Inspection on 25/01/07 for Redstones Care Home

This inspection was carried out on 25th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

Other inspections for this house

Redstones Care Home 11/05/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Redstones Care Home Redstones 8 Surbiton Crescent St. Thomas Exeter Devon EX4 1PB Lead Inspector Rachel Doyle Key Unannounced Inspection 10:00 25th January 2007 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 Redstones Care Home DS0000067190.V305984.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. Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Redstones Care Home Address Redstones 8 Surbiton Crescent St. Thomas Exeter Devon EX4 1PB 01392 421385 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) Redstones Care Home Limited Mrs Sally Louise Mary Richards Care Home 7 Category(ies) of Old age, not falling within any other category registration, with number (7) of places Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12/12/05 Brief Description of the Service: Redstones is a large modern detached bungalow, which is situated in a quiet area of St Thomas. It is within walking distance of St Thomas shopping centre, the local health centre, post office, churches and other local amenities. The home has been extended to provide accommodation for up to seven service users, with five single bedrooms and one double bedroom, which is currently used as a single room. The Provider and their family live upstairs and have a private lounge downstairs. The home is clean, bright and furnished and decorated to a very high standard throughout. There is a good-sized garden that is well laid out and well used by service users during the warmer weather. The Home does not provide intermediate care. The average cost of care is £287-345 per week at the time of inspection. Additional costs, not covered in the fees, include chiropody, hairdressing and personal items such as some toiletries (the Home provides general toiletries for residents’ use as they wish) and personal newspapers. Previous inspection reports are available at the home. Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector undertook this unannounced inspection on 25th January 2007 from 10.00-16.00. There were 6 residents and 1 vacancy at the time of the inspection. All 6 residents were at home. During the inspection 3 residents were case tracked. This involves the inspector looking at the residents’ individual plans of care, and speaking with the resident and staff who care for them. This enables the Commission to better understand the experience of residents living at the home. The inspector spent time with all 6 residents during the course of the day. The inspector also spent time observing the care and attention given to residents by staff and had lunch with residents in the dining room. Two staff were spoken with during the day including the registered manager and the new provider. The new provider was registered with the Commission in July 2006. Prior to the inspection, surveys were sent to relatives to obtain their views of the service provided; 8 were returned. Four residents’ surveys were returned, a further resident who received a survey was unable to fill it in therefore their relative answered on their behalf. Staff were also sent surveys, 4 were returned. Health and social care professionals were also contacted prior to the inspection including General Practitioners and community nurses. Three GPs and 2 health professionals responded. The inspector toured the premises and a sample number of records were inspected which included care plans, medication records/procedures, staff recruitment files, service and maintenance certificates and fire safety records. The previous provider had completed a pre-inspection questionnaire shortly before the inspection and this information had not changed. What the service does well: All residents expressed satisfaction with the care that they were receiving and appeared comfortable with staff. There is a close, long-term staff team who know the residents well and work hard to maintain a family environment, whilst enjoying working at the Home. Residents’ privacy and dignity is well maintained and promoted by staff at the Home. Relatives and friends are encouraged and welcomed to the Home and residents are helped to maintain links with the community. All residents enjoy living at the Home and would not change anything. Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 6 Social activities are well managed, creative and provide choice and interest for those living at the Home. These are varied and residents said that they enjoy the activities on offer and did not feel bored or unstimulated. Residents are able to exercise choice and control over how they spend their day. Meals are very well managed serving varied, tasty and nutritious meals suiting individual preferences in a homely atmosphere. The Home is decorated in a homely, personalised and domestic way providing a comfortable environment for residents. What has improved since the last inspection? What they could do better: The Home does not have a formal admission and assessment procedure or clear records to ensure that they can meet residents’ needs prior to admission. In addition to this there are no care plans to indicate to staff what they need to do for residents to meet their identified needs. This does not promote consistency or comprehensiveness of care for residents. Whilst health professionals advice is sought by the Home appropriately there are no clear procedures to monitor or record pressure area care, falls management, psychological care given or required or action taken in relation to continence promotion, which could result in health care needs not being met at all times. There is not a robust system relating to the Protection of Vulnerable Adults, which could place residents at risk. There is a lack of regular and mandatory staff training and induction, which does not ensure that staff are up to date with good practice when giving care to residents and in some cases that staff know what they are doing. The lack of Manual Handling training could put both staff and residents at risk. The Home has a general lack of recorded Home policies, which does not ensure that staff are aware of correct procedures to ensure consistent care and safety. Recruitment files could be made more detailed to safeguard residents. Improvement could be made in the administration of medication to maintain residents’ independence. Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 7 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. Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 8 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 Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 9 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): 3, 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Admission and assessment procedures have not been formalised and documented to ensure that the Home is able to meet residents’ needs prior to them being admitted. Intermediate care is not provided. EVIDENCE: Three care files were looked at and there was no formal admission policy or assessments. The provider was asked about the Home’s admission and assessment procedure. The Home does not have vacancies very often but there had been two new admissions recently. The provider said that new admissions are usually referred by word of mouth and that they meet the prospective residents and their families when they visit the Home. During the meeting and with discussions with the family the Home decides whether they can meet the resident’s needs. This does not follow any particular format and Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 10 the provider said that they ‘just know’ if they should offer then a place. They also take into account whether the current residents will get on with a new resident, as it is a small home. There are no written records of these assessments. The Home does not confirm to residents in writing that they can meet their needs prior to admission, which is good practice. The Home does obtain information from the multidisciplinary team, which was in the files, but this is not then used to devise a care plan for the resident once they are admitted. The inspector spoke to two residents who had recently been admitted. Both were extremely happy with the admission process and said that they had felt very welcome and that staff had been wonderful to them, helping them to settle in. One relative was visiting and they confirmed that there had been good communication between them and the Home prior to admission. They said that their relative had been much happier since the admission, more than they had been in their own home. They felt that staff gave a lot of reassurance and support. Staff spoken to were able to give details of each of the residents’ needs and preferences but this information was not recorded, which does not ensure consistent care or that all residents’ needs are met or can be met prior to admission. It is not clear how staff are aware of prospective residents’ needs other than through informal chat, one staff member said that there was good communication between staff, but there is no formal assessment procedure or comprehensive documentation. This has been made a requirement at two previous inspections. Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The Home has no clear care planning process or documentation, which does not ensure consistent and comprehensive care. Residents’ privacy and dignity is well maintained and promoted by staff at the Home. Medication is well managed at the Home promoting good health but improvements could be made to promote independence of some residents. EVIDENCE: The 2 health professionals who responded to CSCI surveys had not then visited the Home since the new provider took over although the staff team remains much the same. They were both satisfied overall and felt that the Home worked in partnership with them. All 3 GPs were satisfied overall, although one had not visited for some time. All 7 relatives were satisfied overall with the care that the residents received at the Home. One commented that ‘Redstones Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 12 is a very warm and caring home’. Another said that their relative had received ‘marvellous care and attention’. One relative could not speak highly enough of Redstones saying that they were lucky to have found their relative a place there. One resident said that they did not need anything other than what the Home provided. Another resident has lived at the Home for many years and said that they have always felt that it was a ‘Home from Home’. Three care files were looked at. There were no proper care plans other than basic information such as ‘wears glasses’, brief medical history and contact information. Daily notes are written by staff but these do not relate to any planned care. There was no evidence of any regular reviews of planned care. Residents do have health needs relating to pressure area care, continence promotion, mobility and psychological care. All need some assistance from staff with various aspects of personal care needs. Although staff have good knowledge about how they care for residents in an individualised way none of this is documented. One staff member said that they had learned residents’ preferences. Two staff surveys commented that the home provides a home from home atmosphere, treating residents as individuals maintaining a high standard of care. Documentation does not ensure consistency of care or that all the residents’ needs are met all of the time in an agreed way with the resident. There was no evidence that a continence advisor had been contacted and there is no continence promotion policy at the Home. The pre-inspection questionnaire stated that this was not applicable to the Home although one resident is recorded as having continence problems. Care plans do not reflect how residents can be helped to remain continent. One resident has obviously undergone a positive change in their behaviour and psychological status but this is documented to show progress or actions taken. However, all residents felt that they were well cared for and that the GP and other multidisciplinary team were involved appropriately. Residents can choose any GP they wish. All residents confirmed that they have their hearing, sight and chiropody appointments as necessary. The District Nurse visits on a regular basis and particularly to treat one residents’ pressure areas. However, there is no care plan as to how this residents’ pressure areas are cared for on a day to day basis. For example, there are no details of what preventative equipment is used, how often the resident was able to move themselves to relieve pressure or regular observation of their skin condition and any actions by the Home. The provider said that a specialist mattress and suitable footwear had been discussed and refused by the resident but this was not recorded. Some residents have mobility problems and have had falls. There was no action plan as to how these could be prevented or what action was taken other Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 13 than in the accident form. The provider said that staff have been assisting residents who have fallen up from the floor but there is no Manual Handling policy or hoist at the Home, which puts residents and staff at risk. The provider said that the Home had some equipment but there are no Manual Handling risk assessments or plans for any residents. The provider had contacted the Mobility Centre for assistance with one resident but this was again not documented. The medication system is about to be changed to the Monitored Dosage System as the provider had recognised that the current system is not satisfactory. Staff are about to receive updated training in the near future and a pharmacist will be visiting shortly to implement the system. Medication storage is good and a secure controlled medication cupboard is being fitted. At the time of the inspection none of the residents manage their own medication, which would maintain independence in this area if residents wished. The provider confirmed that this method has not been offered to any residents and no self-medication assessments have been carried out. None of the residents’ rooms have a lockable storage facility, which is generally recommended and required should anyone wish to manage their own medication. The Home’s medication policy is not yet complete but the provider is working on this with a local pharmacist. Staff were seen to be extremely caring and treated residents with respect at all times. One resident has a problem with their skin and staff were attentive to ensure that they were positioned comfortably and safe from any knocks. All residents praised the staff highly and felt that they maintained their privacy and dignity. Residents are not able to have a bath without assistance but the staff maintain residents’ privacy and residents can spend as long as they like in the bath in private and call for assistance when they are ready. There is a lovely family atmosphere at the Home, which all residents commented on. Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities are well managed, creative and provide choice and interest for those living at the Home. Residents are able to exercise choice and control over how they spend their day. Residents’ contact with the community, friends and relatives is encouraged and facilitated by staff. Meals are nutritious and presented in a family-like setting ensuring that residents receive a balanced diet of their choosing. EVIDENCE: Residents and relatives spoken to all said that there was a good range of activities at the Home, like being in a family. One staff member said that the Home was like ‘one big happy family’. Residents are encouraged to be involved in activities although can choose to spend time alone as they wish. Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 15 Recently there has been a very successful coffee morning. External entertainers visit the Home often such as the Brownies, Rainbow club children and carol singers. All residents are able to go out with their families and one resident said how lovely it was to have their relative visit them after work every night. There are no restrictions on visitors. The Home has a changing large print library, music and videos and the provider spends most Sundays chatting with residents, which they said that they enjoyed. There was a very happy atmosphere during the inspection and relatives and residents confirmed that this was always the case. Other activities include the Ide Club for various sessions such as make-up lessons and bingo, outings in fine weather in the Home’s people carrier and organ singalongs. One resident said that they enjoy card games most afternoons so much that they sometimes send their family away. One resident said how they often go out with their family and come back to the Home very late, which is no problem for staff. There is a regular hairdresser who visits the Home and communion fortnightly. The Home keeps a photograph album, which residents showed the inspector with lovely pictures of themselves and their families attending various activities. The provider and staff were arranging for residents to attend a funeral at the time of the inspection and attention was paid to being flexible with their mealtimes. The inspector had lunch with five residents. This is a social affair and there were sandwiches with fillings that residents had chosen and home-made cakes. The residents had chosen to have a cold lunch and dinner later due to a funeral, which they were attending. One resident said that there were a few things that they preferred not to eat and that the Home always offered and alternative. Staff had attended Food Hygiene training and there was a varied menu which residents said was very flexible and that they could have seconds if they wished. All residents and relatives praised the standard of the food. Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 16 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): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements could be made in the recording of complaints and concerns, although residents felt confident that they can raise any issue of concern, which will be acted upon. Formal Adult Protection policies need to be developed so that all staff are aware of the correct procedures to follow to further protect residents. EVIDENCE: None of the 8 relatives who responded to surveys have made a complaint about the Home and almost all were aware of the complaints procedure. Residents spoken to said that they could speak to any member of staff or the provider, who said that any issue would be dealt with as soon as possible. The Home has a complaints policy but does not have a complaints/concerns record book therefore it is unknown what actions are taken for any issues raised by residents. The provider said that the Home had not had any complaints but said that they would encourage staff to record any concerns in the future. The Home has no Protection of Vulnerable Adults (POVA) policy and the provider admitted that staff had not had any training in this field for some time. The Home does have the Alerters’ Guide, which details the procedure in Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 17 Devon for reporting and recognising abuse but the provider and staff did not know the contents comprehensively such as who to contact. Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 18 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, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within the Home is good providing residents with homely surroundings, which are well maintained. The cleanliness of the Home is good although improvements could be made to ensure that staff are up to date with current infection control procedures. EVIDENCE: The Home was warm and comfortable. The lighting, heating, water and ventilation are of a domestic nature and meet the needs of the residents. The Home was very clean throughout and there were no offensive odours. The residents were all very happy with the environment and felt that it was as they would have their home. All rooms were well personalised and comfortably furnished. There is a lovely dining area leading into an open plan lounge through to a light and airy conservatory with comfortable chairs. Residents Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 19 were enjoying a chat, receiving a visitor and reading in this area during the inspection. Outside is a lawned area with garden furniture for the summer months, accessed by a patio door. The Home in general blends in with other domestic bungalows in the area. All areas of the Home were clean and homely. There are paper towels and protective gloves and soap available. Substances Hazardous to Health are stored securely. The Home does not have an infection control policy. The provider said that staff have not had infection control training for some time although information has been given to them about some infections, which they have been treating although this is not documented clearly in the resident’s file. Staff said that there had been some District Nurse input in providing equipment and leaflets. Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 20 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): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The procedures for the recruitment of staff are not fully robust to provide adequate safeguards to people living at the Home. Residents benefit from having experienced and friendly staff in sufficient numbers who have a good understanding of their needs, however a lack of regular training does not ensure that their practices are up to date. EVIDENCE: The Home has not employed any new staff other than the new provider and two members of their family since 2002 and maintains a strong staff team with a very low staff turnover. Staff have a good rapport with both residents and their families and this was confirmed by all the residents and one relative who was visiting during the inspection. There are two carers on duty at all times at the Home and at night there are two sleep in staff who are available if residents need assistance. One resident commented that the staff were wonderful, going above and beyond the call of duty. All residents praised the staff and said that they were well cared for. Staff have obviously got to know the residents very well over time and pay attention to their wishes and preferences. Staff said that they Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 21 enjoyed working at the Home. Two commented that they would not change anything about the Home and were proud to be a member of the team. One relative said that it was a very warm and caring home and that the staff were wonderful. Another said that they could not speak highly enough of the Home and that they were very lucky to get a place there. The Home does not have a clear induction programme for new staff and the inspector discussed Skills for Care with the new provider who said that they would contact this organisation to devise an induction process for the Home. The Home does not have many completed policies for staff to follow although the provider said that they were working on these. Staff training is poor and most mandatory training for staff is not up to date, such as Manual Handling and First Aid. Some staff have attended other training such as dementia care but not for some time. There are no individual staff training files although any training certificates are displayed in the hall therefore it is difficult to inspect staff training and skill mix. There are 8 carers employed at the Home. Four are doing their National Vocational Qualification (a formal care qualification) or about to start. The NVQ assessor visited the Home during the inspection to see a carer and the provider discussed whether another carer was able to be assessed at weekends when they worked and this was possible. Five staff recruitment files were inspected. Three staff have worked at the Home for many years and two are recently employed since the new provider took over the Home. These two had Criminal Records Bureau satisfactory disclosures but the provider could not find the other three. The manager said that these had been done but did not know where they were kept. There were no records of any induction or competency follow up for any of the staff, although the provider said that one had had a verbal induction. All files contained two references for each staff member although one was very brief and not from a past employer, which is good practice. Two, for one staff member were from friends. Employment histories were missing from all files and there are no formal application forms for new staff meaning that gaps in employment cannot be discussed during interview. Two male members of the provider’s family are employed at the Home. The provider said that they did not carry out personal care for residents, who are all female. This was not documented but the provider said that this decision had been made between the family. Neither carer has experience in care and have had no induction or any further training other than food hygiene. The provider said that one resident did need two carers to assist them at times and all 6 needed assistance into the bath. At weekends there is often only the family on duty. It should be made clear what the role of the male carers are and that this is discussed with residents should the need arise. The provider acknowledged that at times residents have fallen at the weekend resulting in Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 22 Manual Handling by carers with no training, which puts staff and the resident at risk. The Home were not aware of the General Social Conduct of Care material and all staff should have a copy. Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 23 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, 33, 35, 38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Some practices do not promote and safeguard the health and safety of residents putting them at risk of harm, although fire procedures and checks are well managed. Residents’ financial interests are safeguarded. Staff do not receive clear guidance to ensure that residents receive quality care in a safe environment. EVIDENCE: The new provider was registered with CSCI in July 2006. As they have minimal recent experience in care they are currently working towards the required Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 24 Registered Managers Award and will also commence an NVQ 4 in Care. The manager, who was registered at the same time, has worked at the Home for many years. The provider is very passionate about caring for the residents and sees them as part of the family, spending a lot of time at the Home talking to the residents. All the residents praised the provider and the manager saying that they could not do enough for them. However, many of the foundations and documentation, which help to maintain a safe Home are not in place such as mandatory training, staff induction, admission assessments, residents’ care plans, staff policies (including Manual Handling and POVA), risk assessments and robust staff files. This could present a risk to staff and residents. It is noted that some of this documentation was not in place when the new provider took over the Home and that the provider said that they have spent the majority of time since moving in helping the residents get used to a new provider and family and getting to know them and the staff team. The annual quality assurance audit needs to be done for 2006/7. The Home sends a questionnaire to relatives and residents separately. Comments were positive so far and the Home has a quality assurance questionnaire, which can be completed anonymously by residents and their families. Any comments needing action or reply need to be addressed and the report sent to CSCI. Radiators are not covered and the provider considers most of them to be a low risk to resident. However, there are no individual resident radiator risk assessments to reflect that there are low risks to current residents. One radiator in the hall was excessively hot and was uncovered presenting a danger to any resident who fell in that area. Risks relating to steps used to access the Home itself at the front and the garden were not documented. There needs to be a clear infection control policy addressing in detail the steps taken by staff to transport soiled laundry to the washing machine as this is in the domestic kitchen area. Staff are not up to date in Manual Handling training, some having had none although there are residents who are at risk of falling at the Home. The provider said that they had discussed lifting residents from the floor without a hoist with a health professional. There were no risk assessments or other documentation or action plans for staff. The Home also does not have a staff member who is trained in First Aid on every shift, which could put residents at risk although the provider said that they were looking into this training. The provider mentioned that there had been an incident recently, which could have been harmful to residents but they had not informed CSCI as they did not know they had to. The Fire risk assessment was very comprehensive having been done recently by a Fire Officer and the Home are working through the Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 25 recommendations. The Home has fitted automatic door closers appropriately to ensure that fire doors are not wedged open and fire checks were all up to date. This area is well managed. Residents’ financial arrangements were discussed with the provider. They said that the Home does not deal with any residents’ financial matters as this is dealt with by families. It is noted that none of the residents have lockable storage in their rooms and that is no Home policy relating to residents’ finances. Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 1 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 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 1 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 x 1 1 Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 (1) (2) Requirement Timescale for action 25/03/07 2. OP7 15 (1) (2) 3. OP8 12 (1) 4. OP18 13 (6) There must be a full assesment for each prospective resident and these must be in writing. You must confirm to the resident in writing that the Home can meet their health and welfare needs. The assessment must be kept under review and revised as necessary. A written care plan must be 25/03/07 developed in consultation with each resident as to how their needs in respect of their health and welfare are to be met. This plan must be available to the resident and kept under review. You must ensure that the Home 25/03/07 is conducted so as to promote the health and welfare of residents. There must be care plans that address robust pressure area care, falls management, psychological care and continence promotion. There need to be clear policies to ensure that staff know the correct procedures and good practice. Suitable arrangements must be 25/05/07 DS0000067190.V305984.R01.S.doc Version 5.2 Redstones Care Home Page 28 5. OP29 17 Schedule 2 6. OP30 18 (1) 7. OP37 17 Schedule 2 8. OP38 13 (5) 9. OP38 13 (4) made, by training staff or by other measures, to prevent residents being harmed or suffering abuse or being placed at risk of suffering harm or abuse. A POVA policy must be developed detailing the correct procedures. Staff recruitment files must contain the information described in Schedule 2 and there must be comprehensive employment application forms detailing employment history and discussion of gaps. References must be obtained from the appropriate sources such as past employer. Staff must attend training, which ensures that they are able to meet residents’ needs at all times. Records must be kept in the Home as stated in Schedule 3 and 4 such as procedures to be followed in the event of accidents or a resident going missing, relevant policies for the efficient running of the Home, residents’ assessments and care plans, a record of the incidence of pressure sores and treatment and notify CSCI of any event under Regulation 37. Manual handling training must be provided for all staff that work with people that have been assessed as having difficulty in mobilising. Manual Handling risk assessments must be completed for all residents and any equipment used as necessary to keep residents and staff safe. There must be at least one first aid trained person in the Home at all times, to make sure that people who use services receive appropriate treatment in an DS0000067190.V305984.R01.S.doc 25/03/07 25/05/07 25/03/07 25/03/07 25/03/07 Redstones Care Home Version 5.2 Page 29 10. OP38 13 (4) (a) accident. Radiators within the Home are uncovered and should be assessed for the risk that present to the people that use the service and action taken to minimise this identified risk. This also refers to steps to access the Home and garden, which could pose a risk. 25/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations You should offer to all residents the option to manage their own medication and assess appropriately with regular reviews and provide lockable storage to all residents in their rooms. It is recommended that the Home has a comprehensive medication policy as priority. You should ensure that all staff are aware of current infection control practices and that documentation relating to infection control are clear. The Home should devise an infection control policy to enable staff to know what is expected of them. You should ensure that all staff files contain a copy of the CRB check until it has been inspected. It is good practice to ensure that references are from a past employer and that at least one reference is not from a friend. You should ensure that all staff complete an application form and that employment history is discussed including gaps. You should ensure that there are individual staff training files and that all staff complete and induction on starting employment in line with recommendations from Skills for Care (previously TOPSS). Staff terms and conditions of employment should make clear what roles staff are employed to do to ensure that all residents’ needs can be met by the staff on duty. You should ensure that any resident who may have valuables at the Home is given lockable storage in their rooms. DS0000067190.V305984.R01.S.doc Version 5.2 Page 30 2. OP26 3. OP29 4. OP30 5. OP35 Redstones Care Home Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ashburton 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 Redstones Care Home DS0000067190.V305984.R01.S.doc Version 5.2 Page 32 - 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. 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