Inspection on 24/07/08 for Redruth Nursing Home

This inspection was carried out on 24th July 2008.

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

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.

Other inspections for this house

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Redruth Care Ltd trading as Redruth Nursing Home Weedon Road Upton Northampton Northants NN5 4RR Lead Inspector Sally Snelson Unannounced Inspection 09:15 24th July 2008 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 Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.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. Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Redruth Care Ltd trading as Redruth Nursing Home Weedon Road Upton Northampton Northants NN5 4RR 01604 585584 01604 587001 Address 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) Redruth Care Ltd Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursiong - Code N to service users of the following gender: Either whose primary needs on admission to the home are within the following categories: Old age, not falling under any other category - Code OP The maximum number of service users who can be accommodated is: 37 2. Date of last inspection Brief Description of the Service: Redruth Nursing Home is situated on the A45 some 2 miles from the centre of Northampton and 3 miles from junction 16 of the M1. Redruth is a large Victorian house standing in approximately 2 acres of grounds and gardens. The home has 37 beds registered but has transferred the use of two double rooms to single en-suite accommodation so would not have more than 35 people using the service. Lounges and dining rooms overlook the gardens. The home offers Nursing care to Older People, and adults with a physical disability. The home also provides care to service users who are terminally ill and require palliative care. In February 2008 the ownership transferred and the registered manager, who had also owned the home, remained in post to offer a smooth transition; She resigned permanently 1st July 2008. At the time of this inspection fees were up to £618.00 per week depending on care needed. Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out in accordance with the Commission for Social Care Inspection’s (CSCI) policy and methodologies, which require review of the key standards for the provision of a care home for older people that takes account of service users’ views and information received about the service since the last inspection. Evidence used and judgements made within the main body of the report include information from this visit. This was the first Key Inspection since the home had been taken over by new owners. Regulatory Inspectors Mrs Sally Snelson and Angela Dalton carried it out on the 24th of July 2008 between the hours of 09:15 and 15:00 hours. The nursing manager and care manager were present throughout the visit to assist with any required information. Verbal feedback was given periodically throughout the inspection and at the end of the visit to them both. During the inspection the care of three people who used the service (known within the home as residents) were case tracked. This included a recent admission to the home, and involved reading their records and comparing what was documented to the care that was being provided. Prior to the inspection we received six surveys from residents or their families and one from a staff member. As a result of the survey we spoke in detail to one family member about the care in the home and have used her comments to aid in our judgements. Documentation relating to staff recruitment, training and supervision and medication administration, complaints, quality assurance and health and safety in the home were also examined. We also spent some time in the communal areas of the home, talking to staff and residents and observing the care practices that were carried out during this inspection. This home had not been inspected since December 2006 and although the quality rating has dropped it is not because care had declined but because staff had not been reporting correctly and have not known what to do with safety checks that were outside the normal parameters. This is mainly because the manager has left and the staff that were acting into the position had not had experience of running a care home in the past. However they were committed to learning and were well supported by the new owner. Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 6 We would like to thank everyone involved for their support and assistance during this visit to the home. What the service does well: One visitor to the home told us, “I am very happy with the way my mother is cared for, all the staff are wonderful”. One resident said “I have loved it here since the first day”. Another wrote in the questionnaire, ‘ I rate Redruth highly!. I have been in 2 care homes and 1 other nursing home so I know what I am talking about”. The home was clean and bright and the new owner had started to improve the environment by replacing worn carpets and changing the use of rooms. The garden was beautifully kept and regularly used. It was overlooked by a number of bedrooms and could be enjoyed by those who could not access it. The service had generous staffing levels, which resulted in a high quality of care delivery and a low staff turnover. Staff were aware of the needs of the people using the service and committed to providing the care. Staff told us of a number of residents who had come into the home with sores that had consequently healed, those who were immobile and were now walking, or for end of life care and were now, some months later, enjoying a good standard of life. The pre admission assessments had both been carried out well in advance of the admission, and contained sufficient detail to ensure that the home had the necessary evidence to show that staff would be able to meet needs. Staff were observed to knock on doors before entering and were observed to speak to people who used the service in a kind and gentle manner. Activities were done at an individual pace: We observed many positive episodes of interaction between staff and residents during our visit. People were well kempt and well dressed. We visited one person who spent most of the day in bed and he had been washed and was clean-shaven Care staff were sensitive to the needs of those residents who found it difficult to eat and gave assistance with feeding. They were aware of the importance of feeding at the pace of the resident, making them feel comfortable and unhurried. Mealtimes were a very sociable occasion and the new management team was working hard to tailor meals to individual requirements by staggering mealtimes. Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Some requirements and recommendations have been made as a result of this inspection and include the need to: •Have an updated Statement of Purpose and Service Users Guide that reflects the current service provided. • Keep a record of medication bought into the home, and its administration to allow for the reconciliation of medication at anytime. • Have a robust complaints procedure • Ensure staff have SOVA training that links to the governments No Secrets policy and any local policies. • Ensure that people have the opportunity to lock bedroom and bathroom doors if they wish. •Give priority to redecorating areas of the home where there were odours noted. • Complete quality assurance surveys and undertake and publish an analysis of them. • Ensure all staff working at the home are supervised at least six times a year • Regularly check water temperatures and if is noted that the water is delivered in excess of 43 degrees this must be risk assessed and appropriate action taken. •Consider self-closing doors so that bedrooms doors do not have to be kept permanently shut, which isolates some of the people using the service. Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.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. Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.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 Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.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): 1,3,6. People who use this service experience adequate quality outcomes in this area. Admissions to the home were not made until after a full assessment of needs had been carried out, so that prospective residents and their representatives could be sure that social and care needs would be met. However at the time of the inspection the documents people needed to give them information about the home were not available. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There was a copy of the homes brochure available in the administrative office. We were told that the Statement of Purpose and the Service Users Guide was being reviewed to reflect the new ownership and management structure. Care Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 11 must be taken that all the information detailed in schedule 1 of the National Minimum Standards is included in the Statement of Purpose, including details of how fees are broken down as required since 01/09/06. We were advised that contracts were also being updated to reflect the new ownership. We viewed the file of the two residents who had been admitted since our last inspection in December 2006. The pre admission assessments had both been carried out well in advance of the admission, and contained sufficient detail to ensure that the home had the necessary evidence to show that staff would be able to meet needs. This home did not provide intermediate care. Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 12 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 People who use this service experience adequate quality outcomes in this area. Most care needs were clearly recorded in individual’s care plans. Medications records were kept, but it was difficult to reconcile some of the medications held by the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: During this inspection we examined three resident’s files in detail. Each file contained a pre-admission assessment that had been completed prior to admission. The assessments were used to formulate initial care plans and then, when these were reviewed, more detailed plans were written. The care plans contained a diagnosis of the resident’s condition, and then went on to explain the level of assistance required for each individual task of daily living. Care Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 13 plans were written on the computer and each month, when they were updated, a synopsis of the previous months plan was written. Staff must ensure that plans are written simply, in a language that all staff can understand. For example the goal for a care plan stated, ‘To promote functional and restoration and maintenance’, we were unclear what this meant, but assumed that it meant the goal was to keep the resident doing what they were currently doing. We did feel that care plans needed to be expanded, and that some of the information that was held in other documents added to the care plans. For example we were aware that one of the residents had a pressure sore that was being dressed, but we could not see from the plan how, or when, the sore was dressed. The information was available, but in a dressings book. We therefore did not see in the care plan any evidence of any improvement or deterioration in the sore, or what staff needed to do to treat the sore. The care manager had already identified the needs to start reducing some of the books used to document aspects of care. For example the weekly bath book was no longer used as residents were having baths when they wanted. We also discussed if it was necessary to list what every resident had eaten in a day. This was completed in another book, so not linked to the nutrition care plan and not necessary for an individual who ate well and did not have weight gain or loss problems. Two relatives told us that they appreciated when nursing notes were in the bedroom so that they could look at the care that was being provided without having to ask for the records. We did not see any evidence of people using the service, or their representatives, agreeing to the care plans. All of the residents were registered with a local GP. The GP visited fortnightly to routinely assess the residents but would visit as and when required between. There was evidence that other health professional, such as a chiropodist, or a diabetic specialist nurse made regular visits to the home. We also noted that the home had purchased specialist equipment such as profiling beds, beds that can be raised and lowered and moved from side to side as necessary, pressure-relieving mattresses, and syringe drivers, a devise to deliver medication, particularly pain killers, in a controlled way. The home had a variety of moving and handling equipment. We observed moving and handling and staff used a hoist to transfer someone from their chair to their wheelchair. This was done in an unhurried way and caused little anxiety because the task was done with the person, as opposed to ‘to them’. At the time of the inspection one hoist needed to be repaired but sufficient hoisting equipment was available to meet people who use the service’s needs. Staff told us of a number of residents who had come into the home with sores that had consequently healed, some who were immobile and were now walking, or for end of life care and were now, some months later, enjoying a good standard of life. We were told that one family was contesting the Health Care Trust’s decision to reduce continuing care funding because of their loved Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 14 one improved condition. This is a credit to the staff skills for caring for people at the end of life. The service provided palliative care within the ‘gold standard framework’ and used Liverpool Care Pathways, this provided a framework in which to provide palliative care and is based upon the latest up to date research in palliative care. Staff had given great thought to anticipate what provisions may be needed in the care of a resident who may die suddenly and have special end of life needs. The home had recently changed to a new pharmacy supplier and was receiving the medications in ‘blister’ packs. As with any new system there had been some teething problems. During this inspection we checked the Medication Administration Record (MAR) sheets. All had been completed appropriately with signatures and omission codes where necessary. The MAR charts in use had been produced by the home, but it was expected that they would start using the ones supplied by the pharmacy when the new cycle started. This would mean staff did not need to write or print out medication lists every month. However the MAR charts we viewed did not indicate how many drugs had been received by the home, this was recorded in another book, but did not include those carried over. Because staff had not always indicated if they had given one or two tablets when a variable dose had been prescribed and because medication was not carried forward, it was not possible to reconcile the medicine. It is expected that management would routinely reconcile medication as part of quality assurance checks. The controlled drugs held in then home were kept securely, and all documentation to indicate when and by whom they had been administered was correct. Staff were observed to knock on doors before entering and were observed to speak to people who use the service in a kind and gentle manner. Activities were done at an individual pace: We observed many positive episodes of interaction between staff and residents during our visit. People were well kempt and well dressed. We visited one person who spent most of the day in bed and he had been washed and was clean-shaven. It was evident that staff worked hard to ensure that even those the people who use the service who received a high level of nursing care were given the opportunity to socialise and get out of bed for a proportion of the day. However we were made aware by a relative that people who remained in their bedrooms could feel very isolated. Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 15 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 People who use this service experience adequate quality outcomes in this area. Care staff were sensitive to the needs of those residents who found it difficult to eat and gave assistance with feeding. They were aware of the importance of feeding at the pace of the resident, making them feel comfortable and unhurried. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A variety of activities were available but the activities logs reflected that they were sometimes sporadic and do not occur daily. There were opportunities for individual hobbies and interests to be pursued: one person who used the service had been given their own part of a small lounge to listen to CDs and read the paper. Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 16 We saw a family member, working as a volunteer, meeting with a small group of people who used the service to do ‘virtual’ horseracing. They each picked the likely winners from the racing pages of the newspaper. The home had a number of small lounges enabling people to meet in small groups or meet their families and friends in private. A daily newspaper of choice was available to every person who used the service. Past and present residents artwork was displayed throughout the building and we witnessed staff walking with people into the well-tended and attractive garden. There were trips out for groups and individuals and staff were aware of the need to increase these and make them available to those who were less able, but would appreciate the opportunity to leave the home. Regular communion services took place for people to attend if they choose. People who used the service made positive comments about the service: ‘I’ve been here for 5 years and wouldn’t live anywhere else.’ ‘I love it, staff are so kind hearted.’ One person who used the service communicates by writing on a notepad and all staff took the time to sit and read what they had written and communicate with them. Mealtimes were a very sociable occasion and the new management team was working hard to tailor meals to individual requirements. There was flexibility and people who require more assistance ate together so that they no one was rushed. However, we observed that pureed food had been mixed together as opposed to being served in separate portions. The management team informed us that this was not usually the case and that the regular cook was off. One of the management team explained that the approach to meals had changed: ‘just because they can’t speak doesn’t mean that you don’t treat them with privacy and dignity’. For example a resident who had always had ‘redybrek’ for breakfast was now being offered more choice and people were not seated until just before lunch was served and therefore did not become frustrated by having to wait. Staff clearly knew people’s needs well; one person was woken for lunch and another left asleep as per their preferences. However we were advised by a relative that there was limited fresh fruit and vegetables available and that the evening meal could be boring and not at all nutritious. They cited pickle sandwiches being offered. The menu was displayed and food was often a topic of discussion at monthly residents’ meetings. Choices were available and last minute changes could be accommodated. Salt and pepper were not readily available at lunch: only one person had access to a saltcellar, although more were brought out during the Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 17 course of the meal, but no pepper was served. Salad was an option but no salad cream was on the table although people were asked if they wanted it and it was brought from the kitchen after the meals were served. It would have been more homely to have it available. Drinks were available throughout the day but were served in plastic beakers and the majority hot drinks were served in plastic cups with spout lids. We felt some people would have been able to manage china or glass. Plate guards were plastic and clipped onto plates to aid independence. Some people who use the service wore large material bibs to protect their clothing, and these were not always removed immediately, which did not preserve their dignity. Some people chose to eat in their bedrooms: we observed a tray being taken with both the main meal and pudding on. The pudding would have melted, as it was ice cream based. There was no provision for meals to be kept hot or cold in other parts of the building and the management team explained one person expected their main meal and pudding to be served together. Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 18 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 People who use this service experience adequate quality outcomes in this area. Staff were aware of the homes complaints policy but it was not available to all, and had not been updated. Most staff had had some training around safeguarding procedures. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Although we saw a lot of policies and documents displayed in the home we did not see the complaints policy, and the staff assisting with the inspection were not aware where it was displayed, or if it was available in formats suitable for those with poor vision or understanding. There was a complaints file held in the office. This included a policy that was out of date. According to the file there had been no complaints made since 2004. We discussed the need for staff to record any concerns raised and how these were dealt with, and suggested the file should also include the high level Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 19 of compliments made to the service. Some people who used the service told us they were able to raise any concerns directly with staff, although one person feared repercussions if they complained. Staff had had some safeguarding training provided by the previous manager. We were concerned that the Local Authority were not involved in this and that senior staff did not know when it was necessary to report an incident to us under Regulation 37, or to the safeguarding team. For example in the accident book we saw evidence of accidents of unknown origin, or that had resulted in medical advice being sought, but we had not been made aware of them. The staff were aware of the need to inform us of any deaths in the home and did so correctly. Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 20 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 People who use this service experience adequate quality outcomes in this area. The home provided a physical environment that met the specific needs of the people who lived there. The home was comfortable and had a programme to improve the decoration, fixtures and fittings, which will make it more homely. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A new owner had recently purchased the service and many positive changes had taken place in a short space of time. New administration facilities had Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 21 been provided, new carpet has been laid and an order for new linen and bed towels had been placed. Double bedrooms had been changed to single use with ensuite facilities built and the main kitchen updated. There were also plans to provide a staff room. At the start of the inspection we commented about the number of staff certificates that were displayed throughout the home in corridors and halls. By the end of the inspection these had been removed and were to be put up in the new staff room, as the home is for the people who live there and it is not normal to have someone else certificate in your home. Some areas of the home had an odour of urine or smelt unpleasant. The management team assured us that there were plans to replace flooring in these areas. There were also plans to redecorate the first floor where there had been a flood resulting in damage to the wall and floor. We noted that bedroom and bathroom doors could not be locked to ensure privacy but again, there were plans to address this. The same was true of replacing worn or damaged furniture. People were given the opportunity to personalise their bedrooms with small items of their own furniture, or ornaments. The garden was beautifully kept and regularly used. It was overlooked by a number of bedrooms and could be enjoyed by those who could not access it. We were advised that some of the shrubs were being cut down and new parking areas made in the garden, which would spoil the view for some. There were some infection control risks identified during the inspection but most were addressed during the inspection. For example clean laundry was removed from the sluice (where waste is dealt with) to a fresh cupboard. We noted hand soap dispensers were being refilled from one container. An infection control training session was planned for the day after the inspection and the management team would seek advice from the trainer about this and for other improved infection control measures to be implemented. The home had successfully cared for people with hospital borne infections. The management team were going to investigate a solution for safely leaving open the bedroom doors of those people who remained in their rooms. This would enable them to observe the comings and goings and prevent isolation. A relative also commented about this to us. Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 22 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 People who use this service experience good quality outcomes in this area. There were consistently enough staff available to meet the needs of the people using the service. Staff had been correctly recruited to ensure that they were safe to work with vulnerable people. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We were told that there were 47 staff employed by the home and that there were no current vacancies. The rotas confirmed that there were usually nine care staff in the morning, six in the afternoon and four on duty over night, plus housekeeping staff as necessary. Because of the generous staffing levels staff were able to spend time meeting individual needs at an individual pace and the homes statement ethos of ‘caring with care’ was truly apparent. The home benefited from a core team of staff who clearly worked well together. Because of the staff compliment and the good will of staff to cover each other’s absenteeism the home did not have to use agency staff. Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 23 People who spent a high proportion of time in their rooms welcomed spending time with housekeeping staff and we witnessed some spirited conversations as rooms were being cleaned. As already mentioned we were concerned about bedrooms being kept shut and isolating those residents who remained in their bedrooms. Almost half of the care staff had NVQ level 2 or above, and more were working towards it. Staff personal files would benefit from being sorted and divided into sections so that it was easy to see how staff had been recruited, what training they had had and how recruitment checks had been carried out There had been no new staff employed since the previous manager had left so we did not have the opportunity to check current recruitment practices, but as they had been good in the past we did not expect them to change. Because a number of the policies and procedures were out of date, or had not been reviewed it was not apparent if staff were working in line with the homes policy and best practice. We did not see any recent evidence that staff annual skills assessments had been updated or that staff had had an individual performance review. The previous manager carried these out in order to assess training needs. They would also be used to show how the home could meet the assessed needs of current and prospective residents. We were told that the new owner had offered to support training for staff by paying for the training, but not the time spent at the training. We advised the nursing and care manager that all staff were entitled to a minimum of three paid days training a year, and expected to see a training matrix that supported this and included the mandatory and specialist training necessary to meet the needs of the groups of people the Statement of Purpose indicates the home could care for. The management team were making efforts for the day and night staff to be seamless by ensuring all staff attended team meetings and worked together. Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.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, 35,36,38. People who use this service experience adequate quality outcomes in this area. The two acting mangers were showing a commitment to the role and to working to support each other. Staff must be aware of the consequences of safety checks that are outside the expected parameters. We have made this judgement using a range of evidence, including a visit to this service. Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 25 EVIDENCE: The previous manager had also been the owner of the home. After the sale she had remained for some months to support the new owner, but since the 1st July 2008 had resigned completely. The new owner was visiting the home almost daily but he did not have a care background. Two members of staff had been identified to act into the management role, one had nursing qualifications and was referred to as the nursing manager the other was a senior carer with over 20 years experience at the home. Prior to the inspection we had advised the new owner that the registered manager did not have to be a nurse, as long as they had the support of a nurse team for clinical decisions. The new care manager had already demonstrated a fair and effective management style with the staff team. The acting managers had considered how they were going to ensure that the care they provided was of a good quality and met the expectations of the stakeholders. They had started by sending out questionnaires to relatives, which were just being returned. We advised both the managers that to meet this standard they needed to be able to show how they had used the information they had been given to provide and plan care, and that a range of stakeholders had been questioned. The AQAA was completed and returned by the owner. It was brief and gave minimal information about the service because it had to be completed in a short timescale, as the first request for this information did not reach the service. The owner was aware that there was minimal evidence to support any of the claims made within it. The staff team were having staff meetings. The last staff meeting was the 15th July 2008. Minutes were posted for all staff to read and would be accessible to visitors in the home. The new owner had used his first staff meeting to introduce himself to staff and outline his plans for the home. He had also met with relatives for the same reason. The home held small amounts of money on behalf of seven residents, none were the people we were case tracking. We therefore randomly choose one account to look at. The money held matched that recorded on the finance sheet and there were receipts to support any use of the money. The administer told us that many families were billed for extra such as hairdressing or newspapers and some residents held small amounts of money in wallets and purses. Staff supervision had been ad-hoc and the service would not achieve the recommended six supervision sessions for each staff member in one year at this inspection. Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 26 Fire safety checks were routinely carried out by the maintenance person and their was evidence that identified faults were corrected immediately. However the hot water was tested and was in excess of the recommended 43ºC measuring 59ºC during the inspection. Records demonstrated that this was an ongoing situation. It was addressed during the inspection but daily temperatures must be recorded to ensure that a safe temperature is maintained. We were also disappointed that staff had measured the excess temperatures and recorded them, and not taken action. The sluice was not locked and people who use the service and visitors would have access to potentially dangerous equipment. The kitchen did not have a fly screen fitted and the windows were open on the day of inspection, which may compromise food safety. The lounge door was held open with a door wedge, which would pose a danger if there were fire. The management team will investigate a safe solution and seek advice from the fire service. Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 27 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 1 X 2 Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 4,5,6 Requirement The home must have an updated Statement of Purpose and Service Users Guide that reflects the current service provided. The recoding of medication into the home, and at the time of administration must be robust enough to allow for reconciliation at anytime. A complaints procedure must be available for all and documentation of any complaints received must be recorded including how they were investigated and the outcome. Staff must have SOVA training that links to the governments no secrets policy and any local policies. People must have the opportunity to lock bedroom and bathroom doors if they wish. Priority must be given to redecorating areas of the home where there were odours noted. The home must complete quality assurance surveys and undertake and publish an analysis of them. DS0000071480.V363888.R01.S.doc Timescale for action 01/10/08 2 OP9 13(2) 01/09/08 3 OP16 22(1-6) 01/10/08 4 OP18 12 (1) 01/10/08 5 6 7 OP24 OP26 OP33 12 (4)(a) 23 1(a), 2(d) 24 (1) 01/10/08 01/10/08 01/01/09 Redruth Care Ltd trading as Redruth Nursing Home Version 5.2 Page 29 8 9 OP36 OP38 18(2) 13(4)(a) All staff working at the home must be supervised at least six times a year. There must be regular checks of water temperatures and where the water is delivered in excess of 43 degrees this must be risk assessed and appropriate action taken. 01/01/09 01/09/08 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 4 5 6 Refer to Standard OP12 OP15 OP19 OP30 OP31 OP38 Good Practice Recommendations Consideration should be given to ensuring that activities provided suited the needs, preferences and capabilities of those they were intended to stimulate. Consideration should be given to providing crockery that appears more homely. Care should be taken that the plan for redecorating and refurbishing the home is adhered to. There should be an easy way of assessing the training needs of the staff both individually and as a team. The owner should put forward a candidate to be considered by us for registration. Consideration should be given to self-closing doors so that bedrooms doors do not have to be kept permanently shut which isolates people using the service. Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Redruth Care Ltd trading as Redruth Nursing Home DS0000071480.V363888.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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