA32 YA33 All care workers at the home should have achieved, or be working towards, an NVQ qualification of at least Level 2 standard. The provider should keep staffing levels under ongoing review to ensure that service users’ individual needs can be met by the home. Further development of the home’s training programme should occur so that staff benefit from comprehensive induction and foundation training that meets Skills for Care standards. Specialist training should be arranged for all staff to ensure that they are able to meet the individual needs of service users, for example, training in total communication, autistic spectrum disorders, mental health awareness and challenging behaviour. The provider should produce an annual development plan for the home based on the views of service users as obtained through the quality assurance process. The recording of fire drills should be expanded to include a list of individuals (service users and staff) participating in the drill. Fire drills should be carried out at variable times of the day, including times when staffing levels are reduced. Individual fire training / drill records for staff are recommended so that it is clear where staff have not participated in the training sessions and drills. 7. YA35 8. YA39 9. YA42 Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Redcroft DS0000065720.V307162.R01.S.doc Version 5.2 Page 32 - 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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