Inspection on 26/11/08 for Redwood Care Centre

This inspection was carried out on 26th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Redwood Care Centre 29/08/07

Redwood Care Centre 31/07/06

Redwood Care Centre 13/06/05

Redwood Care Centre 28/04/05

Redwood Care Centre 07/10/04

Redwood Care Centre 24/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Redwood Care Centre 179 Epsom Road Merrow Guildford Surrey GU1 2QY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Patricia Collins     Date: 2 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Redwood Care Centre 179 Epsom Road Merrow Guildford Surrey GU1 2QY 01483532562 01483306514 admin.redwood@careuk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Care UK Community Partnerships Ltd Name of registered manager (if applicable) Mrs Gillian Sampson-Hudson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 50 The registered person may provide the following category of service: Care home with Nursing (N) to service users of the following gender: Either whose primary care needs on admisison to the home are within the following category : Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Redwood Care Centre is a purpose built care home with nursing for fifty older people of either gender, over 65 years of age. Service provision includes short and long term care also intermediate care. The South West Surrey Social Care Team and Guildford and Waverley Primary Care Trust provide assessment and therapeutic services in two dedicated units, comprising of 20 beds. The aim is to provide care for people in these Care Homes for Older People Page 4 of 32 care home 50 Over 65 50 0 Brief description of the care home units on a short-term basis to support them in moving back home after a period in hospital or onto to other suitable care settings. The care in all units is provided by the registered organisation, Care UK Community Partnership. This is a national independent provider of health and social care services working in partnership with Local Authorities and Primary Care Trusts. The accommodation is single storey and wheelchair accessible throughout. Bedrooms are all single occupancy with washbasins and emergency call bells, in five living units, each of ten beds. The units have their own communal lounges with television and music centre; combined dining rooms and open plan kitchenettes. These are comfortably furnished and domestic in style and character, with accessible bathing and toilet facilities and access to enclosed, well maintained grounds. There is ample communal sitting areas throughout the building and a large lounge used for social activities. Parking spaces are to the front and rear of the premises. The home is situated in a residential area close to Guildford town. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The weekly fee for the service is 875 pounds. The last key inspection took place on 29th August 2007. The inspection visit was unannounced, forming part of the key inspection process using the Inspecting for Better Lives (IBL) methodology. It was undertaken by one inspector over ten hours. The report will say what we found as it is written on behalf of the Commission for Social Care Inspection (CSCI). The home manager and deputy manager facilitated the inspection. Judgements about how well the home is meeting the national minimum standards for older people and Care Homes for Older People Page 6 of 32 quality of care are based on the cumulative assessment, knowledge and experience of the home since its last inspection. We have taken account of information supplied by the home manager in the annual quality assurance assessment. This is a selfassessment focusing on how well outcomes are being met for people using services. It also gave us some numerical information. We also considered feedback in survey questionnaires received from eight people using services, a care manager and two health professionals, including a general practitioner(GP). The inspection process incorporated a tour of the grounds and premises, visiting all communal areas, the kitchen, utility room, staff room and some bedrooms. We sampled various records also policies and procedures. Direct and indirect observations took place of care practice, medication administration, arrangements for serving lunch and assisting people with eating and of a group activity. Discussions took place with some people using the homes services, management and other staff and visitors. Judgements about the state of well being of people using services that we were unable to communicate with have been based on observations of their body language and general appearance; also on information in records and their interactions with staff and their environment. We wish to thank all who contributed information and participated in the inspection process. Also the people using the homes services, management and staff for their time, hospitality and cooperation during the visit. What the care home does well: What has improved since the last inspection? Care notes were more detailed than at the time of the last inspection. Those sampled provided a clear record trail of how the needs of individuals were being met. A key worker system had been introduced and named nurses had been allocated line management responsibilities for units. Staff are working on promoting independence in daily living activities and gradually incorporating this within care plans, reflecting individual preferences and choices. Effort is made to obtain medical information from general practitioners before admissions, where practicable. The medication ordering system had improved and other pharmacy improvements specific to the operation of the assessment units were noted. People using services have opportunity to attend resident committee meetings, which is a new development, enabling more control and influence over decisions. The committee had engaged in planning various social events with the active living adviser, for example, a beach day, summer fayre and Olympics day. The staff team has received training to help them to promote activity based and goal orientated care. The range of social social activities has been extended, affording more choice and includes a monthly pub outing. The chill and heat catering system Care Homes for Older People Page 8 of 32 operating at the home is now supplemented by home cooked food. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures and documentation for enabling an informed choice of home should be reviewed. Assessment processes for people referred for long-term placements are efficient to ensure individual needs can be met. People admitted solely for intermediate care are helped to maximise their independence. Evidence: An up - to - date statement of purpose was prominently displayed in the reception area at the time of the inspection visit. This clearly set out service provision specific to the user group of older people aged over 65 years with physical frailty, requiring nursing care. The South West Surrey Social Care Team and Guildford and Waverley Primary Care Trust provide assessment and therapeutic services in two dedicated units, comprising of 20 places. The aim of these units is to provide care for people following hospital admissions, on a short-term basis, supporting people to return home or onto to other care settings. Care UK provides the care for all people accommodated Care Homes for Older People Page 11 of 32 Evidence: in the home. Nurses working on the assessment units spoke of a high demand and turnover in two beds designated for short assessment periods of two to three weeks duration. These beds are also used for people at risk, on a 24 hour hour basis. Admission referrals may be via the Social Services Social Care Team, the Primary Care Trust Rehabilitation Team or directly from people self-funding their care. The assessment and rehabilitation services contract was under review at the time of the visit. The manager acknowledged the need to critically look at admission needs and objectives for these units as admissions were currently not always within the existing criteria. Admissions to units not designated for rehabilitation and assessment take place following a comprehensive needs assessment carried out by a skilled and experienced staff member. The homes management is efficient in obtaining summaries of assessments undertaken by professionals and copies of care plans for all referrals before agreeing admissions. Though not standard practice for the homes staff to undertake pre-admission assessments for people referred to the rehabilitation and assessment units, if the information received in professional assessments indicates needs cannot be met, the homes staff will undertake their own assessment. The homes management has specifically requested referral and hospital discharge personnel to plan admissions before 17:00 hrs. Nurses stated that admissions frequently take place outside these specified hours which is not in the best interest of people using services. Emergency admissions are accepted if they meet the admission criteria following assessment and when all necessary documentation is available. If not possible to assess before admission they are usually admitted to the assessment units. Discussions with the home manager confirmed an understanding of the importance of having sufficient information when choosing a care home. Attention was drawn to feedback from people using services who responded to our survey in which many felt improvement could be made in this area. A number stated there was a need for more information to be provided prior to admission, to enable an informed decision. The manager confirmed that copies of the homes statement of purpose were given out on request but not routinely. A service users guide had been produced and was displayed in the reception area. This was informative and said by the manager to be issued to people taking up permanent placements, on admission. It details what prospective people using services can expect, giving a clear account of the homes services and facilities. The manager stated her intention to further develop this document to make it more accessible to people using services, meeting their diverse communication needs. Past inspection reports were displayed in a public area together with the complaints procedure. Letter from relatives and representatives of people using Care Homes for Older People Page 12 of 32 Evidence: services and survey outcomes were also displayed, giving users views of the home. A leaflet had been produced providing information about services and facilities for people referred for admission to the assessment units. Social Care Team and Primary Care Team staff were stated to have a supply of these leaflets. People consulted on these units during the visit however were unable to recollect receiving copies of the same. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are mostly put into practice. Some shortfalls in practice were identified and drawn to the attention of management. Evidence: Files of people using services were sampled and observations confirmed compliance with previous requirements. Specifically for records to include progress in achieving care goals recorded in individual plans of care and of care interventions. Care plans had been generated from comprehensive assessments of needs and drawn up with people using services. Care plans reflect the diversity needs of people using services. Computerised care plans and assessments enable ease of password controlled access for staff and management. Hard copies of care plans sampled on units were not maintained up to date and it was not clear of their purpose as staff confirmed they followed electronic plans. An individual key worker system had been implemented and allocated named nurses Care Homes for Older People Page 14 of 32 Evidence: were delegated line management responsibilities for each unit. Staff promote independence in every day activities of daily living, respecting and enabling individuals preferences and choices. Examples include encouraging people using services to help themselves to vegetables from individual serving dishes on tables and to make tea and coffee for themselves, if they wish and can safely do so. Work was said to be taking place on producing life story books to assist staffs understanding of the personal, social lifestyle needs of people using services. Other changes include a concerted effort being made to gather medical information before admission. The community pharmacist had been consulted and improvement reported to the medication ordering systems; also to systems for obtaining pharmaceutical supplies, including oxygen, for people admitted to the assessment units.The manager spoke of the recently implemented resident of the day scheme. Each person using services was stated to be selected in turn, when all nursing observations were carried out, their bedrooms deep cleaned and clothes tidied. Staff are expected to consult the individual and accommodate any special requests, for example, something special they would like to eat or drink or to do. Personal care delivery was mostly observed to respect the privacy and dignity of people using services at the time of the visit. Staff were discreet and sensitive in their practice for promoting continence. Staff had received infection control training and generally a good standard of hygiene practice was evident. A shortfall in this area relating to the storage of urine bottles on bedside tables in two bedrooms next to drinking glasses and cups, was discussed. Bathrooms and toilets were clean and hygienic with supplies of paper towels and liquid soap. A yellow bag clinical collection service was in place and hygienically managed. The home has a retained General Practitioner (GP) who visits four times a week and more often on request. People admitted for intermediate care are registered with the medical practice as temporary patients. Medication is administered by nurses and medication storage, including controlled drugs, was sampled in one of the two medication rooms. The storage room was clean and well organised. The medication records sampled were satisfactorily completed and signed. Feedback to our survey from a care manager highlighted occasions when tablets were seen on bedroom floors, suggesting the need for improvement in medication administration procedures. It was not stated whether this had been drawn to the attention of management. The majority of the medication dispensed in a monitored dosage system. The deputy manager confirmed that the GP carried out regular medication reviews. GPs use a password controlled electronic medical records storage system at the home, also maintaining hard copies of medical records. Risk assessments processes are generally robust and risk management plans had been Care Homes for Older People Page 15 of 32 Evidence: produced. An electronic system exists to raise staffs awareness to risks when files are opened. Health monitoring takes place, enabling people using services access to healthcare services and health allied professionals. Observations confirmed the need for improvement in the quality of nurse leadership and direction to care staff on the assessment units on the day of the visit. The manager confirmed awareness of the need to provide additional training for nurses and team leaders, which is planned. Staff breaks need to be better organised and staff supported in managing their workload and supervision of practice needs to improve. Poor practice observed during the inspection in one of the assessment units and discussed with the manager needs to be seen in the context of these management deficiencies. The need to ensure new staff completing assessments are fully trained and competent was also discussed, on noting an inaccurate assessment of the mental status of a person recently admitted. Comments received from a care manager though mostly positive about standards of care, suggested areas where improvement could be achieved. It was said that sometimes staff shout to each other on corridors, personal and private information about people using services. Other comments included the need for nurses to be more robust in following up with GPs arrangements for readmission to hospital of people exhibiting inappropriate behaviour towards others. Also for improved communication between nurses and other health professionals relating to people referred for day hospital appointments and for therapists care plans to be followed. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using services are able to make choices about their life style and receive support to develop and maintain life skills. Social, cultural and recreational activities meet their individual expectations. There is a choice of meals and a balanced diet is served, meeting individual dietary needs. Evidence: The kitchen was visited and found to be clean and tidy. An Environmental Health Officer was stated to have inspected food safety at the home last year and requirements made were stated to have been met. Catering staff provide home made cakes and take orders for personalised birthdays cakes for people using services. They were planning one in the shape of an aeroplane for one individual. On the day of the visit the company supplying the home with chilled meals which are then heated and served was show - casing an increase in the range of dishes available in the activities lounge. People using services, visitors and staff were tasting the new dishes. Observations confirmed that meals were served from heated trolleys in dining rooms on the living units by care staff. On sampling these dishes they were found to be tasty however feedback from people using services confirmed the view that the meals lacked variation. Care Homes for Older People Page 17 of 32 Evidence: Discussion took place with the manager regarding complaints documented from a relative about catering standards specific to vegetarian meals. This had been resolved. The homes management is in the process of moving away from the current chill and cook system. A new chef had been appointed the week prior to the inspection, in addition to the head chef, with the intention of providing home cooked suppers. Improvements to catering include provision of cooked breakfasts on Saturdays and home cooked roast dinners. The home has a range of communal living areas and each unit has its own lounge with television and music centre. Group and individual activities are provided as part of a structured activities programme. People using services have control over how they spend their time . Activities include craft afternoons, visits from a local farmer with farm animals, exercise classes to music and themed events, replicating community activities. The homes activity coordinator was appointed in May 2008 and works Monday to Friday between the hours of 10 a.m. and 4 pm. These hours are flexible and may include weekends to support social events. Maple lounge is where the majority of activities take place. This include television and arts and crafts areas and a reminiscence corner. On special occasions, such as Christmas, Easter, St Georges and St Valentines days, people using services have their meals in this area, sometimes with a relative or partner. Maple Lounge is also used for entertainment and exercises. Discussion took place with the activities organiser as part of this inspection. Records of activities were sampled, recording attendance. The homes service users guide makes reference to opportunity for people using services to attend religious services. On the first Wednesday of the month a Vicar provides a communion service at the home, followed by tea and cakes. There is an in-house shop and once a week the activity organiser takes the shop trolley round to the units. The hairdresser visits once a week and can come in on other days by request, if given plenty of notice. The home has Pamper Me Days included in the activity programme, which include manicures provided by staff. The former activities organiser has a new role as active living adviser, working across a group of homes operated by the organisation. Discussion with her about her role confirmed she offers help and advice to people using services in maintaining independence in areas of personal care, eating and drinking. There are no restrictions on visitors. A residents committee meets monthly which family members are welcome to attend. This affords them with opportunity to be involved and contribute to decisions and planning activities and social events. There is a mobile pay phone for the use of people using services. Care Homes for Older People Page 18 of 32 Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using services are protected by the homes policies and procedures. They and their representatives benefit from knowing the home takes all complaints seriously and use them to improve services. Evidence: The complaint procedure displayed by the front entrance is a corporate procedure and does not include information about the Commission for Social Care Inspection, as required by the regulations. The manager was requested to look into this. The complaint procedure is also referenced in the service users guide and statement of purpose. The manager maintains an electronic record of complaints providing an audit trail of complaints and of the action taken. This record demonstrated that complaints are taken seriously. We received one anonymous complaint about the home since the last inspection, in January 2008, raising concerns about staffing levels and other staffing issues. These matters were used to focus the inspection when assessing Outcome Area 6. 11 complaint had been investigated by management in the past twelve months. Two complaints relating to the same person using services recently investigated had resulted in refresher training in moving and handling being implemented for the team. Discussions with the manager clarified letters confirming the outcome of complaints were not always provided to complainants and sometimes feedback given verbally. It was suggested as a matter of good practice that a written outcome of complaint investigations be provided to all complainants. Care Homes for Older People Page 20 of 32 Evidence: The home adheres to the local multi-agency safeguarding adults procedure. Staff training records demonstrated that staff receive safeguarding awareness training as part of their induction. There is an ongoing programme of safeguarding training for the team, using theory el box training which is a computer-based training package. The homes Annual Quality Assurance Assessment (AQAA) was noted to be inaccurate in that it did not refer to three safeguarding incidents since the last inspection. The outcome of these was discussed with the manager at the time of the inspection. Disciplinary matters associated with these incidents were also discussed and related staff turnover. The manager confirmed that the culture of the home was changing and reported improvements in a number of areas. Policies and procedures safeguard money belonging to people using services. Up to fifty pounds may be deposited with the administrator for safekeeping. The administrator was consulted during the inspection and demonstrated robust record keeping practices relating to this money. People using services are protected by the homes staff recruitment, vetting, induction and training practices. Discussion took place with the deputy manager regarding use of special chairs with integral tables that can be secured. The home has five of these tables and the use of one for a person without mobility was reviewed. Though evident this chair was not used as a form of restraint for this individual, management was advised to develop a protocol for use of these chairs, to protect people using services from inappropriate use. The need to ensure a multidisciplinary risk and benefits assessment is carried out was discussed. Failure to do so may place individuals at risk of restraining methods which could cause them harm and violate their rights. The person using services must have agreed to the use of safety equipment/furniture, if they have capacity to do so and/or relatives must be consulted. The outcome of the assessment and action required must be documented in care plans. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using services benefit from living in a comfortable and hygienic environment that is suitable to meet their needs. Some attention is necessary to minimise environmental hazards. Evidence: A tour of the building was carried out. The bungalow style and layout of the premises meets disability diversity needs and is fully wheelchair accessible. The purpose built living units provide all single bedroom accommodation in five living units, each accommodating ten people. A comment from a health professional indicated the need to review how bedroom accommodation is used for partners. Living units have communal lounges with television and music centre, combined with dining rooms and open plan kitchenettes. An emergency call system is fitted throughout and bedrooms have a television point. A mobile pay phone is also provided. Specialist bathing facilities are available and hoists.The home was clean and odour well controlled. Since the last inspection additional standing hoists had been purchased, more robust cleaning schedules implemented and water temperature valves had been replaced. The wheelchair maintenance and cleaning schedule had also been enhanced. The decor and furnishings were of a good standard and a maintenance programme was evidenced. The home has a laundry and people using services or their relatives are requested to label clothing. Care Homes for Older People Page 22 of 32 Evidence: As at the time of the last inspection, observation was made of decor and corridors being similar in appearance which did not aid orientation around the home. On this occasion a visitor was observed to have difficulty in locating the exit when leaving Elm unit and headed instead for Oak unit. A staff member commented that this was not uncommon. This feedback was given to the manager who agreed to look into the possibility of signage. On the day of the visit there was a problem with the heating and an engineer had been called out. This was very disruptive to the home, some areas very cold necessitating people having to vacate their bedrooms and other areas were excessively hot. The grounds are well cared for and there are a number of seating areas to choose from. An environmental risk assessment needs to be carried out to address shortfalls in the buildings security during the visit. Staff had not secured the front door that morning after taking in the milk delivery. The side gate of the enclosed garden leading to the car park and road was left wide open, as was the door to the garden on the unit nearest the gate. On leaving the home in the dark the car park was hazardous owing to inadequate external lighting. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management, supervision and direction of staff on the assessment units needs to be reviewed as does the adequacy of staffing levels. People using services are protected by staff recruitment and training practices. Evidence: The rotas sampled demonstrated that staffing levels during the day were between two to four nurses, dependent on the activities of the day and two care assistants allocated to each unit. Staff work either long days of twelve hour shifts or early and late shifts. Staff are allocated fifteen minutes tea breaks and thirty minutes for lunch. Night shifts are twelve hours and night staffing levels are two nurses and four care assistants. Night staff have a break of one hour. Observations during the inspection visit on one of the assessment units were made of poor care practice, inadequate staff supervision and direction, shortfalls in staff communication and team work and failure to ensure adequate observation levels in communal areas. A requirement has been made for review of the adequacy of staffing levels. It was also suggested to the manager that computer terminals be supplied in the two assessment units, the same as other units. Staff on the assessment units spent a significant amount of time out of the units in a central office recording computerised care notes, further depleting observation and staffing levels. The nurse in charge had not ensured staff were able to take their breaks and the information received indicated this was not an isolated occasion. Care Homes for Older People Page 24 of 32 Evidence: Nurses have rotating responsibility for units so that they know the whole home. The rotation is every two weeks but management is considering extending this period based on feedback from nurses. Discussions with the manager included the high turnover rate in staff since the last inspection. Whilst this was acknowledged the manager confirmed that since she had taken up post three permanent staff had left, the remainder were bank staff who were drawn from colleges and tended to be transient. The bulk of the staff turnover was stated to be when the former manager was in post. It was said there had been significant staffing difficulties and challenges investigated under safeguarding adults procedures. Disciplinary action had followed and some staff turnover associated with this. The manager was reminded of the requirements for notifications under regulation 37 of any allegation of misconduct by staff or the registered person. The manager said she had implemented Exit interviews for staff who had recently left. One had obtained a post in a care home paying more money, another had moved out of the area and another felt the dependency levels were too high. Staff recruitment continues to be a challenge. The homes advertises locally, in job centres and colleges. The manager stated that the recruitment process includes being clear of dependency levels and the provision of nursing care. The home had recently recruited twelve care assistants from overseas who were qualified nurses though not registered to practice in the United Kingdom. They are currently studying for a health and social care national vocational qualification (NVQ) at college. The staff files sampled demonstrated robust recruitment and vetting procedures are followed. The manager produced evidence of staff whose first language is not English being assessed as part of the recruitment process on literacy and language skills. Part of the process included a recruitment open day in which prospective staff met with people using services in the home and staff and could see for themselves the dependency levels. The recruitment process included presentations, case study assignments and one to one interview. They spent time with the home manager on their first day in post, going through the homes philosophy of care, ethos and key policies and procedures. The deputy manager is their designated mentor. New staff have a three month care development induction before working towards NVQ qualifications in care. The hotel services team of catering, housekeeping and laundry services staff and the maintenance person are supervised and supported by the administrator. An ongoing staff development and training programme was demonstrated. A healthcare assistant who is a trainer in moving and handling and safeguarding adults was consulted during the visit about her new training coordinator role, which she shares with the deputy manager. The home had recently implemented use of the L Care Homes for Older People Page 25 of 32 Evidence: Box electronic learning system, and this was still being rolled out for all staff. It can be used at home however an obstacle to this has been that there is only one lap top. The training coordinator reported having commenced group training sessions using this system which staff whose first language is not English report finding helpful. The homes training records held electronically were observed to be fragmented across two systems. The home manager had recognised this and spent time undertaking a training analysis for all staff, a copy of which was examined. This evidenced staff were in receipt of relevant training. The training coordinators and the manager were requested to ensure one coherent system and record of staff training, available for inspection. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes management and administration ensures best practice operational systems for continuous improvement, in which the views of people using services are listened to. Whilst the homes management generally promotes their health, safety and welfare some shortfalls were identified. We can be confident, having discussed these with the registered manager that the necessary improvements will be made. Evidence: A change of home manager took place in April 2008. The new manager has worked in the care sector for over fifteen years, having previously managed four care homes. The home manager has been registered since carrying out the inspection visit. The home manager has relevant management qualifications but not a professional nursing qualification. The expectation within the care homes national minimum standards (NMS) to appoint a nurse to registered managers posts for care homes providing nursing remains. However, where a care home is unable to recruit a registered Care Homes for Older People Page 27 of 32 Evidence: manager with nursing qualifications, providers can propose a non-nurse as registered manager provided they identify or appoint a clinical lead nurse and the proposed registered manager satisfies the requirements of the care and management standards of the NMS. The deputy manager is a registered general nurse with over twenty eight years experience and has delegated lead responsibility for directing and supervising clinical care. The senior team includes registered nurses, an administrator and hotel services team leader, a maintenance person and activities organiser. The South West Surrey Social Care Team and Guildford Waverly Primary Care Team provide assessment and therapeutic services in the assessment units. Observations suggest the management team is cohesive with clearly defined roles and responsibilities. The manager demonstrated a clear understanding of the principles and focus of the service. These are based on organisation values and priorities and take into account changing needs of people using services. Based on the available information it was concluded that the management of the home promotes equal opportunities. The manager stated her commitment to the provision of person centred care and effective outcomes for people using services. She is aware of where further improvements can be made and work is in progress to formalise a development plan.The need to develop the management skills of individual nurses was identified during this inspection. It was positive to note the homes management had already recognised this and was taking action to provide leadership and team management training for nurses and team leaders. The inspection also identified the need for review of the adequacy of staffing levels. The manager was noted to be acting on the need to improve her own time management by delegating management tasks and responsibilities within the senior management team. The Annual Assurance Assessment (AQAA) contains clear, relevant information that is supported by a wide range of evidence. The data section of the AQAA was mostly accurately completed. The need to ensure notification made of all significant events was discussed. These must include all relevant disciplinary matters, all safeguarding incidents and pressure sores acquired in the home or present on admission of grade two or over. Quality assurance systems include carrying out surveys of people using services and their representatives. The last survey took place in February 2008 and the findings were displayed in a public area. A system operates for statutory visits to be undertaken on behalf of the provider, by line managers, also by home managers peers as part of their professional development. A recent change of line manager for Redwood was reported. The home works to clear health and safety policies and staff are trained to put this theory into practice. Whilst the home has a consistent record of meeting relevant health and safety and other safety legislation and of closely monitoring its own practices, some shortfalls were identified. These have been commented on under the relevant quality outcome area of this report. The need for all Care Homes for Older People Page 28 of 32 Evidence: staff to take individual responsibility for ensuring a safe environment was discussed. In additional to deficiencies in security and poor external lighting, staff who distributed secondary heaters to bedrooms during the visit did not demonstrated due diligence in risk-prevention relating to the heaters hot surface temperature. The deputy manager was noted to have had to go behind staff, creating barriers around the heaters with furniture to ensure the safety of people using services. People using services are supported in safeguarding personal money. The administrator operates a system for securing money and valuables. Care Homes for Older People Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 27 18 Staffing levels require review on the assessment units to ensure staff numbers are appropriate for the health and welfare of people using services. This will promote more effective teamworking, enhance practice and enable staff to take their breaks. 02/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 31 It is recommended that the statement of purpose contains information regarding arrangements at the home for a lead nurse with delegated responsibility for clinical care. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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