Inspection on 05/07/05 for Redlands Acre

This inspection was carried out on 5th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Redlands Acre 05/02/07

Redlands Acre 05/12/05

Redlands Acre 16/12/04

Redlands Acre 27/07/04

Redlands Acre 19/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Redlands Acre 35 Tewkesbury Road Longford Gloucester GL2 9BD Lead Inspector Ruth Wilcox Unannounced 5 July 2005, 09:30 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. Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Redlands Acre Address 35 Tewkesbury Road Longford Gloucester GL2 9BD 01452 507248 01452 507248 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) CTCH Ltd Mrs Ruth Hartland Care Home 26 Category(ies) of OP old age (26) registration, with number of places Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 16 December 2004 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, one of which has a small sitting area, 1 large lounge and a lounge/conservatory. The home also has another lounge, which is referred to as the ‘quiet 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. Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over four hours on one day in July. The Registered Manager was not present for the inspection, but the carer in charge of the home on the day was able to provide assistance where required, and the Group Care Manager also attended to offer help. The home appeared organised, calm and homely, with soft music playing in the hallway. Care records, the management of medications, the standard and choice of meals, and the opportunities for choice and social contact for the residents were inspected, as were the policies and procedures for protecting the rights of vulnerable residents, and quality monitoring systems. A tour of the premises took place, and staff were observed going about their duties whilst interacting with the residents. The care of three residents in particular was closely looked at. Twelve residents were spoken to directly to obtain their view of the care and services they receive in the home. There was direct contact with five staff, all of whom were very welcoming and helpful, and were open to the inspection process. What the service does well: Redlands Acre provides a comfortable, safe and homely environment for those people living there. There is an inclusive and welcoming atmosphere for families, friends and other visitors. There appears to be a strong sense of community there, with a small number of older people, not receiving care but residing in bungalows attached to the home, participating with certain aspects of home life and enhancing social contacts for residents. The dependency levels are fairly low at the time of this inspection, and full respect is shown to individuals’ personal choices and independence. A good standard and choice of food is provided, with residents’ satisfaction levels high. There is a fairly stable staff team, who have good opportunities for enhancing their skills through professional development, and all have undergone specific training for the protection of vulnerable older adults. Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: 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. Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 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 Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 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) 3, 4 & 6. The home’s admission procedure ensures that all service users are admitted to the home on the basis of a full assessment of their needs, ensuring that they can receive the care that they require. EVIDENCE: Residents are admitted to the home on the basis of a fully documented assessment of their personal needs, which can be performed in hospital or in the person’s own home, as appropriate; the assessment tool used for this purpose is comprehensive, and goes on to form the basis for a care plan when the resident is admitted to the home, once a further assessment based on the Activities of Daily Living model is completed. There is currently a lower dependency group of residents at Redlands Acre, whose needs are met appropriately, by the skill mix of the staff, and appropriate interventions of other health care professionals in the community. However, in order to further improve upon facilities in the home, there are plans to install a platform lift later this year, to meet the needs of anyone becoming unable to manage the stairs. The home does not provide intermediate care. Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 Page 9 Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 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 & 10. There is a care planning system in place, which could be improved upon in some regards, in order that staff have all the information they need to satisfactorily meet residents’ health and personal needs. There is a good system for managing medications, however failure by staff to keep consistently accurate records could pose a risk to the residents. Personal support in this home is offered in such a way as to promote the residents’ privacy, dignity and independence. EVIDENCE: Residents have a personal plan of care devised in consultation with them, which although in a standardised format, is based on an assessment of their individual needs, and is recorded and reviewed accordingly. Risk assessments are recorded with associated planning, however during case tracking some shortfalls were identified. In one case a risk of the resident developing pressure sores was identified; there was no written plan of care to address this, or recording to support any action or inaction by staff. In another case a resident with mental health needs had been seen by the psychiatric Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 Page 11 services on three occasions since admission; there was no written care plan to address this very evident need. Staff source health care services in the local community for the residents, in accordance with individual needs and requirements. The home works collaboratively with health services, though must now keep more comprehensive care planning with reference to health needs. Residents confirmed that staff are fully respectful of their privacy and dignity in all aspects of their lives, and the home’s commitment to this is evident in the ‘Residents’ Charter’ and in care plan recording. Medications are managed by staff in the main, though residents choosing to self-medicate are able to do on the basis of a risk assessment. Medication charts are clearly printed by the supplying pharmacist and recorded by staff, though isolated instances of poor recording were seen. This included the incorrect recording and stock balance of a returned to pharmacy drug, and a discontinued item remaining unchanged on the chart, and failure to sign all hand written entries and include a second signature as a witness. Medications are stored safely, however the failure to consistently date liquid medications when they are opened made it difficult to be assured that they were being used within their expiry time. Controlled drugs, although safe, are not stored in a compliant metal cupboard specifically designed for the purpose. Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 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) 13, 14 & 15. The consideration and respect that is shown by staff towards residents ensures that residents are able to exercise control and choice in their daily lives, and can welcome their families and friends into the life of the home. The home offers a good standard of varied food to meet the residents’ nutritional needs, in accordance with individual likes and dislikes. EVIDENCE: Residents are able to spend their time how and where they choose. All said that staff are respectful to their choices, and that their families and visitors are welcome at any time, and can participate fully in the life of the home. The people who reside in the small bungalows situated at the rear of the home, who are not in receipt of personal care from the staff, but who live more independently and participate socially and at meal times with the residents, further enhance the sense of community at Redlands Acre. There is also an ethos in the home of promoting individuals’ independence and autonomy as far as possible. A choice of well-cooked and appetising food is offered to residents, and all confirmed their appreciation and satisfaction with the meals provided. The service of lunch was seen, and individual choices and requirements were observed with staff providing assistance where needed. The two dining rooms were pleasantly laid, and the meal was taken in a calm and unhurried fashion. Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 Page 13 Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 Page 14 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) 18. The home’s Adult Protection policies and staff’s knowledge and awareness of them helps to provide a safe environment, with the rights of service users upheld. EVIDENCE: The home has written policies and procedures for the protection of vulnerable adults, and has copies of other relevant documents and information available. Staff receive mandatory training in abuse at induction, and all of those on duty had done mandatory adult protection training during their NVQ course. All spoken to were aware of the Whistleblowing procedures to follow if they had any concerns. Systems are in place to allow service users to place money with the home for safekeeping if they wish, with records kept, to which they can have access. Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 Page 15 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) 25. Recent investment has provided additional safety measures in the environment to further promote the safety and comfort of the residents. EVIDENCE: Work to make hot radiators safer has been completed since the last inspection with the provision of radiator guards; this work has been carried to an aesthetically high standard, and is a good safety measure for vulnerable residents. Hot water temperatures are made safe by the provision of blending valves to the hot taps. Staff perform random monitoring of water temperatures, in order to check for any anomalies; records for this were not seen on this occasion. Since the last inspection the Proprietor has confirmed that hot water temperature at storage is at an appropriate temperature of at least 60 degrees centigrade for the prevention of Legionella. Upper level window openings are restricted as an additional environmental safety measure. Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 Page 16 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) EVIDENCE: Although none of the Standards in this section were inspected directly on this occasion, there was evidently a small cohesive staff team on duty, fully meeting the needs of the residents in a timely and efficient manner. Residents were generally very complimentary about the staff team. Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 Page 17 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 & 34. The introduction of a self-audit tool for the home to monitor levels of service for the residents could be further improved by increasing the frequency with which the views of residents and relatives are formally sought. The overall management, including the business management, has ensured safeguards for the service users. EVIDENCE: CTCH Ltd is introducing a series of self-audit assessment tools into the home as part of a quality assurance monitoring system. The Manager will assess the home’s performance in nine separate areas, which relate to the National Minimum Standards. The results will then be followed up by the Group Care Manager and discussed with the Manager and an action plan drawn up to address any areas of concern. Resident satisfaction questionnaires have previously been given to residents to complete, in order to measure levels of satisfaction with the services and care Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 Page 18 offered at the home, however this has not been done for some significant time now. Residents themselves indicated that the Manager and staff do all they can to address any comments or concerns they may have. Robust financial and business management systems are in place, with the centre for business activity being focused in the head office at Cedar Lodge. The Proprietor and General Manager do the financial planning for Redlands Acre, with only limited budgetary responsibility devolved to the home Manager. Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 Page 19 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 x x 3 3 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 x 13 3 14 3 15 3 COMPLAINTS AND PROTECTION x x x x x x 3 x STAFFING Standard No Score 27 x 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 x x 3 x x 3 3 x x x x Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 Page 20 YES 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 7 Regulation 15(1) Requirement The Registered Manager must ensure that care plans clearly detail how each individual need regarding the health and welfare of the service users is going to be met. (This is with particular reference to those at risk of developing pressure sores and to those with mental health needs on this occasion) (Previous timescale of 31/1/05 not met) Medications must be administered in accordance with General Practitioner instructions, or otherwise Medication Administration Records must contain recorded evidence that a medication course has been completed or discontinued. (Previous timescale of 31/1/05 not met) Staff must date liquid medications on opening in order to ensure they are not used beyond their expiry time. Staff must sign any handwritten entries or amendments on medication charts in full. Staff must maintain accurate records of all medications Timescale for action 31 August 2005 2. 9 13(2) 31 August 2005 3. 9 13(2) 31 August 2005 31 August 2005 31 August 2005 Page 21 4. 5. 9 9 13(2) 13(2) Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 disposed of or returned to pharmacy. 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. 3. Refer to Standard 9 9 33 Good Practice Recommendations Staff should ensure that two members of staff sign any handwritten entries on medication charts. The home should make provision to store controlled drugs in a cupboard that is compliant with the Misuse of Drugs (Safe Custody) Regulations 1973. The home should re-introduce the Resident Satisfaction surveys as part of the quality assurance monitoring programme. Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL3 4AB 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 Redlands Acre D51_D03_s16555_Relands Acre_v233624_050705_Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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