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Inspection on 14/12/05 for Redmount Nursing Home

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

This inspection was carried out on 14th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 care team provide good nursing and personal care to the clients who live their that is also to the satisfaction of the relatives and the General Practitioner`s who service the home. The documentation, including the care plans are well structured and provide good evidence of how care is delivered. The management team work in harmony keeping the staff moral and delivery of care at good levels.

What has improved since the last inspection?

The manager has now been approved by the Commission for Social Care Inspection following its rigorous procedure`s to establish her suitability for the role. The moral of the staff appears to be continually improving as is the communication skills of the overseas staff.

What the care home could do better:

The National Minimum Standards relating to the equipment and environment need to be reviewed so that clients have the appropriate equipment to meet their needs and are assured that the environment is properly adapted, i.e. has suitable bathing facilities, adequate prevention against hot surfaces and appropriate beds for the nursing clients.

CARE HOMES FOR OLDER PEOPLE Redmount Nursing Home Your Health Ltd 21 Old Totnes Road Buckfastleigh Devon TQ11 0BY Lead Inspector Doug Endean Unannounced Inspection 14th December 2005 2:25 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 Redmount Nursing Home DS0000028789.V256998.R01.S.doc Version 5.0 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. Redmount Nursing Home DS0000028789.V256998.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Redmount Nursing Home Address Your Health Ltd 21 Old Totnes Road Buckfastleigh Devon TQ11 0BY 01364 642403 01364 643187 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) Your Health Ltd Mrs Patricia Jane Knowling Care Home 42 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10), Old age, not falling within any other category (10), Physical disability over 65 years of age (35) Redmount Nursing Home DS0000028789.V256998.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Registered for maximum 10 OP Registered for maximum 10 DE (E) seervice users 65 years and over Registered for maximum 10 MD (E) service users 65 years and over Registered for maximum 35 PD (E) service users 65 years and over Date of last inspection 25th May 2005 Brief Description of the Service: Redmount Nursing Home is situated within 150 yards of the main street of the town of Buckfastleigh, which is on the edge of the Dartmoor National Park. It is also just a short distance from the A38 / A384 junction at Buckfastleigh, the A38 leads to the cities of Plymouth and Exeter. The home is a large detached property that has been extended and adapted to provide care to physically disabled people who need both personal and nursing care. It is part of a group of homes that operate under the company name of “Your Health Ltd”. The accommodation is arranged on three floors that are served by two shaft lifts and two staircases. Service Users rooms, communal space and the kitchen area are contained on the ground and first and second floors. The office, a meeting room/staffroom and laundry are situated on the lower ground floor. There are car parking spaces available at the front of the home. The small garden and patio areas are accessible to all Service Users including those in wheel chairs. There are 26 single rooms and 8 shared rooms, the majority of which have ensuite facilities. The home is registered to cater for 42 Service Users (aged 65 and over), 35 of which are registered for Service Users who require nursing care. There are disabled toilets and bathrooms, and a variety of equipment including hoists and pressure relief aids that are available for Service Users who are assessed as needing them. The home has a registered nurse on duty at all times. The home is managed by an experienced registered nurse and an experienced administrative manager. Redmount Nursing Home DS0000028789.V256998.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report should be read along side of the previous report in order to establish the homes performance against the National Minimum Standards during this inspection year. This unannounced inspection took place during the afternoon of the 14th December 2005 beginning at 14.25 hours and finishing at 17.00 hours. The inspector chose to carry out a themed inspection having covered the core standards during the first inspection that was carried out in May of this year. The theme was environment and client satisfaction. The inspector case tracked four clients looking at the environmental provision to meet their assessed needs. In total one relative, six clients were spoken to, one relative and three staff members. There was a tour of the home looking at the provision of equipment to meet the needs of the clients and the National Minimum Standards. What the service does well: What has improved since the last inspection? What they could do better: The National Minimum Standards relating to the equipment and environment need to be reviewed so that clients have the appropriate equipment to meet their needs and are assured that the environment is properly adapted, i.e. has suitable bathing facilities, adequate prevention against hot surfaces and appropriate beds for the nursing clients. Redmount Nursing Home DS0000028789.V256998.R01.S.doc Version 5.0 Page 6 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. Redmount Nursing Home DS0000028789.V256998.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Redmount Nursing Home DS0000028789.V256998.R01.S.doc Version 5.0 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 the following standard(s): 1, 2 & 4. The information provided in the Statement of Purpose and Service Users Guide should inform any prospective client of the service they can expect if the choose to move into the home. The provision of bathing facilities and adjustable beds is no longer satisfactory for the number and disability levels of the clients at the home. EVIDENCE: There is a professionally prepared Statement of Purpose and Service Users Guide. They are clearly laid out and provide enough information for a prospective service user to make a decision about whether the home may be able to meet their needs. The documents include a complaints procedure and a copy was seen in each of the service users rooms. The inspector saw a sample number of contracts that provide information about the terms and conditions of residency. The local authority contracts do have a breakdown of the fee structure to separate out the personal care payment from the nursing care payment, where this is paid. The present version of the homes own contract that was seen during the inspection does not have this breakdown of fee that is required by regulation 5A. Redmount Nursing Home DS0000028789.V256998.R01.S.doc Version 5.0 Page 9 The tour of the home revealed that the provision of adjustable beds for those clients who receive nursing care and who have manual handling and mobility issues is limited. The tour of the home also revealed that the number of bathrooms in use has decreased to below that set in the National Minimum Standards. The home is staffed by care staff who have been prepared for the job by good induction and ongoing training such as infection control and manual handling. A number of the Senior care staff are actually Registered Nurses in their own country and some are undergoing “Adaptation” training to allow them to practice as a Registered Nurse in this country. Every shift is led by a Registered Nurse and they are supported by adequate numbers of care staff and ancillary staff such as catering, domestic and maintenance. Redmount Nursing Home DS0000028789.V256998.R01.S.doc Version 5.0 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 the following standard(s): 7 The care of the clients is guided by well produced care plans following good assessment using every resource and source available. EVIDENCE: The files of four nursing clients were used to track the care they receive and the provision of equipment presently at the home. The files and the care plans were found to be well constructed and the information such as the care plans were informative and regularly reviewed. There are risk assessments in the home that support the use of such equipment as bed guards. Care staff were observed writing their interactions and observations in clients files under the supervision of the Registered Manager. Redmount Nursing Home DS0000028789.V256998.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 12 & 13 The staff promote good relationships between the clients, their relatives and friends and themselves. The level and type of activity involving the clients meets their social, psychological and some physical needs. EVIDENCE: Most of the clients that were spoken to said that they do have visitors on a regular basis and that the staff at the home make them feel welcome. They can also see their visitors in the communal areas or in their own rooms if they wish. Some of the clients are able to leave the home, usually under supervision, to visit friend or fulfil hobbies and interests, i.e. fishing. The inspector spoke to one relative who was visiting and she reported a high level of satisfaction with the care and the facilities offered by the home. The homes routine allows for activities each day either run by a member of staff who is allocated to plan and execute an activity (alternating daily) or by an outside entertainer. The inspector observed staff involved in activities with the clients during the afternoon and spending time to talk to them also. The visitor remarked on the excellent party that had taken place during the previous weekend and included visitors to the home. There was a poster at the main entrance advertising the Christmas Activities planned to take place over the month of December. Redmount Nursing Home DS0000028789.V256998.R01.S.doc Version 5.0 Page 12 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 the following standard(s): EVIDENCE: This section was reported on during the last inspection. Redmount Nursing Home DS0000028789.V256998.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 19, 20, 21, 24 & 25. The home is clean, tidy and has regular maintenance however there is a need to address the shortfall that has occurred in equipment and facilities to meet the needs of the disabled and nursing clients as well as the National Minimum Standards. EVIDENCE: The home employs their own in house maintenance man who does keep the home in good decorative order and provides good records to support the other maintenance work he does or that is carried out by outside contractors. This was seen at the last inspection and not looked at on this occasion. The home has good levels of communal space on the ground floor that includes a lounge, dining room and a conservatory. The clients were congregated mainly in the lounge area that was warm and comfortable. In this area the television did provide some entertainment for the clients whilst others were engaged in the days social activity also in the same area. Other clients were in a separate lounge area off the main lounge that offers a quite retreat. The furniture was generally domestic in nature. Redmount Nursing Home DS0000028789.V256998.R01.S.doc Version 5.0 Page 14 There are en-suites in most bedrooms and six of these also provide bathing facilities. During the tour of the home the inspector became aware that one bathroom on the first floor had its bath taken out. Also a ground floor shower room was not in use and seemed to be used as a store room. This left one large bathroom on the ground floor, one old style shower room on the first floor and one shower room on the second floor. This does not now meet the number of facilities required by the National Minimum Standards the formula being at least one assisted bath (or assisted shower providing this meets residents needs) to 8 service users for pre-existing care homes at 16th August 2002. The present provision is three baths for 36 clients. The inspectors tour of the home revealed that the provision of adjustable beds for those clients who receive nursing care and who have manual handling and mobility issues is limited. Presently many nursing clients with significant manual handling needs are provided with non-height adjustable divan beds. During the tour of the home the inspector found that the radiators in some areas were not provided with radiator guards or were not of the low surface temperature design. The radiator in the dining room was hot and may present a risk to clients. Redmount Nursing Home DS0000028789.V256998.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: This section was reported on during the last inspection. Redmount Nursing Home DS0000028789.V256998.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 The newly approved Registered Manager has the qualifications, experience and leadership skills to deliver good nursing care by utilising the skills of her care team that are employed by the home. EVIDENCE: The home now has an experienced Registered Nurse with Nursing Home management experience as their Registered Manager. She has recently been processed by the Commission for Social Care Inspection and found to have the qualifications and experienced to be approved for the role of the homes Registered Manager. She has current knowledge and experience working with people who fall within the category of registration that the home takes. Within the home she is supported by the Administration Manager who is equally experienced in her role and works along side the Registered Manager. There are clear lines of accountability in the home and with the external management. Redmount Nursing Home DS0000028789.V256998.R01.S.doc Version 5.0 Page 17 The other core standards were reported on during the last inspection. Redmount Nursing Home DS0000028789.V256998.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 X 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 2 X X 2 2 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 3 X X X X X X X Redmount Nursing Home DS0000028789.V256998.R01.S.doc Version 5.0 Page 19 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 OP2 Regulation 5A Timescale for action Where nursing care is being 01/01/06 provided, the contract shall have a breakdown of how the fees are proportioned to include the funded nursing care and personal care amounts. The registered person shall 30/03/06 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of the service users. The provision of suitable adjustable beds for those in receipt of nursing care, whose assessment warrants one, and the provision of an adequate number of suitable bathing facilities strategically placed around the home. The registered person should 28/02/06 make arrangements to reinstate the bathing facilities to provide sufficient numbers of bathing and shower facilities with hot and cold water supplies to meet the needs of the service users in line with Department of Health guidance. The registered person shall 30/03/06 DS0000028789.V256998.R01.S.doc Version 5.0 Page 20 Requirement 2 OP4 12(1)(a) 3 OP21 23(2)(j) 4 OP24 12(1)(a) Redmount Nursing Home ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of the service users. The provision of suitable adjustable beds for those in receipt of nursing care, whose assessment warrants one, and the provision of an adequate number of suitable bathing facilities strategically placed around the home. 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 OP25 Good Practice Recommendations There should be a review of the risk assessment of the home in relation to hot surfaces that should be done as a priority. Particular attention should be paid to the provision of a design solution to prevent burn injury from hot radiators. Redmount Nursing Home DS0000028789.V256998.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Redmount Nursing Home DS0000028789.V256998.R01.S.doc Version 5.0 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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