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Inspection on 05/02/07 for Redlands Acre

Also see our care home review for Redlands Acre for more information

This inspection was carried out on 5th February 2007.

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

Redlands Acre provides a pleasant and homely environment for the residents living there, and is welcoming to visitors. The home has the benefit of a long serving manager and a committed core team of staff. Residents and visitors all speak very positively about the staff here. Residents are admitted to the home on the basis of a full assessment of their individual needs. Once admitted, a personal plan of care is drawn up for each resident. Residents spoken to directly were themselves very happy with their care and the way in which they were treated by staff. They confirmed that staff always show respect for their privacy, their personal choices and their preferred ways of spending their time. Visitors too were very satisfied with the way in which their relative was looked after at Redlands Acre. Staff at the home work together with other health care professionals to ensure that residents receive all the medical help that they need. Residents are able to manage their own medications if they choose and are able to do so; residents retaining independence in this home is supported by the staff, as far as practicable. Residents have the opportunity to participate in a range of social opportunities, which includes the pursuit of personal hobbies and interests; however there were occasions when staff were not spending time with residents socially, and residents were sitting quietly and unattended. They are enabled to remain part of the local community, with access to amenities and facilities. There is generally a good standard of meals served here, with residents satisfied with the quality and quantity of food they have. People can be assured that the home takes any complaint seriously, and has a thorough approach to addressing any that are received. There are policies and procedures in place for the protection of the vulnerable residents, which staff are familiar with through training, and the home offers a safe and transparent system for safeguarding personal monies or valuables for those residents wanting such a service; it was recommended however, that this system should be regularly audited to ensure continued accuracy. New staff are recruited using thorough employment procedures, and receive a structured induction to the home with good support and guidance from more experienced staff. Staff are generally adequately trained for their roles, however there was some additional training required in relation to the cook, and some of the care staff. Staff are encouraged to obtain further qualifications to National Vocational standard, and the home has made excellent progress in this area.

What has improved since the last inspection?

The home has introduced a new assessment process for new residents, which is much more thorough and comprehensive, enabling staff to gain a much more in depth understanding of individual needs. Redecoration in the environment has been ongoing, with some new items of furniture, a new oven and some new carpets having been purchased. Some of the smoke detectors have been upgraded.

What the care home could do better:

Isolated additions are required to improve the standard of recording in some parts of the care plan documentation, so that care delivered to residents is accurately recorded. Medications are generally well managed, but some improvement is required in relation to recording and review of certain aspects of residents` medication administration charts. Although most aspects of the home were well maintained and decorated, there were some areas that were identified as needing attention or repair. A bath hoist had not been serviced and safety checked recently, and had to be removed from use until such time as it was. Many areas of the home were kept clean, fresh and well presented, however the kitchen, laundry and some bedrooms had not been cleaned to an acceptable standard, and require some improvement. Impacting on this is the expectation on the care staff to carry out cleaning tasks in these areas. Lack of time and motivation among the team is a big factor, and must be taken into account as part of the review of these arrangements that the home has been required to undertake. The laundry room and its facilities are not entirely suitable for purpose, particularly in relation to infection control, and would benefit from being upgraded. The home`s approach to monitoring quality of standards and services has been very informal, with very few structured systems in place. Although the manager and staff are committed to providing a good service and life for the residents, the home should adopt a range of monitoring tools as part of determining the quality of its service for residents.

CARE HOMES FOR OLDER PEOPLE Redlands Acre 35 Tewkesbury Road Longford Gloucester Glos GL2 9BD Lead Inspector Mrs Ruth Wilcox Unannounced Inspection 09:00 5 February 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Redlands Acre DS0000016555.V320037.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 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. Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Redlands Acre Address 35 Tewkesbury Road Longford Gloucester Glos GL2 9BD 01452 507248 01452 507248 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) CTCH Ltd Mrs Ruth Hartland Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th December 2005 Brief Description of the Service: Redlands Acre is a care home providing personal care to 26 older people over the age of 65 years. Nursing care can be accessed from community resources if needed. The home is situated on a main route into Gloucester city, and is owned and managed by CTCH Ltd. The home has been converted from a large property, with the addition of some purpose built bedrooms on the ground floor. Access to the first floor is gained by the use of a staircase only; there is no stair or shaft lift in the home. However, the vast majority of bedrooms are situated in accessible locations on the ground floor. The home provides 26 rooms, 23 have en-suite facilities, which include a toilet and washbasin. The home provides an assisted bathing facility, and has a specifically designed shower room. The communal areas are situated on the ground floor and consist of two dining rooms, 1 large lounge and a lounge/conservatory. The home also has another lounge, which is used as a smoking room. The conservatory connects the main house to the rear of the property where there are eight attached bungalows, which provide unregistered sheltered accommodation. Residents from this accommodation are welcomed into the life of the home on a daily basis, in terms of a meal and social activity. Information about the home is available in the Service User Guide, which is issued to prospective residents, and a copy of the most recent CSCI report is available in the home for anyone to read. The charges for Redlands Acre range from £329.00 to £435.00 per week. Hairdressing, chiropody and newspapers are charged at individual extra costs. Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector carried out this inspection over two days in February 2007. A check was made against the requirements that were issued following the last inspection, in order to establish whether the home had ensured compliance in the relevant areas. Care records were inspected, with the care of three residents being closely looked at in particular. The management of residents’ medications was inspected. A number of residents and visitors were spoken to directly in order to gauge their views and experiences of the services and care provided at Redlands Acre. Some of the staff were interviewed. Survey forms were also issued to a number of residents, visitors and staff to complete and return to CSCI if they wished. 10 of residents, 50 of relatives and 60 of staff surveys were returned. Some of the survey comments feature in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, training, supervision and provision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 6 What the service does well: Redlands Acre provides a pleasant and homely environment for the residents living there, and is welcoming to visitors. The home has the benefit of a long serving manager and a committed core team of staff. Residents and visitors all speak very positively about the staff here. Residents are admitted to the home on the basis of a full assessment of their individual needs. Once admitted, a personal plan of care is drawn up for each resident. Residents spoken to directly were themselves very happy with their care and the way in which they were treated by staff. They confirmed that staff always show respect for their privacy, their personal choices and their preferred ways of spending their time. Visitors too were very satisfied with the way in which their relative was looked after at Redlands Acre. Staff at the home work together with other health care professionals to ensure that residents receive all the medical help that they need. Residents are able to manage their own medications if they choose and are able to do so; residents retaining independence in this home is supported by the staff, as far as practicable. Residents have the opportunity to participate in a range of social opportunities, which includes the pursuit of personal hobbies and interests; however there were occasions when staff were not spending time with residents socially, and residents were sitting quietly and unattended. They are enabled to remain part of the local community, with access to amenities and facilities. There is generally a good standard of meals served here, with residents satisfied with the quality and quantity of food they have. People can be assured that the home takes any complaint seriously, and has a thorough approach to addressing any that are received. There are policies and procedures in place for the protection of the vulnerable residents, which staff are familiar with through training, and the home offers a safe and transparent system for safeguarding personal monies or valuables for those residents wanting such a service; it was recommended however, that this system should be regularly audited to ensure continued accuracy. New staff are recruited using thorough employment procedures, and receive a structured induction to the home with good support and guidance from more experienced staff. Staff are generally adequately trained for their roles, however there was some additional training required in relation to the cook, and some of the care staff. Staff are encouraged to obtain further qualifications to National Vocational standard, and the home has made excellent progress in this area. Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Isolated additions are required to improve the standard of recording in some parts of the care plan documentation, so that care delivered to residents is accurately recorded. Medications are generally well managed, but some improvement is required in relation to recording and review of certain aspects of residents’ medication administration charts. Although most aspects of the home were well maintained and decorated, there were some areas that were identified as needing attention or repair. A bath hoist had not been serviced and safety checked recently, and had to be removed from use until such time as it was. Many areas of the home were kept clean, fresh and well presented, however the kitchen, laundry and some bedrooms had not been cleaned to an acceptable standard, and require some improvement. Impacting on this is the expectation on the care staff to carry out cleaning tasks in these areas. Lack of time and motivation among the team is a big factor, and must be taken into account as part of the review of these arrangements that the home has been required to undertake. The laundry room and its facilities are not entirely suitable for purpose, particularly in relation to infection control, and would benefit from being upgraded. The home’s approach to monitoring quality of standards and services has been very informal, with very few structured systems in place. Although the manager and staff are committed to providing a good service and life for the residents, the home should adopt a range of monitoring tools as part of determining the quality of its service for residents. Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 8 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. Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A satisfactory assessment process prior to admission to the home gives prospective residents an assurance that their needs can be met. EVIDENCE: Copies of pre-admission assessments carried out on three more recently admitted residents confirmed that the assessment had been conducted and recorded in full before their admission to the home was agreed. In addition to verbal confirmation the home will now adopt the practice of providing written confirmation of placement offers following assessment, as is required. Appropriate care assessments and health information from other health and social care professionals involved in each case were also on file where applicable. Redlands Acre does not provide intermediate care. Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Despite certain shortfalls in recording, the care planning system generally provides staff with the information they need to satisfactorily meet residents’ health and personal needs. Some minor improvements in the medication administration systems are required to ensure that residents are not put at any risk of potential errors. Residents are treated with courtesy and respect. EVIDENCE: All residents have a recorded plan of care that is based on an individual assessment of their health and personal needs. In the majority of cases plans are regularly reviewed, although there were some very isolated gaps in this. Residents are involved to some degree in the drawing up of their personal plan of care. Three were chosen for closer scrutiny as part of the case tracking exercise. Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 12 Although plans largely recorded the care and support needed, shortfalls were identified in two cases. Staff had not recorded a pressure sore risk assessment in one case, although this person was evidently not at risk in this regard anyway; this had been addressed by the second day of this visit. The daily notes for the same person showed that there was a skin condition to the legs requiring a prescribed treatment and the intervention of the district nurse. Staff when interviewed were quite clear about this and were carrying out this element of care in this case; however, there was no documented plan of care to address this, with nursing interventions not recorded clearly. In the second case, although mobility needs were identified on assessment, the associated care plan was minimal and not adequately informative to staff. Also in this same case, the nutritional risk assessment showed that they were at significant risk nutritionally. The risk assessment tool contained guidance for staff to follow in terms of actions to take in response, but the associated plan of care was not actually reflective of this; some staff interviewed were able to confirm that monitoring in this regard did take place however. Records and direct observation confirmed that the residents are afforded regular medical reviews and consultations, and access to a range of health care services, either in the community or in the home. The home has direct access to general practitioners, district nurses, continence specialist nurses, optical, dental and chiropody services. In one particular case there was a lot of involvement and support from the psychiatric services, with good, clear communication between all parties. Although there are currently no residents requiring pressure relieving mattresses or hoisting equipment, there are clear protocols laid down and understood by staff in the home for sourcing such equipment when needed. Residents are able to self-medicate in this home if they wish and are able, and can do so on the basis of a documented risk assessment; at least two residents were doing this. The home has recently changed its pharmacy supplier, and has clearly printed Medication Administration Records for each person. The home has done well to introduce clearly drafted protocols, easily accessible to staff, in relation to the use of any medications prescribed on an ‘as necessary’ basis, or as an external therapy. Variable dosages are recorded in the main, although there were some isolated gaps with this. Staff had signed for administering medications consistently. There were isolated instances where a medication was not being given strictly in accordance with the prescribed order, such as with an inhaler or a particular liquid medication; this was because the resident had not needed it. There were no coded entries to identify reasons for omission, and the instructions had not been reviewed in order to be more accurate either. Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 13 Storage of medications is safe, with appropriately detailed records for receiving and disposal of all types of medication. The majority of medications are supplied in a monitored dosage system, with a smaller number dispensed in boxes or bottles; staff date such items when opened, to ensure they are not used beyond their expiry time. Random audits were carried out on three specific medications and there were no discrepancies noted. All staff involved in medication administration have received specifically accredited training from a local college. The home has reference material, but it was suggested that the main drug reference book be updated, as it was out of date. Residents surveyed, or spoken to directly during the visit, without exception, indicated their satisfaction with the care and the way in which they were treated at Redlands Acre. Each said that staff were very helpful and kind, and also confirmed that their privacy was respected always. One lady said that staff always knocked on her door before entering. Another person elected to keep their door locked when they were not in there. Relatives surveyed, or spoken to directly, were largely completely satisfied with the care their relative received. Staff were observed to be gentle, discreet and sensitive when dealing with residents. Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home makes efforts to ensure that the opportunity to engage in social activities is offered to all residents, and that they can exercise choice in their daily lives, and keep close contact with their families and friends. Despite some shortfalls in the kitchen, residents’ dietary needs are adequately catered for, with food available to meet individual tastes and choices. EVIDENCE: A social events and dates calendar is produced each month, copies of which are displayed and also provided to each resident. The calendar for this month showed a small range of social opportunities, which included group activities such as video shows, a clothes show, music and movement, a sherry morning and a game. Special dates also featured for celebration such as Valentines Day, Shrove Tuesday, and a 100th birthday party. The home endeavours to maintain links within the local community, and has contact with a school and church, and ensures that residents are able to go out to local amenities such as garden centres, public houses and other homes within the CTCH Ltd group. Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 15 Residents themselves confirmed that they do have things to keep them occupied, with some able to pursue a personal hobby or interest. Residents’ choice in relation to lifestyle and how they spend their time was clearly respected and supported by staff, and one resident had the equipment needed to enable her to do this in her own room; this included a speakerphone to allow her to participate in her chosen religious meetings. This was of great importance to her, as she felt part of the congregation still. Her supper times had been adjusted for her in order that she would not be interrupted during meetings. This person was partially sighted and had a large button telephone, talking clock and talking book to assist her. Despite a programme of events, residents were observed sitting in the lounge in sociable groups, unattended by staff for periods, and with little going on around them. Visitors were observed coming in and out of the home; two were spoken to directly. In addition to the visitor surveys, each of these confirmed that they felt very welcome in the home, and could visit at any time they wished. Each found staff helpful and approachable, providing them with information as necessary, and consulting with them appropriately. Visitors were offered refreshment. Residents were seen moving freely around the home, spending their time where and how they chose. One resident particularly mentioned that she could ‘do as she pleased’. One resident said he ‘still managed to go outside a bit on his own’. Residents could state their preferred times of bathing. One resident was having particular problems settling in the home, and staff had made efforts to replicate her familiar past routines to try and help her. Advocacy, CSCI and funding information was displayed in the home for anyone who may have been interested in this. Individual bedrooms appeared different and varied, as residents are supported to personalise their rooms with their own treasured belongings. Residents also have a degree of choice with their meals. Two choices of lunch and pudding were offered, and a list of residents’ individual choices had been supplied to the cook for her reference; there were at least two supper options as well. The cook was aware of any special diets, and had prepared soft meals for some, and diabetic sweets for others. Residents were very satisfied with the quality and quantity of food provided for them. Snacks were available between meals, and homemade cakes were prepared. The kitchen was seen before the service of the lunchtime meal. Many parts of the kitchen were unclean, including shelving, equipment, the interior of the refrigerator, the floor and food container boxes. There was a cleaning schedule, but this clearly had not been observed. Certain foodstuffs Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 16 requiring refrigeration had been left at room temperature and had to be disposed of. It is of some concern that it is the care staff who have the responsibility for cleaning the kitchen; this arrangement is contributing to a lack of time and motivation to carry out this task properly, and also towards residents sitting alone during the afternoons. The home must review these arrangements, in order that the kitchen is better maintained, and that care staff skills are better utilised with the residents. Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good system for dealing with complaints, with evidence that residents and visitors feel any concerns they may have are listened to and acted upon. The home’s Adult Protection policies help to provide a safe environment for the residents. EVIDENCE: Redlands Acre has a written procedure for dealing with complaints, which is clearly displayed in the home. The home has not received any complaints recently, and therefore there were no records to inspect. Resident survey responses confirmed that they have confidence in the staff to listen and act upon their concerns should they raise any, with all knowing who to speak to and how to make a complaint if necessary. Visitor surveys also confirmed their awareness of the home’s complaints procedure, should they need it. Residents and visitors spoken to directly, without exception, said that staff were most approachable and helpful if concerns were raised, and acted swiftly to address them. Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 18 The home has written policies and procedures for the protection of the vulnerable residents, although these now needed updating in certain areas. Policies also included the disciplinary procedures for staff in the event of any concerns. Most staff had received updated training in recognition and how to deal with abuse just recently, with more due to attend in the immediate future. Those spoken to were able to discuss the level of training they had received, and were conversant in adult protection issues. Power of attorney arrangements were in place for more vulnerable residents where appropriate. Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite concerns in relation to certain aspects of the environment, residents are provided with a mostly clean and comfortable place to live. EVIDENCE: There is a peripatetic maintenance person within the CTCH Ltd group of homes. Records of maintenance are kept, and the home is generally well maintained and decorated. Since the last inspection redecoration has been ongoing wherever necessary, and new items of furniture, a new oven and some carpets have been purchased. Some smoke detectors have been replaced. The communal areas are well presented, but as cold weather coincided with this visit the temperature in the Sandhurst lounge was not warm enough for residents to use in comfort. There were large patches of discolouration on the Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 20 carpet in here, which the manager thought was regular staining; she resolved to address this with the cleaner. The glass sliding door between this lounge and the adjacent interior lounge was noted to be stiff, and should be corrected, as residents and staff need a degree of force to move it. In one of the resident’s bedrooms, which was identified to the manager at the time, there was significant damage to the vanity unit, and moisture permeable material was exposed due to a large piece of surface material breaking off. The home was reasonably clean in most areas, although certain bedrooms had not been adequately vacuumed, and two rooms in particular were poorly cleaned; one of these rooms had an unpleasant odour. One visitor commented, that in her opinion, the home was very poorly cleaned. The laundry room would benefit from some refurbishment and improvement. The two washing machines do not have a sluicing cycle and are not capable of washing to high temperatures. It has long been the intention of the home to replace these machines with more effective ones, but there is still no progress in this regard. In addition to this, there are no hand washing facilities in the laundry room, with only a hand sanitising gel made available as a substitute. Some of the hard surfaces in the laundry were dirty, and there was at least one broken tile on the floor, all of which could pose an infection control risk. It was also noted that above head height cupboard doors were in a poor condition with broken slats, and should ideally be repaired. Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although staff are provided in sufficient numbers to meet the needs of the residents, current deployment and non-care related duties have the potential to impact on this in an adverse way. Recruitment procedures ensure that suitable staff are employed for the protection of residents. The arrangements for their induction and training are mostly satisfactory, with staff able to learn the skills necessary for their role. EVIDENCE: The staff rota demonstrates that there are three carers on duty during daytime hours, with one waking and one sleep-in carer overnight. The sleep-in arrangement, although not ideal, has been in place at this home for some considerable time now, and should remain under constant review in relation to its appropriateness for the needs of the residents. The registered manager works in a supernumerary capacity. A cook is on duty every day of the week, and a cleaner is on duty on four days. Despite having twenty-six residents in their care, the three carers are expected to undertake a very significant range of non-care tasks, which include catering for breakfast and supper, laundry, and cleaning residents’ bedrooms and the kitchen. To assist them with laundry and bigger cleaning tasks, a fourth carer is provided to work in the middle of the day on certain days of the week. Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 22 Despite isolated concerns on staff surveys the manager is doing well to ensure an appropriate skill mix of staff in the home more consistently. Efforts have been made to cover staff absence and sickness, but there have been occasions when this has proved problematic, resulting in only two care staff being on duty during the evening; these circumstances would not be considered safe. Staff spoken to indicate that there is a good team essentially, with these staff, plus other staff survey results, expressing concern about the amount of noncare tasks they are expected to perform. Despite isolated comments in staff surveys indicating that meetings and supervisions did not often take place, this was not borne out during this visit. There were recorded minutes of regular staff meetings, and the manager was advised to incorporate the practical supervision provided to staff into the formal supervision programme in writing. Residents and visitors all spoke very positively about the staff in the home, with isolated comments that there were inadequate numbers on occasions. Despite some qualified care staff leaving in recent months, the home is making excellent progress with the National Vocational Qualification (NVQ) training programme for care staff. Seven carers are qualified to at least level 2, with four of these at level 3. One of the senior carers is going on to do the NVQ level 4 training. Three staff files were chosen for inspection, on the basis of their recruitment to the home since the last inspection. Each record contained application forms, including a full employment history. Records of interviews were seen. Evidence of the required pre-employment checks was seen in each of the files, including medical checks, proof of identity, two written references, Protection of Vulnerable Adults (POVA) checks and Criminal Records Bureau (CRB) clearances. A new worker, who had just started in the home, confirmed that she had been allocated to a supervisor for the duration of her induction. She confirmed she had felt very well supported, and had attended a structured induction day with an external training provider, and had received an in-house programme of basic topics to learn. Staff surveyed said that they had received induction and ongoing training, and those spoken to directly confirmed the same. Training records showed a range of topics that had been delivered for staff, which included mandatory and optional subjects, each of which was relevant to the worker’s role and responsibilities. However, a new cook had not yet attended Food Hygiene training, and care staff had not attended any specific training in dementia, despite some residents’ having needs in this regard. Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 23 Staff are issued with certificates of their learning for their own personal training record, and are encouraged to maintain and develop their own personal and professional portfolio. Staff are also issued with the General Social Care Council (GSCC) Code of Conduct. Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Despite isolated concerns, there are some good management systems in place here to ensure that the interests, and health and safety of the residents are safeguarded. EVIDENCE: The manager is very long serving at Redlands Acre, and is registered with CSCI for her position. She does not hold a formal current management qualification, but has attended ongoing training relevant to her role and responsibilities. Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 25 The registered care provider ensures that monthly quality monitoring visits to the home are conducted, with reports produced on the basis of findings, as is required. There is evidence that internal audits are carried out in certain areas of the home with improvements made where necessary, but these do not appear to have been particularly structured, with no recorded auditing tools and action plans available. Residents’ surveys have been distributed in the past in order that they might provide feedback on their views and experiences of the service here; however, this exercise has not been repeated for some significant time. The manager does remain very accessible to residents and their families however, and regularly consults with them on an informal basis; despite this one visitor commented on survey that they would like more contact with senior staff. Some formal meetings have been held, to which relatives are also invited, and although these are poorly attended, residents have been given the opportunity to discuss aspects of their home, and how it is run. Staff share in the outcomes of CSCI inspections, and are informed about the home’s strengths and areas of weakness for improvement. Some residents have placed personal money with the home for safekeeping. Clear and transparent records for each person, which include transaction details, running totals, and receipts, are kept. Two random audits on residents’ monies proved to be largely correct, with a four pence discrepancy found in one, which was rectified immediately. A regular audit of these arrangements by the home would have picked this small error up at the time it was made. Residents or their representative can sign to acknowledge any transactions, but if this is not possible two staff members sign the records to witness on behalf of the resident. The home has a written health and safety policy. Staff had received training in fire safety and manual handling, with all qualified in basic first aid. Night staff had only undergone fire drills in recent months and must attend a more intensive fire safety update, as the day staff have. A fire risk assessment is in place, and this is now to be reviewed in order to incorporate the fire safety training needs of each individual member of staff. Safety checks and maintenance of equipment is undertaken in a timely fashion, although the electrical installation safety check is now overdue for renewal by several months. A bath hoist, sited in an unused ground floor bathroom, had not been serviced or checked for safety; this must be rectified or removed from possible use completely. Hot water temperatures were regularly checked for safe levels, and records showed that hot water is stored at appropriate temperatures for the control of Legionella. Accident records are maintained, and these are audited on a monthly basis. The environment was generally safe and secure. Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 (1) & 17(1.a) Schedule 3 (3.m) Requirement Timescale for action 31/03/07 2 OP9 13(2) 3 OP15 16 (2.j) The registered manager must ensure that staff prepare written care plans that incorporate and plan for all aspects of care which are needed in each case; (This is with particular reference to dietary and mobility requirements, and the care of skin conditions and associated health/nursing care on this occasion) 31/03/07 The registered manager must ensure that: • When medication dosages are omitted, staff record a reason for it, so that it is clear that medications have been addressed in strict accordance with prescribed orders, and to avoid the risk of errors • Instructions for medications are reviewed by a Doctor, if they are no longer in line with the residents’ requirements. The registered manager must 31/03/07 ensure that appropriate steps are taken to maintain the kitchen and its equipment in a clean and DS0000016555.V320037.R01.S.doc Version 5.2 Redlands Acre Page 28 4 OP19 23(2.p) 5 OP19 23(2.c) & 13(3) 6 OP26 13(3) 7 OP26 13(3) 8 OP27 18(1.a) 9 OP30 18(c.i) & 16(2.j) 18(c.i) 10 OP30 11 OP38 23(4.d) hygienic condition, so as to reduce any infection risks to residents. The registered person must ensure adequate heating in the Sandhurst lounge, so that residents may use this room in comfort if they wish. The registered manager must ensure that repairs are implemented to the vanity unit in the identified resident’s bedroom, so as to improve the appearance and to remove the infection control risk. The registered person must provide CSCI with written details of their plans to improve and upgrade the laundry facilities. The registered manager must ensure that the laundry room is thoroughly cleaned, and any broken floor tiles are replaced to prevent any infection control risks. The registered manager must carry out a review of the provision and deployment of staff, with particular focus on the non-care tasks they carry out whilst endeavouring to meet the needs of the residents; the results of this review must be provided to CSCI. The registered manager must ensure that Food Hygiene training is delivered to the new cook. The registered manager must ensure that Dementia/Mental Health related Care training is provided for care staff, in order that they are sufficiently skilled to meet any needs of residents in this regard. The registered manager must ensure that fire safety and prevention training is delivered DS0000016555.V320037.R01.S.doc 28/02/07 31/03/07 30/04/07 31/03/07 30/04/07 31/03/07 31/05/07 31/03/07 Redlands Acre Version 5.2 Page 29 12 OP38 13(4.c) 23(2.c) to all night staff, so as to promote the safety of the home and residents at all times. The registered manager must ensure that the ground floor bath hoist be removed from use until such time as it is serviced and deemed safe for use by a qualified engineer. 28/02/07 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 2 Refer to Standard OP7 OP26 Good Practice Recommendations Care plan reviews should be carried out on at least a monthly basis. The registered person should ensure that: • A wash hand basin is provided within the laundry room • The existing washing machines are replaced with more suitable models. A designated laundry assistant and evening catering assistant should be employed. The registered manager should ensure that resident and visitor surveys are more regularly carried out, as part of the quality monitoring systems. The registered manager should establish and utilise auditing tools as part of the quality monitoring processes, and produce an action plan on the basis of any assessments, which demonstrates all actions to be taken as a result. The registered manager should carry out regular audits on the arrangements to safeguard residents’ monies in the safe. The registered manager should ensure that an updated electrical installation safety check is carried out. 3 4 5 OP27 OP33 OP33 6 7 OP35 OP38 Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Redlands Acre DS0000016555.V320037.R01.S.doc Version 5.2 Page 31 - 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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