Inspection on 04/12/08 for Redroof House

This inspection was carried out on 4th December 2008.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Redroof House 26/01/09

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Southfields

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Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Redroof House 40 Mill Road Epsom Surrey KT17 4AR     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lisa Johnson     Date: 0 4 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Redroof House 40 Mill Road Epsom Surrey KT17 4AR 01372748247 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Ranjith Hikkaduwa Liyanage,Mr Nethaji Jayawardana,Maithri Jayawardana Name of registered manager (if applicable) Mr Nethaji Jayawardana Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 5. The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Date of last inspection Brief description of the care home Redroof is a converted House set in its own grounds. It is close to a shopping area and is approximately ten minuites from Epsom town centre by car. The service provides support to five adults with learning disabilities. Accomodation is situated over two floors . One bedroom is provided on the ground floor. There are two sitting rooms and a large kitchen. There is one communal toilet on the ground floor. Three bedrooms have en suite facilities and the other two bedrooms have access to a large bathroom Care Homes for Older People Page 4 of 27 Over 65 0 5 Brief description of the care home which has a jacuzzi bath. There is a small enclosed garden to the rear of the property and car parking spaces are available at the front of the house. The weekly fee is £1,000 Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This visit was part of a key inspection. The site visit was unannounced and took place over four hours and twenty minutes commencing at 9:20am and finishing at 13:40pm. Mrs. L Johnson regulation inspector carried out this visit. Information was provided to us by the service prior to this visit in the Annual Quality assurance assessment (AQAA). This is a self assessment that focuses on how well outcomes are being met for people using the service. Reference is made to this document throughout this report. During this visit we spoke to one person who lives in the service and one member of staff. We also had the opportunity to speak with the registered manager and the other Care Homes for Older People Page 6 of 27 two registered providers. During this visit we conducted a full tour of the premises, looked at care plans, risk assessments, staff personnel and training records and policies and procedures. The inspector would like to thank the person living in the service managers and staff for their time, assistance and hospitality during this inspection. Improvements in staff recruitment practices must be embedded into practice and demonstrate that people living in the service are fully protected from harm. The quality rating is a reflection of this What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with accessible information that they need to know to make an informed choice about the suitability of the home as a place to live. Peoples needs are assessed prior to admission to the home. Evidence: The home has developed a detailed and comprehensive statement of purpose and service user guide which is accessible to people with the inclusion of pictures. The statement of purpose details the aims and objectives and the services that it is able to provide. The home was registered with the Commission in July 2008. One person has been admitted to the service. The home has an admissions policy in place. The manager had conducted a pre- admission assessment for this person which covered health, personal, social, cultural and religious needs. Further information had been obtained Care Homes for Older People Page 10 of 27 Evidence: from the persons previous placement and community care assessments. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the personal support from staff in the way they prefer and their health needs are met. Further improvement is needed to ensure that the medication in the home is stored safely. Evidence: The service has produced accessible detailed and comprehensive person centred care plans, which had been provided for the one person currently residing in the home. The care plan also included a health action plan. Information was recorded about the persons health, personal, communication, social, cultural and religious needs. The persons likes, dislikes and preferences were also recorded. The persons health action plan detailed the persons health and personal needs and how to keep them healthy and the regular health screen checks that they require including chiropody and opthalmic appointments. This persons care plan identified that they require an accessible shower with a chair. This person has access to an en suite bathroom and the service has demonstrated that the appropriate equipment has been Care Homes for Older People Page 12 of 27 Evidence: provided. We were informed that discussion has taken place with the persons General Practitioner about an occupational therapy assessment referral. A moving and handling assessment had been completed and information was recorded about the nutritional needs of this person to maintain their health and wellbeing On arrival at the home one person was being supported by a member of staff with their personal care in the privacy of the persons bedroom. This persons care plan identified that it is important to them to be allowed to get dressed in their own time. The homes medication practices were examined. There is medication procedure in place and a list was available for all staff trained to administer medication. Systems are in place for the receipt and disposal of medication.Medication is dispensed by a local chemist using the monitored dose system (MDS). During this visit it was observed that the medication record for one person had been hand transcribed by staff for on item, which did not record the correct information for one item. This was brought to the attention of the manager who attended to this matter during this visit. However it was recommended as good practice that where any medication is transcribed by staff this should be checked and signed by two members of staff . During this visit one persons medication was seen to be stored in an unlocked cupboard in the kitchen. This practice was discussed with the manager who then moved this medication to a locked facility. Discussion took place with the manager about ensuring that medication is appropriately stored following good practice guidance. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the service are supported to take part in appropriate activities and take part in the local community. People are supported to maintain links with their family and friends and they are offered a well balanced diet. Evidence: Care plans contain information in How i spend my week. Information supplied in the AQAA stated that people moving into the home will be provided with a range of appropriate activities with the home and the local community based on their abilities and preferences. During this visit we looked at the activities currently being provided for one person who resides in the home. This person enjoys listening to music and told us that he likes Freddy mercury which the service has responded to. This person likes going out for walks or visiting Epsom town centre. Peoples religious needs are supported and this person visits church and the home has accessed a local church group which they attend. The AQAA states that the service intends to support people maintaining daily living skills and to be supported in carrying out household activities. Care Homes for Older People Page 14 of 27 Evidence: Information supplied in the AQQA states that the service will strive to encourage people to maintain contacts with their family and friends. The manager told us that their are no visiting restrictions and that people can receive visits at any time During this visit staff were observed to be friendly, caring and attentive to the needs of the person living in the home. They were asked by staff about their preferred choice of breakfast who also spent time listening and engaging with them. People living in the service are able to bring any favorite possessions into the home. A persons bedroom seen during this visit was personalised meeting their preferences. The service has produced four weekly menus and information seen demonstrated that these were varied and well balanced and recorded two choices. Information seen on one persons care plan demonstrated that staff were aware of the nutritional needs of people and fresh fruit was available in the kitchen . Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a complaints procedure and people can be confident their views will be listened to. People living in this service are at some risk of abuse and harm due to the recruitment practices in the service which does not fully safeguard them. Evidence: The home has produced a statement of purpose which is accessible to people being formulated with pictures. The manager is intending to display this in the home. Since being registered with the Commission no complaints or concerns have been brought to our attention or to the home. During this visit we viewed the homes local safeguarding vulnerable adults from abuse procedures. it was not clear as there were two policies. One made reference to the local authority procedures and the other did not. Therefore it was recommended that the manager review this matter. The home has a copy of the local authority safeguarding vulnerable adults from abuse policies, although it was recommended that the updated version is obtained. Three members of staff training records were sampled. Two members of staff had received safeguarding training, although one persons training record indicated that they had not received this, which was also confirmed by them.Therefore it is required that all staff receive up to date safeguarding vulnerable adults from abuse training to Care Homes for Older People Page 16 of 27 Evidence: ensure the safety and wellbeing of people living in the service. Further concerns were identified in relation to the staff recruitment practices in the home ( Refer to standard 29) Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is well maintained, comfortable, clean and hygienic Evidence: The home is situated in a residential area close to local shops and is a short distance from Epsom town centre by car. A full tour of the premises was conducted. The home has converted, redecorated and furnished to a good standard and is modern and domestic in style. There is a main lounge and a smaller separate lounge and a large modern kitchen which has a dining table. There is a communal toilet on the first floor and a large bathroom with a shower and jacuzzi style bath There is a small enclosed garden to the rear of the property. One bedroom on the ground floor is provided with en suite facilities and four other bedrooms are situated on the first floor which were comfortable and colour coordinated. The manager has purchased handrails which are to be fitted shortly and they intending to install a ramp ensuring accessibility for wheelchairs. During this visit discussion took place with the manager in respect of other equipment they may need to be provided to assist older people. The home is currently in the process of arranging a referral to an occupational therapist. Care Homes for Older People Page 18 of 27 Evidence: The home was cleaned to a high standard and infection control procedures are in place. During this visit a health and safety matter was identified (refer to standard 38) Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by enough staff and in the main competent and trained staff . People living in this service are placed at risk by not following robust recruitment procedures Evidence: On arrival at the home there was one member of staff supporting one person. The manager arrived at ten OClock. The duty rota was examined which demonstrated that appropriate numbers of staff are provided during the day. At night time people are supported by a waking member of staff. Currently staff are supplied by the services sister home. We were informed that the home will be recruiting externally. The service supports staff to complete National Vocational Qualifications and an induction programme for staff has been developed based on the Skills for Care induction standards. Staff are supplied with a copy of the General Social Care Code of conduct During this visit we sampled the training files for three members staff which demonstrated that hey receive statutory training, although one area was identified needing improvement. (refer to standard 18). Care Homes for Older People Page 20 of 27 Evidence: We were informed that training takes place externally and the service also employs an external training consultant who visits the service. During this visit we sampled the personnel files for three members of staff. All files contained a fully completed application form and work history. However two peoples files didnt contain written references, although we we were informed that one persons was filed at the providers other home. We were informed that due to a delay verbal references were obtained for the other person. We were informed that staff do not commence employment in the home until an enhanced criminal record bureau check is obtained (CRB) .Three members of staff files contained CRBs, however two out of three of these had been obtained from the persons previous employer and they not been updated by their current employer prior to them working in this service. Protection of vulnerable adult first checks (POVA) had also not been obtained. These concerns were discussed with the providers who agreed with us that this was an area for improvement. By not following robust recruitment practices the home has placed people living in the home at risk by not carrying out important checks and written references before staff work in the home. The registered persons have committed a serious breach of the Care Homes Regulations 2001. The registered persons must make arrangements to ensure that staff who have not received had a CRB carried out in their current employment make arrangements for them to be supervised. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an experienced manager in post. Systems are in place to gain the views of people living in the service ensuring that the home will be run in the best interests of people. Peoples financial interests are safeguarded. Further improvement is needed to ensure that peoples health and safety is fully protected. Evidence: There are three registered providers for this service. One of these people is also the registered manager of this service and their other sister home who currently divides their time between both services. The registered manager is a qualified learning disability nurse and holds a diploma in management and has a number of years of managing learning disability services. The other two providers maintain close links with the service and visit the home on a regular basis, hold meetings and provide on call arrangements. As this service has only been registered with the Commission recently they have not Care Homes for Older People Page 22 of 27 Evidence: yet carried out quality assurance surveys, however the manager showed us the format that they will be using and that they also intend to carry out relative surveys. These have been made accessible to people with the use of pictures. Information supplied in the AQAA states that the home intends to hold regular consultation meetings with people to gain their views. Monthly quality visits have not been been carried out yet but this is intended to be conducted shortly.The service has also implemented a dignity in care audit. The home has a range of policies and procedures and information supplied in the AQAA states that these are brought to the attention of staff which was confirmed by one member of staff during this visit. However the implementation of procedures in respect of staff recruitment has not been fully implemented ensuring that people living in the service are fully safeguarded. Appropriate records were maintained for the safekeeping of monies for one person. where people require support with managing their monies this was recorded in the care plan. A range of risk assessments have been conducted. Records were maintained of water temperature records, although these have were not recorded recently which was brought to the attention of the manager. During this visit the kitchen cupboard containing substances hazardous to health was not locked. This matter was brought to the attention of staff who attended to this matter during our visit. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 13 The registered persons must 08/02/2009 make arrangements, by training staff or by other measures, to prevent people using the service being harmed or suffering abuse or being placed at risk of harm or abuse. This is to ensure the welfare and safety of people living in the service. 2 29 19 The registered persons must 22/01/2009 ensure that staff are not employed in the home unless they have completed a thorough recruitment process, satisfactory written references, and CRB/POVA First check and that all required documentation is in place. The registered person must make arrangements that where employment checks have not been completed for staff currently working in the Care Homes for Older People Page 25 of 27 service that they are supervised until satisfactory employment checks have been obtained. This is to ensure that the safety of people living in the service is protected Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 It is recommended that two members of staff check and sign medication records that have been hand transcribed by them as safe practice. It is recommended that the manager obtains the updated local authority safeguarding vulnerable adults from abuse procedure. It is recommended that the registered person reviews the homes local safeguarding vulnerable adults from abuse procedure 2 18 3 18 Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!