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Inspection on 11/07/05 for Redhouse Nursing Home

Also see our care home review for Redhouse Nursing Home for more information

This inspection was carried out on 11th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides very individualised personal care using comprehensive care planning and deliver this in a friendly atmosphere and a very pleasantly presented environment, many service users commented that the meals provide added quality to life in the home . The staff group is very stable and enjoy their involvement in providing a good range of in-house activities, many staff having been employed for many years. There is a commitment to training staff and young people being a placement area for Age Concern training.

What has improved since the last inspection?

The Statement of purpose and Service User Guide have been reviewed and amendments made. The previous requirements and recommendations made at the last inspection have been addressed and completed in good time. New carpets have been fitted throughout the corridors, dining rooms and some bedrooms. As required by the previous inspection hot water management and monitoring has improved.

What the care home could do better:

The overall assessments of needs requires to be reviewed on a regular basis in addition to the identified needs with current care plans that are reviewed monthly. The admission document should be completed fully even if the statement is that the item is not applicable, confirming that consideration has been given.The home should extend their falls risk assessment to all service users and not just those with known risks. A photograph of each service user should be available in some part of the case file. Further action should be taken to eradicate the unsafe practice of re-sheathing used hypodermic needles. The home should seek service users views on activities they would like to expand the current range. The home needs to demonstrate its responsiveness to the findings of its own monitoring of the environment and services such as documenting the action taken to a high temperature reading of a hot water outlet. The kitchen windows and external door should be fitted with fly screens enabling these to be opened during hot weather. The registered provider should document the active involvement in the home by way of providing a report of a monthly unannounced visit to inspect the premises, meet service users any visitors that may be present and discuss findings with the manager.

CARE HOMES FOR OLDER PEOPLE Redhouse Nursing Home 55 Redhouse Street Walsall West Midlands WS1 4BQ Lead Inspector Richard Eaves Unannounced 11th July 2005 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Redhouse Nursing Home E55 S20793 Redhouse NH V236733 110705 Stg4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Redhouse Nursing Home Address 55 Redhouse Street Walsall West Midlands WS1 4BQ 01922 616364 01922 616364 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Sukhdev Singh Sidhu Mrs Wendy Marie Morgan Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Redhouse Nursing Home E55 S20793 Redhouse NH V236733 110705 Stg4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 24th January 2005 Brief Description of the Service: Redhouse Nursing Home is a small, friendly and homely service, providing a service to the immediate community for older persons of the area and employing staff also from the local population. The home is situated close to local amenities and is conveniently served by public transport. The Home has a clear philosophy, aims and objectives and these are included in the statement of purpose, which provides a comprehensive document, which is available to prospective and current service users. The current mission statement identifies a commitment to staff training and updating. The Home provides in-house catering and laundry services and all grades of staff are encouraged to relate on a personal level to the service users, enhancing the feeling of homeliness. Redhouse Nursing Home E55 S20793 Redhouse NH V236733 110705 Stg4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken by one inspector over one day and included obtaining the views of service users and a number of visitors through conversation. The home was found to be functioning efficiently in the absence of the manager and service users were appropriately and neatly attired and were happy to comment positively about the home and the staff. One visitor came across as being ambivalent towards the home but would not discuss any issues, the manager was aware of this and is trying to overcome any perceived problems. The overall impression was that there was a great deal of satisfaction with the care and services provided by the home. In addition to seeking the views of service users information was gathered from care records, observing staff involved in their duties and a tour of the building. What the service does well: What has improved since the last inspection? What they could do better: The overall assessments of needs requires to be reviewed on a regular basis in addition to the identified needs with current care plans that are reviewed monthly. The admission document should be completed fully even if the statement is that the item is not applicable, confirming that consideration has been given. Redhouse Nursing Home E55 S20793 Redhouse NH V236733 110705 Stg4.doc Version 1.40 Page 6 The home should extend their falls risk assessment to all service users and not just those with known risks. A photograph of each service user should be available in some part of the case file. Further action should be taken to eradicate the unsafe practice of re-sheathing used hypodermic needles. The home should seek service users views on activities they would like to expand the current range. The home needs to demonstrate its responsiveness to the findings of its own monitoring of the environment and services such as documenting the action taken to a high temperature reading of a hot water outlet. The kitchen windows and external door should be fitted with fly screens enabling these to be opened during hot weather. The registered provider should document the active involvement in the home by way of providing a report of a monthly unannounced visit to inspect the premises, meet service users any visitors that may be present and discuss findings with the manager. 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. Redhouse Nursing Home E55 S20793 Redhouse NH V236733 110705 Stg4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Redhouse Nursing Home E55 S20793 Redhouse NH V236733 110705 Stg4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 4 & 5 The homes Statement of Purpose and Service Users Guide are a good source of information that prospective service users can use to make an informed choice about admission to the home. The assessment process should be regularly reviewed to ensure changes over time are identified so that service users developing risks can be minimised. The admission documentation should be completed in full in a timely way to ensure that service user wishes can be met. Confirmation that assessed needs can be met furthers enables service users to make informed decision about entering the home as does the opportunity to visit and trial the services offered. EVIDENCE: The Statement of Purpose and Service Users Guide have been reviewed and modified to include details of the new room since completion of the registration process. Service users are admitted on the basis of assessments undertaken by qualified nursing staff using a document that covers a wide range of personal Redhouse Nursing Home E55 S20793 Redhouse NH V236733 110705 Stg4.doc Version 1.40 Page 9 details and physical needs and preferences. This document is supplemented in most cases by a care management assessment and further developed on admission by an in-depth, activities of daily living assessment and a range of individual risk assessments. Documented evidence of service user or their representative involvement was seen. In inspecting a random sample of case files it was observed that some admission details were incomplete explained as a decision made to delay until a later time and reviews of assessments are currently restricted to risk assessments and those with known needs and care plans. A letter is given prior to admission confirming that assessed needs can be met by the Nurse led team that have a particular specialist interest in the care of the elderly frail with nursing requirements. The letter invites prospective service users to visit and experience time at the home. Redhouse Nursing Home E55 S20793 Redhouse NH V236733 110705 Stg4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 & 9 Care planning at the home is good, clear and consistent, providing staff with the necessary directions of actions required, to ensure that service users care needs are fully met and health is promoted. Arrangements for the administration of medication are good and ensure service users medication needs will be safely met. EVIDENCE: A random selection of case files were inspected and used for case tracking, these comprise of a consistent format and contain a range of assessments including those for activities of daily living and risk assessments specific for falls. One case file was observed not to include a falls risk assessment and a requirement is made to ensure this is undertaken for all service users. Other risks assessed include, pressure areas, continence, nutrition, moving and handling and use of bed rails. Identified needs generated care plans which detail the actions required by care staff to meet needs and minimise risks and included contingency planning for conditions such as diabetes mellitus and epilepsy. Care plans are subject to at least monthly review and more frequently if short term or subject to continuing change, such as wound care. Redhouse Nursing Home E55 S20793 Redhouse NH V236733 110705 Stg4.doc Version 1.40 Page 11 Service users healthcare is fully met maximising as far as practical the service users own capacity for self care. Each has a GP and other allied medical support is obtained as required, chiropody is provided both through the NHS and privately, routine foot-care is provided by experienced in-house staff. The Home has a good supply of equipment for the promotion of tissue viability and prevention of pressure sores. Each case file showed that the service user or other family member were involved in the development of the plan. A photograph of each service user must be included within the case file. The Home provides a policy and procedure for dealing with medicines and these were observed as being implemented by staff in all aspects of medicines management. At the time of the inspection no service users were selfmedicating. Medicines are provided on a 28-day cycle by a pharmacy service that also monitors and advises the Home on medicines policy and practice. During the inspection it was observed that the medicines room temperature was at 25 degrees centigrade, the home must monitor and take action to ensure that 25 degrees is not exceeded. It was observed that the practice of re-sheathing used hypodermic needles was prevalent and action must be taken to ensure it is discontinued. Redhouse Nursing Home E55 S20793 Redhouse NH V236733 110705 Stg4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 The home provides a limited but varied social and recreational activity programme that provides interest and pleasure for service users. Visitors are welcome and help to keep service users informed about the wider community. The meals are wholesome and meet the nutritional needs of service users while providing for choice and personal taste. EVIDENCE: An activities calendar is provided and regular in-house features include aerobics, bingo, natural therapies, parties and garden events. During the year the range of leisure activities in the Home has been extended and now include very popularly Karaoke and arts and crafts work, which again is well received. Many service users have been registered with ring and ride and use the facility for shopping trips. Visiting clergy provide regular communion for a number of service users. The home has open visiting and a number of family members were observed to visit across the day. The 4-week rotating menu provides for a nutritious diet and choice, take up by individual service users is monitored and recorded. Cooked options are available at breakfast, lunch and high tea and snacks are available at all times. Special diets, religious and cultural dietary needs are catered for. Cakes are provided for birthdays and other special occasions. Redhouse Nursing Home E55 S20793 Redhouse NH V236733 110705 Stg4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The home complaints and protection policies are robust providing a safe environment in which service users feel they can voice concerns and that these will be listened and responded too. EVIDENCE: The complaints procedure is readily accessible to service users and their supporters with reference in the contract, the statement of purpose and is on display on the notice board. No complaints have been received since the previous inspection. The home has robust procedures for responding to any suggestion of abuse and in-house training is given in adult protection procedures. Redhouse Nursing Home E55 S20793 Redhouse NH V236733 110705 Stg4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 The standard of the environment within the home is good, clean and hygienic providing an attractive, safe and homely place in which service users live and work. EVIDENCE: During the inspection the home was found to be clean, hygienic and free from offensive odours. Decoration is in good order with some having been undertaken recently, the bedrooms and communal rooms are comfortably furnished to provide a homely environment. Records are kept which detail routine maintenance and redecoration. On inspecting the hot water temperature monitoring records it was noted that water in the en-suite to room 8 was regularly recorded as high with no documented corrective action taken. This was addressed as an immediate requirement. The carpet in the recently vacated double room on the first floor was very stained and should be replaced if it doesn’t come clean. A requirement is made to fit fly screening for the window and external door to the kitchen. Redhouse Nursing Home E55 S20793 Redhouse NH V236733 110705 Stg4.doc Version 1.40 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The home has a stable, well-motivated and trained staff offering consistency of care and an enthusiastic staff group keen to maximise the quality of life for the service users. EVIDENCE: The rotas confirm that numbers across the 24 hour period and skill mix of qualified and unqualified staff are appropriate to the needs of service users. The ancillary services provide a full 7-day service. The home is used for the placement of trainees provided by Age Concern. Redhouse Nursing Home E55 S20793 Redhouse NH V236733 110705 Stg4.doc Version 1.40 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 36 & 37 The home regularly seeks the views of service users and relatives to assess its performance in meeting their needs. Leadership is good at the home with supervision and direction to staff to ensure that the service users receive consistent quality care this should be further demonstrated by documented involvement of the proprietor. Records maintained by the home support the delivery of care and services that ensure consistency and safety for service users. EVIDENCE: The home has recently engaged in a survey of service users satisfaction and separately a survey of relatives. The inspector was informed that the responses of both were positive and supportive of the home, in the absence of the manager the findings were not available to view. Redhouse Nursing Home E55 S20793 Redhouse NH V236733 110705 Stg4.doc Version 1.40 Page 17 The proprietor while regularly in attendance at the home does not undertake formal monthly regulation 26 inspections, a requirement is made to implement this. The home does not take responsibility for service user finances or act as appointee. Small amounts of money left by family are fully recorded on an individual record with receipts and counter signatories. This money is used for private chiropody, hairdressing, manicures, toiletries and cigarettes. A sample of records required by regulation were inspected and found to be maintained in good order, up to date and stored in compliance with the Data Protection Act. Redhouse Nursing Home E55 S20793 Redhouse NH V236733 110705 Stg4.doc Version 1.40 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x x 3 2 x Redhouse Nursing Home E55 S20793 Redhouse NH V236733 110705 Stg4.doc Version 1.40 Page 19 No Are there any outstanding requirements from the last inspection? 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 3 Regulation 14(2) Requirement The registered person must keep the assessment of needs under review and revised as circumstances change The registered person must undertake a falls risk assessment for all service users and review regularly The registered must implement a programme of staf f training and practice that demonstrates the danger of re-sheathing used hypodermic needles to eradicate this practice. The responsible person must ensure a safe supply of hot running water is provided at all service user outletsat all times. The responsible person must fit fly screening to the kitchen window and external door. The registered provider shall visit the home on an unannounced basis at least monthly, prepare a report and provide a copy to the Commission. Timescale for action 31.8.2005 2. 3 14(1)(a) 31.8.2005 3. 9 13(3) 31.8.2005 4. 19 13(4) immediate 5. 6. 19 37 16(g) 26(1)(3) (4) (5) 31.8.2005 31.8.2005 Redhouse Nursing Home E55 S20793 Redhouse NH V236733 110705 Stg4.doc Version 1.40 Page 20 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 Good Practice Recommendations Redhouse Nursing Home E55 S20793 Redhouse NH V236733 110705 Stg4.doc Version 1.40 Page 21 Commission for Social Care Inspection Halesowen Office, Mucklow Office Park West Point, Mucklow Hill Halesowen B62 8DA 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 Redhouse Nursing Home E55 S20793 Redhouse NH V236733 110705 Stg4.doc Version 1.40 Page 22 - 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. 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