Inspection on 06/07/07 for Redcroft

This inspection was carried out on 6th July 2007.

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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Redcroft 15/07/08

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 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 6th July 2007 09:20 Redcroft DS0000065720.V345080.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.V345080.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.V345080.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) info@applehouse.co.uk Apple House Limited Mrs Romaine Estelle Lawson Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Redcroft DS0000065720.V345080.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. 4th August 2006 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. The property has a second floor which is currently used as office space. The home is staffed on a 24 hour basis with one person sleeping-in between the hours of 22.30 and 06.00 hrs. 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. Fees for individual service users at Redcroft are variable depending on their assessed needs. Up-to-date information on current fee levels has not been provided by the home for the purpose of this report. Guidance on fair terms in care homes contracts may be obtained from the Office of Fair Trading – www.oft.gov.uk Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection of the service. The inspection took place over approximately nine hours on 6th and 10th July 2007. The purpose of this inspection was to assess the home’s progress in meeting the key National Minimum Standards since the last key inspection of the service in August 2006 and a specialist inspection by the Commission’s Pharmacist Inspector in October 2006. At the time of this inspection there were six people living at Redcroft. During the inspection we were able to take a tour of the home, meet all the people who use the service and observe some interaction between them and staff. Discussion took place with the Registered Manager, Romaine Lawson. A sample of records was examined including some policies and procedures, medication administration records, health and safety records and service user and staff files. Prior to the inspection, an Annual Quality Assurance Assessment (AQAA) was completed by the provider and submitted to the Commission. Surveys were distributed by the home to people who use the service, their relatives, care managers and health care professionals on behalf of the Commission. A total of thirteen surveys were received and information from these sources is reflected throughout the report. A total of twenty-three standards were assessed at this inspection. What the service does well: The home ensures that the needs of people who use the service are assessed before they move in. This ensures that the home can meet people’s requirements and that they benefit from a smooth transition. Individual needs and choices are respected and people are encouraged to make decisions about their lives and take appropriate risks. People have opportunities to do activities they want and access their community on a regular basis which promotes their rights to an ordinary life. Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 6 People receive the support they need with their personal care and routines in the home are flexible enough to ensure that individual preferences can be met. Redcroft is spacious, clean and comfortably furnished and comments from relatives indicated that providing a homely environment and ‘family atmosphere’ is something the home does well. The provider is committed to improving the home and is developing ways of reviewing and monitoring the service to ensure that it is run in people’s best interests. What has improved since the last inspection? There was some improvement in the recording of people’s food intake although it is suggested that recording continues to be more specific and descriptions such as ‘sandwiches and fruit’ reflect the content of sandwiches and type of fruit chosen by the service user. Health and safety practices in the home have been reviewed with appropriate action taken to ensure that water temperatures are safe, refrigerator temperatures are recorded and that staff access health and safety training as part of their induction programme. Documentation of fire drills has also improved so that it is clear who has been able to participate in an evacuation. This helps ensure that people who use the service are safe in their home. Care plans now contain more detail about people’s personal care needs and risk assessments seen at this inspection had been dated to show when they were last reviewed. The home’s medication policy and procedures have been reviewed and staff access training to develop competence in supporting people with their medication needs. The provider has distributed a copy of the home’s complaints procedure to all relatives of service users so that they are aware how to raise concerns and an easy-read booklet on how to complain has been developed for service users. The provider has linked up with a local training initiative to promote staff’s access to nationally recognised qualifications. Staff also benefit from a structured induction programme which gives them the basic knowledge and skills they need to fulfil their role. The home’s quality assurance process has been fully implemented, this involving consultation with service users, their relatives and representatives in order to produce an annual development plan. Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 7 What they could do better: As a result of this inspection, one requirement and ten recommendations have been made. The provider must be able to satisfy themselves that they have enough evidence that all appropriate checks have been carried out on care workers. Although information in care plans was generally good there is potential for development with regards to goal-setting processes, organisation of the records and ensuring that they are in a format that is accessible to service users. People who use the service did not always feel that their privacy was respected in the home and it is recommended that the home looks at this area to improve outcomes for service users. The recording of health care appointments should be more comprehensive and give information about the outcome of each appointment. In addition, where people need for support with specific healthcare procedures training should be given to staff to ensure that they are competent and that service users’ needs are being met. Care plans should contain information about arrangements in place for people to take their medication safely and any in-house training that is given should be clearly documented. Improved documentation around the recording of complaints is recommended to evidence how the home is addressing concerns and ensuring a positive outcome for the service user. The home’s training programme should be further developed to ensure that all staff access specialist training that reflects service users’ individual needs and suitable training in abuse awareness. For those staff with supervisory responsibilities, further training should be accessed so that they are fully equipped for their role. Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 8 The home should ensure that care workers on duty at night are confident of procedures in place to evacuate the home in the event of a fire. The provider should liaise with their ‘competent person’ to look at ways that night-time fire drills can be simulated to test staff’s knowledge of procedures. 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.V345080.R01.S.doc Version 5.2 Page 9 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.V345080.R01.S.doc Version 5.2 Page 10 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 service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home ensures that assessments are undertaken for all prospective service users so that arrangements can be put in place to meet their needs and preferences and they benefit from a smooth transition. EVIDENCE: One person has been admitted to Redcroft since the last inspection. However, this person transferred from the provider’s other home in Bournemouth and therefore their needs were already known to the service. In addition, the service user was familiar with Redcroft and had visited the home on several occasions prior to the transfer. Care Managers from the Local Authority and the Community Learning Disability Team were involved in facilitating the person’s move to Redcroft and discussion with the service user indicated that he had been involved in the process. At the last inspection of the service this standard was met with assessments for new service users having been carried out prior to their admission. These were seen to include information about service users’ needs and preferences and contained evidence that the service user themselves had been involved in the assessment process. Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 11 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. The home respects people’s individual needs and abilities and promotes their ability to make decisions in their lives. EVIDENCE: A sample of support plans were inspected. Mrs Lawson reported that it had been identified by the service that support plans in place needed some reorganisation so that there is one comprehensive document for each service user which specifies their needs and wishes and how these will be met. The plans for one service user seen during the inspection comprised an Essential Lifestyle Plan and various other care plans all of which contained information about the individual’s needs. Some documents contained more information than others about specific issues and therefore we concur with the view that information should be amalgamated into one comprehensive document. In addition, the home should look at ways in which to develop Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 12 plans in a format that is accessible to service users to promote their ownership of the plan. Plans seen contained a good level of information about the person’s likes, dislikes, friends and family, communication, preferred activities, spiritual needs, mobility and things that are important to them. One person had expressed a wish to join a Church and there was written evidence on file that they had been offered opportunities to do this. Where individuals are able to be independent in certain aspects of their care this had also been detailed; ‘I can put my cereal in a bowl, pour in the milk and take it to the table. You may need to help me with spreading butter and jam as I can put on too much.’ Where one service user had recently left school and had started to attend a day service the plan had been updated to include this. The plan showed some consideration of the individual’s goals, for example, ‘I would like to buy an exercise bike’ and documentation indicated that this had been achieved but evidently, the goal-setting process is an area which could be expanded upon so that where people have long-term goals, for example, to live more independently or gain paid employment, there is a structured action plan to show how they are working towards this. Observation of interaction between staff and service users during the inspection showed that they are encouraged to make choices and decisions with regards to their everyday lives. This is promoted by flexible routines in the home which mean, for example, that people can have breakfast when they wish and choose what they wish to do with their time. It was clear from discussion with the Registered Manager and staff team that everyone in the home is treated as an individual and that they are conscious of the need to promote people’s individuality, for example with regards to holiday choices. Minutes of a recent residents’ meeting evidenced that people who use the service are involved in making decisions with ideas being put forward for activities they would like to do. All four service users responding to the survey indicated that they are involved in making decisions in their home. Comments received from relatives and social care professionals also indicated that this is something the home does well; The home ‘respects personal choice’; ‘Staff support people to maintain their independence while providing choices’. A sample of risk assessments was seen. These covered potential risks for service users in accessing the community and maintaining freedom and privacy in their home. Documentation indicated the level of risk, the likelihood and the actions to be taken by care workers to promote safety. For example, where there is a risk of someone becoming anxious when using a vehicle, precautions such as ensuring the person is wearing a seatbelt and that a member of staff is sat next to them to offer support were identified as measures that would reduce the likelihood of any risks. It was clear that the focus of the assessments was to promote people’s independence with due regard for their safety. Risk assessments seen had been reviewed in May 2007. Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 13 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 who use the service enjoy positive lifestyles in their home and community and are enabled to do activities of their choice. EVIDENCE: Discussion with the Registered Manager indicated that the home is striving to individualise people’s daily activities so that they are enabled to pursue interests, work or educational courses of their choice. One service user spoken with told us that he does voluntary work on one day each week at the airport but that this would soon be increasing to two. Another service user attends a specialist day service on two days each week. Other service users attend various colleges and education centres to take courses in reading and writing and art. Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 14 Review of daily diaries in the home indicated that in recent weeks people had been supported to access their community including trips to the beach and forest, visits to local towns, pub lunches, local shops and the supermarket. The home has a part-time Activities Co-ordinator who supports service users in doing a particular interest of their choice on a regular one-to-one basis. One service user told us that he likes to visit a range of places in the local area during his one-to-one time including going to the garden centre, to Bournemouth town centre and Poole Quay. He also told us that he goes swimming on a regular basis at a local leisure centre, supported by a member of staff. A relative responding to the survey commented that taking the clients out and enabling them to participate in what is going on in the community is something the home does well. Two other relatives noted that they felt there was room for improvement in this area in that the home should ‘make sure they are aware of all the opportunities the service users can access’ while another felt that there could be more opportunities available for people to go to clubs and social events in the evening. The Registered Manager has told us in the home’s Annual Quality Assurance Assessment (AQAA) that they have researched resources in the local and wider community to identify suitable activities for people who use the service and they plan to continue to improve on this in the next year. A range of home-based activities was also seen to be in place for people including, on the day of the inspection, a cake-making session and a keep fit session by an external, trained instructor. All four service users responding to the survey told us that the activities they are offered are good. Discussion with people who use the service and staff indicated that all service users have contact with family and friends. People’s support plans included information about their ‘circle of support’. Of five surveys returned by relatives, two said that the home always helps their family member keep in touch with them, two said that this is usually the case and one indicated that they never received telephone calls from their friend or the home; ‘I wish they could contact me from time to time.’ One service user spoken with told us that they had a friendship with someone who lives in a nearby care home and they enjoy going to the pub together for a game of pool. Observation of people in their home indicated that they have access to all communal areas and can help themselves to drinks and snacks as they wish. In addition, people are encouraged to participate in domestic tasks around the home and people were observed hovering, putting crockery in the sink following meals and putting groceries away following a trip to the supermarket. Observation of life in the home also demonstrated that service users can access their bedroom at any time of the day should they wish for privacy or need time to themselves. Out of four surveys returned by service users, half felt that their privacy was respected in the home, the remaining half indicating that this was sometimes the case. One out of three social care professionals Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 15 stated that they felt people’s privacy and dignity was always respected, two stating that it was usually respected. One stated that they felt this was because not all staff appeared properly informed about working in a personcentred way. It is suggested that the home looks into these issues to identify ways in which the service can be more responsive in promoting a personcentred approach and further educate staff in this area. Service users’ support plans offer information about people’s likes, dislikes and needs with regards to eating and drinking. Where one person has sensitivity to certain foods this had been documented in their care plan. People’s level of independence in relation to eating and drinking has also been recorded with the support they need at meal-times; ‘I need support to make sure I don’t put too much cereal in the bowl and squash in the glass.’ On the day of the inspection, service users were supported to go to the supermarket to buy some groceries and it was evident that their various choices were accommodated by staff when preparing lunch. There was generally sufficient information available regarding the meals eaten by individuals in the home although it was suggested that this also includes snacks to give a full picture of people’s nutritional intake. It is also suggested that recording is more specific so that descriptions such as ‘sandwiches and fruit’ inform the reader of the content of sandwiches and the type of fruit chosen. Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 16 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. People who use the service benefit from personal support that meets their needs but improvement in some aspects of documentation is needed for the home to evidence that effective communication with health care professionals has been established. EVIDENCE: Care plans inspected offered a good amount of information about people’s personal care requirements, for example, ‘If X is having a bath they need stepby-step guidance to put the plug in, physical and verbal prompts to fill the bath, get in and wash themselves and when finished, to dry themselves properly.’ It was also evident in the plan that the individual prefers to have a bath and hair wash every evening and that support must be given by a care worker who understands the individual’s communication needs. Of the four service users responding to the survey, three stated that they felt well-cared for by staff, one indicating that they ‘sometimes’ felt well-cared for. All stated Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 17 that the staff treat them well. One relative commented that staff seemed to be caring when they visited and they observed care workers giving support that was suited to their family member. People’s files showed that visits from health and social care professionals had been recorded. One sampled indicated that the person had attended appointments with their psychiatrist, psychologist, community nurse, general practitioner, optician and care manager. However, there was no information in the appointments log to show the outcome of each appointment. Where a service user needs support with stoma care, staff confirmed that written procedures by a specialist nurse are in place. It was suggested that the home looks to provide specific training in this area so that care workers are deemed ‘competent’ with this task. Some positive comments were received regarding the support people receive with their physical and emotional health care needs, one relative reporting that the home supports his family member well when he has an emotional problem and a social care professional told us that the health of the service user they had placed in the home has improved considerably since living at Redcroft. Some shortfalls in communication were identified by another care professional, however, who indicated that the home had not always kept them informed about changes in a service user’s health although they added that changes had been made by the provider to improve communication. The arrangements in place to support people with their medication were inspected. Since the last inspection the home has reviewed their medication policy and procedures. Medication is stored securely in a metal cabinet which is fixed to the wall. Medication is supplied by a pharmacy in monitored dosage systems and records were in place to document all medicines received into and leaving the home. A sample of medication administration record (MAR) charts were checked. These showed details of medication sensitivities and where none are known this had been recorded. Medication had been signed for by the care worker responsible for its medication suggesting that medication had been given as prescribed. In addition, where medicines had been handwritten on the MAR chart this had been signed by two members of staff to ensure the accuracy of the instructions. The home have implemented a system to audit medication on a daily basis which they report works well for them. A homely remedies list is not in place in the home as staff report that they would look at each person’s need on an individual basis and liaise with the pharmacy to ensure that the person is given the most appropriate remedy to meet their needs. It was noted that people’s care plans could be expanded to include more information on how each service user takes their medication and any specific support they require. The Registered Manager reported that staff have attended various training courses in medication administration including inhouse training, training from the pharmacy and training from an external agency. The manager reported that this is currently under review to ensure Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 18 that people’s training is consistent with the home’s procedures. There is no system in place at the present time to record any in-house training and shadowing that takes place in the home and this is recommended to ensure that there is a system by which staff are deemed competent to support people with their medication requirements. Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 19 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 adequate 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 protected by the home’s procedures on complaints and reporting abuse but improved methods of documenting outcomes for people are needed. EVIDENCE: The home’s complaints procedure was seen. This has been reviewed to include the recording of concerns and how these will be dealt with by the home. A booklet on ‘How to Make a Complaint’ was seen. This was in an easy-read format. A service user spoken with could not recall having been given a copy but stated that they would speak to the manager if they were concerned about something. All four service users responding to the survey indicated that they knew who to speak to if they were unhappy. Four out of five relatives also stated in surveys that they knew how to make a complaint about the care provided by the home if they needed to. Of these one reported that the provider had always responded appropriately when they had raised concerns, three said that this was ‘usually’ or ‘sometimes’ the case and one said that they had always worked out any problems with staff when they visited. The home’s Annual Quality Assurance Assessment (AQAA) states that four complaints have been received by the service in the past twelve months, two of which were upheld. According to the AQAA all had been resolved within Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 20 twenty-eight days. The home’s complaints and concerns record was inspected. Details of complaints / concerns had been documented with some correspondence also on file showing the home’s response to issues raised. In some instances it was not clear whether this was the final outcome of the investigation and indeed, whether the person raising the concern was satisfied with the action taken. For one complaint received by the service there was no documentation on file at the time of the inspection. The Registered Manager was able to give an account of the progress made in relation to the complaint. However, it is recommended that the home develops a written framework by which the progress and outcome of complaints and concerns is tracked to ensure that timescales are adhered to and all issues have been responded to fully. The provider has told us in their Annual Quality Assurance Assessment that they have clear policies on abuse awareness and the protection of vulnerable adults and that all staff are aware of these policies. They have also told us that they use training packs to update staff on abuse awareness but aim to expand on this in the next year with further in-house and external training. Of two staff training records inspected, one showed evidence of the person having completed external training in abuse awareness. It is therefore recommended that the home develops more effective systems for recording inhouse training and, as they have already identified, aim to identify further external training in this subject area. Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 21 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 offers an environment to service users that is comfortable, clean and provides a homely atmosphere. EVIDENCE: Redcroft is a large, spacious house situated in a residential suburb of Bournemouth. Effort has been made by the provider to create a homely feel with furnishings that are comfortable and fittings that are domestic. Service users have their own bedrooms which are also spacious and have been personalised to the taste of the individual. People spoken with during the inspection told us they liked living at Redcroft. A relative also commented in a survey that one thing the home does well is to ‘create a homely atmosphere’, another stating that there is a ‘family atmosphere’ at Redcroft providing ‘as close to a home environment as they are able.’ Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 22 At the time of the inspection the home presented as clean and tidy. The provider has told us in their Annual Quality Assurance Assessment that they have a policy for preventing infection and managing infection control and an action plan in place with regards to this. Arrangements are in place for the disposal of clinical waste in the home. Infection control training forms part of the home’s induction programme and there was evidence on the two staff files sampled that this had been completed. Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 23 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, 33, 34 and 35 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. Some shortfalls around recruitment and training have been identified which, when addressed, will ensure that service users benefit from safe, skilled and knowledgeable staff. EVIDENCE: There is a clear staff structure in the home comprising the Registered Manager, a House Manager and a team of Support Workers. The House Manager undertakes some supervisory roles in the home and has completed a National Vocational Qualification (NVQ) in Care at Level 3 and an introductory certificate in management. The home’s Annual Quality Assurance Assessment states that Support Workers in the home are currently working towards their NVQ Level 2. The provider has made links with local training initiatives to facilitate this. One care worker spoken with during the inspection, who had recently joined the team at Redcroft, reported that she had recently completed a Diploma in Health and Social Care. It was suggested to the Registered Manager that advice is taken to identify how this qualification equates with the NVQ Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 24 framework. Some concerns around the experience and training of staff at times over the past year were raised by a relative and a social care professional in surveys; ‘They must get the right type of people and keep training up to a level’. It is suggested that the home reviews their recruitment procedures and training and development plan to ensure that staff who work in the home have the necessary knowledge, skills and experience to do so. At the time of the inspection, only the Registered Manager and House Manager have permanent contracts with Apple House Limited, other staff being employed through a care agency although working exclusively at Redcroft. In addition to management staff, there are currently three Support Workers sharing day-time hours and two night staff who between them cover nighttime hours. One relative responding to the survey felt that the home would benefit from more staff. Another expressed some concern about the number of staffing changes that had occurred in the home which they felt was unsettling for their family member. Records showed that there had been an occasion when a student undertaking a placement at the home, who was also under the age of 21, had been left alone with service users for a period of time while staff and other service users were out. The Registered Manager was reminded that this is not appropriate and was referred to the National Minimum Standards regarding this. The provider has outsourced their human resources function to an external agency who recruit staff on their behalf. The records of two care workers were inspected for evidence that they have had appropriate checks carried out on them to determine their suitability to work with vulnerable adults. Both files showed evidence of proof of identity and a profile from the care agency which included information about their disclosure from the Criminal Records’ Bureau, previous work experience and qualifications and references. An application form was on file for one care worker but this did not include evidence of a full employment history. The Registered Manager was reminded that it remains their responsibility to assure themselves that appropriate checks have been carried out on people who come to work at the home. As such, they need to be able to confirm for themselves that people have a full employment history, that references have been obtained from the person’s last employer and that any issues relating to the outcome of recruitment checks have been discussed with the care worker and the outcome of this documented. Induction training for all new staff is arranged through the care agency which covers several aspects of health and safety, protection and bereavement awareness. In addition to this is an in-house orientation where staff are introduced to internal procedures including those around support plans, mobility aids, reporting, complaints and lone working. Other training was also seen to be provided to some staff including ‘Breakaway’ training, Person Centred Planning training and instruction around record-keeping. The Registered Manager confirmed that she is looking into sourcing training around the Mental Capacity Act. One social care professional stated in a survey that Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 25 they felt ‘Staff have not always had the right training to work with this particular client group’. It is recommended that the home develops a training plan which is firmly based around the specific needs of people who use the service, for example, training in total communication, mental health awareness, autism, stoma care and epilepsy. Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 26 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. The provider is taking appropriate action to identify ways in which the service can be improved for the people who live there and put plans in place to respond to these. EVIDENCE: There are clear lines of accountability within the home from the Directors of Apple House Limited to the Registered Manager, senior staff within the home and team of Support Workers. Although the registered persons have remained the same, there have been some changes in the management and staffing structure of the home since it’s opening in December 2005. Comments from relatives and social care professionals indicate that such changes have had Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 27 some impact on the running of the home. One commented that communication between the home and social care professionals had at times been inadequate although it was acknowledged that the home had started to introduce changes to address these shortfalls. The provider has continued to communicate well with the Commission regarding notifiable incidents in the home and changes in management arrangements. It was evident during the inspection that the newly-appointed House Manager has taken on some delegated duties from the Registered Manager who works at the home on a part-time basis. While the House Manager has an NVQ in Care and has completed an introductory certificate in management it is recommended that they continue to develop professionally to be fully equipped for their new supervisory role. Quality assurance surveys were distributed by the home to service users, their families and health and social care professionals in 2006. Surveys asked people for feedback on various aspects of the service including the quality of the accommodation offered in the home, the activities and how staff respect the privacy, dignity and independence of people who use the service. Feedback has been collated in the form of a service development plan for 2007 which outlines how the service aims to improve. It was noted that the service development plan covers outcomes and objectives for both homes in the Apple House Limited group. It is therefore suggested that the provider considers separating these into two plans as the outcomes for each home may be different and objectives set should be specific to each home. Staff training records sampled at this inspection showed that they are now enabled to access health and safety training as part of their induction programme. This includes training in fire safety, food hygiene, moving and handling and basic first aid. The home has a fire risk assessment which was completed in 2006 by a fire safety agency and is now due for review. Two staff files were inspected, both indicating that the care workers had undertaken training in fire safety as part of their induction programme in April 2007. A specialist fire safety agency also carries out fire safety training twice yearly for care workers in the home. The Registered Manager was reminded of the need to ensure that all staff, including night staff, attend fire safety training on a regular basis. Records showed that monthly practice evacuations are carried out in the home and that all service users had participated in recent evacuations. It is recommended that the home seeks further advice from a competent person regarding carrying out drills at night to ensure that night staff are aware of procedures and know how to evacuate the home in an emergency. An external company had serviced the home’s fire alarm system and emergency lighting in May 2007. It was noted during a tour of the home that a fire extinguisher on the first floor of the home was not attached to the wall and it is suggested that the provider takes appropriate advice on this. Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 28 Since the last inspection, thermostats have been fitted to water outlets to control hot water temperatures in the home. There was documentation to support that regular checks are carried out on water temperatures and therefore that risks of scalding to people in the home have been reduced. Refrigerator temperatures were also seen to be recorded on a regular basis to ensure that food is stored at an appropriate temperature and that people are safe in this regard. Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 29 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 2 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 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 3 X X 2 X Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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 YA34 Regulation 19 Requirement 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. This will help ensure that people who use the service are fully protected. Timescale for action 01/10/07 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 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. These recommendations are repeated from the last inspection of the service. Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 31 The home should look at how care plans are organised and bring information together into one document where possible so that it is easier to follow and review. 2. YA16 The provider should review issues around privacy in the home with people who use the service. Staff should receive training in personhood, equality and diversity to ensure that people’s needs are met in these areas. The recording of healthcare appointments for each service user should be more comprehensive so that there is clear information on file about the outcome of each appointment. Specific training in stoma care should be provided to staff with a system in place by which care workers are deemed competent to support people with this aspect of their care. Guidance from the Royal Pharmaceutical Society should be followed with regards to the receipt, recording, storage, handling, administration and disposal of medicines. Support plans should contain more information about the specific needs of people in relation to medication and arrangements in place to support this. In-house training on medication administration including shadowing should be recorded so that there is a clear process in place by which care workers are deemed competent to support people with their medication. 5. YA22 Documentation in relation to all complaints and concerns should be held on file and there should be evidence of a clear audit trail from receipt of the complaint to the final outcome. The satisfaction of the complainant with the outcome of complaints and concerns should be checked so that the provider knows whether people are satisfied with the action that has been taken. All staff should receive suitable training in abuse awareness. All training undertaken, including in-house training, should be documented. The provider should ensure that people left in charge of DS0000065720.V345080.R01.S.doc Version 5.2 Page 32 3. YA19 4. YA20 6. YA23 7. Redcroft YA33 8. YA35 the home are aged 21 or over and have suitable experience, knowledge and skills to be able to work alone with service users. Specialist training should be arranged for all staff to ensure that they are able to meet the individual needs of service users. This recommendation is repeated from the last inspection of the service. 9. 10. YA37 YA42 People with management and supervisory responsibilities in the home should be given appropriate accredited training to be fully equipped for their role. Fire drills should be carried out at variable times of the day, including times when staffing levels are reduced and night staff are on duty. Redcroft DS0000065720.V345080.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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.V345080.R01.S.doc Version 5.2 Page 34 - 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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