Inspection on 06/09/07 for Redwood House Residential Home

This inspection was carried out on 6th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Redwood House Residential Home 01/02/07

Redwood House Residential Home 08/11/05

Redwood House Residential Home 01/12/04

Redwood House Residential Home 25/05/04

Redwood House Residential Home 20/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Redwood House Residential Home 11 Cherry Hill Road Barnt Green Worcestershire B45 8LL Lead Inspector Deborah Sharman Unannounced Inspection 6th September 2007 09:00 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 Redwood House Residential Home DS0000018478.V341580.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. Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Redwood House Residential Home Address 11 Cherry Hill Road Barnt Green Worcestershire B45 8LL 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) 0121 445 2268 0121 447 9700 admin@redwoodcare.co.uk Redwood Care Homes Ltd Mrs Nicola Jayne Hill Care Home 28 Category(ies) of Dementia - over 65 years of age (28), Old age, registration, with number not falling within any other category (28), of places Physical disability over 65 years of age (28) Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia, over the age of 65 years - Code DE(E) Physical disability, over the age of 65 years - Code PD(E) The maximum number of service users who can be accommodated is 28. 1st February 2007. 2. Date of last inspection Brief Description of the Service: Redwood House is a large detached house, set in extensive grounds consisting of mature gardens and lawned areas. Ramps and pathways enable easy access for residents. The home has recently had a passenger lift installed to enable ease of access to the first floor. Redwood House is registered to provide residential care for up to 28 older people who are frail, who may have physical disabilities or who may have experienced a mental health need. The home chooses to care for up to a maximum of 27 people. At the time of this inspection 20 residents were accommodated. Accommodation is provided in 24 single bedrooms, 11 of which have en-suite facilities and two double bedrooms with wash facilities but without en suite. Respite care can be provided if there are vacancies. The stated aim of Redwood House is to provide quality care in a safe and comfortable environment, where residents have the freedom of choice in the management of their own lives and where they are treated with dignity and respect. Redwood Homes Ltd acquired Redwood House in March 1998. There are several homes within the group. The registered manager is Mrs Nicola Hill is responsible for the day-to-day management of the home. At inspection the Manager stated that fees at Redwood House currently range from £350.00 to £430.00 per week. Additional charges are made for personal items such as hairdressing, newspapers and toiletries and private chiropody. Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector carried out this unannounced key inspection between 9.00 am and 5.00 pm. As the inspection visit was unannounced this means that no one associated with the home received prior notification and were therefore unable to prepare. As it was a key inspection the plan was to assess all National Minimum Standards defined by the Commission for Social Care Inspection (CSCI) as ‘key’. These are the National Standards, which significantly affect the experiences of care for people living at the home. Progress the home has made towards meeting previous CSCI requirements issued to ensure improvement was also assessed. Information about the performance of the home was sought and collated in a number of ways. Prior to inspection the Commission for Social Care Inspection was provided with written information and data about the home in their annual return. Additionally prior to inspection, the Commission for Social Care Inspection sought the views of people living at the home and those of their relatives and other professionals associated with the home. Written responses were received from 6 relatives and one health professional. Three people who live at Redwood House returned questionnaires about their experience of living at the home. All this information was analysed prior to inspection and helped to formulate a plan for the inspection and has helped in determining a judgement about the quality of care the home provides. During the course of the inspection the Inspector used a variety of methods to make a judgement about how service users are cared for. The Registered Manager was available throughout the inspection day to answer questions and generally support the process. The Inspector interviewed a care staff member, chatted briefly with people living at the home about their experiences during a tour of the environment, ate lunch with residents which gave the opportunity to talk in more detail to two new residents. The Inspector also spent some time with the chef who explained the menu process and how she obtains feedback from residents about the meals she provides. The Inspector assessed in detail the care provided to one person using care documentation and sampled a variety of other documentation related to the management of the care home such as training, recruitment, staff supervision, maintenance of the premises, accidents and complaints. Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 6 What the service does well: There is a happy jovial atmosphere at Redwood House and lots of friendly interaction and banter between staff and residents. When the Inspector arrived, residents were enjoying a sing along. During a later tour of the environment, residents were sitting in small social groups and there was a lot of laughter, interaction and humour observed. People were genuinely having fun and enjoying each other’s company. Feedback received was exceptionally positive and residents and relatives alike who provided feedback and who spoke to the Inspector on the day of inspection are delighted with how their needs are met. A consistently positive theme in the feedback received was about the staff: ‘The carers communicate well with the residents, in a warm and friendly manner. ‘Attentive, helpful and supportive care provided in a friendly environment’ ‘From day one they have gone out of their way to meet mums needs.’ ‘Visiting would be much more difficult without the support of staff’. ‘I think this is an exceptional home where staff are well trained, happy and rarely leave’. ‘I visit my mother regularly but if the care home staff feel that she needs to see me between visits they don’t hesitate to contact me. This gives me a lot of reassurance.’ ‘They show genuine affection towards residents’ ‘The happy atmosphere and interaction between staff and residents is quite brilliant. All my family find it a pleasure to visit my relative at any time of day. ‘Staff are excellent’ ‘It’s a very pleasant place to be’. ‘I am more than happy with the place, the conditions and especially the staff’ ‘The meals were also consistently praised. Residents are provided with real choice based on their likes and dislikes, which are known to the staff and chef. Portions are generous and well presented. Residents look forward to their meals. One resident has put on 3 stone and four pound since admission to the home recently.’ Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The newly introduced care plan format is unclear and although staff are getting used to it, it is not sufficiently individualised or person centred. In addition the needs of a resident whose situation had significantly changed had not been updated in the care plans and risk assessments. Discussion with staff showed that they were aware of the changes and how to meet them. But lack of care planning fails to ensure sufficient accountability and the potential for error and risk to the resident exists. Assessment of medication practice highlighted the need to improve a number of practices. There are weaknesses in the audit systems where errors are not being noted or responded to. Staff are no longer using correction fluid on medication records which are legal documents but over writing signatures indicates that staff are signing for having administered medication before they have done so. Comparing the number of signed for tablets in records to the number of tablets remaining also casts doubt on the integrity of the medication administration and recording system. This does not assure that residents are receiving their medication as prescribed and this compromises their health and welfare. Some social activity is provided but it is difficult to thoroughly evidence. A relative has commented that it doesn’t seem to be a priority and a resident told the inspector that she does ‘not a lot’. There is capacity to increase understanding of how to engage residents with dementia in activity. There has been significant investment in improving the premises and most parts of the environment provide either very good or very acceptable accommodation. A few areas particularly communal bathing facilities remain in Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 8 need of improvement to provide a standard that concur with the rest of the premises and modern expectations. A number of new requirements to bring about improvement have been issued as a result of this inspection. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. Quality in this outcome area is good. People are satisfied that they receive sufficient information about the home and have the opportunity to visit before deciding to move in. The home satisfies itself that they can meet people’s needs before offering them a place and people living there are delighted with how their needs are met. Documentation however to support these processes could improve. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager assures herself that the home can meet people’s needs before a place is offered by carrying out an assessment that involves the potential resident and their families. Potential residents value the opportunity to visit and spend time at the home before they make the decision to move in. Staff are satisfied that they are provided with sufficient information in advance about how to meet new residents needs. Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 11 Documentation to support all parties during the admission process however could be better. Brochures about the home are out of date and have not been reviewed to comply with new regulations and the recent changes following the homes registration for additional rooms. The Statement of Purpose dated 2003 is particularly in need of review. Contracts outlining terms and conditions of residency appear to be available only for residents who are privately funded. This does not provide all residents with equal information about the rights and responsibilities of all parties. An assessment carried out by a funding authority was not available to support the care planning process. New residents spoken to however were happy and had settled well with one new resident stating ‘I can’t fault the place, the staff are marvellous’. Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is adequate. Care plans are in place and people living at the home are very satisfied with how their care and health needs are being met. Some inadequate systems however provide the potential for error and risk to people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans do not contain space for information about individuals. The format is generic, too busy, tick box style with lists of options of which none or few may apply to the subject. They cannot be said therefore to be person centred. For example the assessment carried out in respect of the resident case tracked shows her to like music, singing and knitting and to be a practicing catholic. The predetermined needs on the care plan template do not include these options and therefore, with no space to individualise the format, these needs are not addressed within the plan of care. Some of the completed interventions within care plans serve as a protocol to be followed in the event of their being a care need. E.g. the symptoms of constipation are listed with Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 13 staff being advised within of what action to take in these circumstances. However this was not an assessed need for the person case tracked but could lead staff to assume it is. On the other hand needs that had been identified in the pre admission assessment such as anxiety, Alzheimer’s, the fact that the resident does not like baths or showers, her need for regular chiropody and how to support her need to practice her religion are not included in a plan of care at all. Significant changes in need following discharge from hospital where dependency had increased were not reflected in the plan of care or risk assessments which had been reviewed on the day of discharge and noted as ‘no change’. Discussion with staff however indicated that they were aware of the change in need arising from the hospitalisation and the resident on this occasion was not being disadvantaged. Chiropody is provided regularly but records of treatment were not available. The only record is the receipt book. Records of individuals’ treatment must be stored in their individual records of care. In spite of the resident’s reluctance to bath or shower, records show that she has been offered a bath weekly. Her right to refuse was respected but as she has gained in confidence and developed a relationship with staff she has been enjoying a regular bath recently. She has also put on a significant amount of weight since admission and it is important that the care planning system is used to identify this resident’s optimum safe weight. Records show that the resident case tracked had wandered off away from the premises on three occasions making her exit through an external door. Risk assessments had been previously completed and the doors were alarmed to reduce the risk of this. However the risk assessments did not sufficiently consider a range of risk variables and the incidents happened when a deliveryman left the alarmed doors ajar. The control measure therefore failed. Following these incidents the risk assessments were not reviewed but it appears that staff were alerted to be more vigilant and there have been no further concerns. Risk assessments must be continually reviewed and updated in the event of change. The resident’s health has been monitored by keeping medication under review, which has lead to a reduction in dosage. Following a recent fall in the home and a subsequent operation the resident has been visited by a District Nurse and a GP and prescribed painkillers have been offered but mostly refused. A health professional consulted is satisfied with the overall health care provided within the home. A relative wrote ‘the staff are usually very watchful and on two important occasions have identified a potentially serious problem which might have lead to hospitalisation and an operation. The Dr was called and the matter dealt with promptly. I put this down to staff being well trained, alert and vigilant’. Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 14 Assessment of medication practice highlighted the need to improve a number of practices. There are weaknesses in the audit systems where errors are not being noted or responded to. Medication is checked in upon delivery but the label on one dossett did not reflect a recent prescription to half the dosage. The Manager therefore could not be sure that the medication supplied complied with the prescribed dose. This was not noticed or queried with the supplying pharmacist at the point of delivery. A telephone call to the pharmacist on the day of inspection confirmed the correct dose had been supplied but the label had been printed incorrectly. The Manager counts tablets weekly but had not used this information to recognise that there was a discrepancy. At inspection the number of signed for tablets in records were compared to the number of tablets remaining and there was a discrepancy meaning that staff had signed for medication that had not been administered. This casts doubt on the integrity of the medication administration and recording system. Staff are no longer using correction fluid on medication records which are legal documents but over writing signatures indicates that staff are signing for having administered medication before they have done so. This does not assure the accuracy of the medication records or that residents are receiving their medication as prescribed and this potentially compromises their health and welfare. Since the last inspection appropriate storage has been purchased for controlled drugs. This should be secured to a wall with rag bolts ready for use. Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. Whilst there are some activities provided there is scope for improvement. People however enjoy contact with friends and relatives and they very much enjoy their meals and mealtimes. The quality of meals and choices available is very good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On arrival at the home the Inspector heard residents enjoying a sing-along. During a later tour of the premises residents were enjoying old time music in one lounge. There was a lovely up beat fun atmosphere with a lot of laughing and joking and bantering with staff. A visiting one-year-old baby provided lots of entertainment and opportunity for engagement. Feedback from most relatives indicates that residents are supported to lead the life they choose. Activities generally however are difficult to evidence. Prior to inspection one relative wrote ‘organised activities don’t happen enough. It appears to be a low priority’. In response to a question about what she does and how she spends her time a resident said ‘we don’t do a lot.’ Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 16 Perusal of written activity records did not show a different picture as in two months from the middle of June six activities were recorded, largely group activities that the majority of residents chose not to join in. The recorded activities included skittles, bingo, snakes and ladders, singing and ‘fitness and fun’. The fitness and fun instructor visits fortnightly. A barbeque was planned for the day following inspection. Discussion with a staff member confirmed that the group activities that are recorded take place and added that there is also a showing of ‘film of the week’ and occasional walks in the lovely grounds giving one to one opportunities for residents and staff. Activities however could be more proactive and more structured around individual interests and needs. For example, one resident told the Inspector and manager how much she loves ironing and offered to do some ironing. Subject to risk assessment and with supervision this is something that could be explored to provide the resident with a sense of role, purpose and independence with a view to maintaining or extending skills. A staff member said that the Baptist ladies visit and engage residents in hymn singing. Prior to inspection a relative with reference to their minority religious denomination said ‘the staff have tried to be very accommodating and have taken time to identify any special requests. They encourage ministers to attend and go out of their way to make our family feel very welcome’. There was less in place to meet the spiritual needs of a practicing catholic resident whose assessed needs indicated the need to take communion. There were conflicting views from staff as to whether family support this area of her life. This issue could have been assessed in more detail. There was not a care plan for this and staff in discussion were unsure how they could support this resident’s spiritual needs. The dining room provides a pleasant eating environment although seating capacity will need to be reviewed when the home fills its newly registered additional rooms. All residents eat independently. The menu has two alternatives and residents are consulted in advance of each meal and are provided with the meal of their choice. Residents like and dislikes are known and the Inspector observed at lunchtime that the resident being case tracked had been provided with the meal of her choice, as she was known not to like the alternative. The chef said she monitors residents’ feedback about meals by both meeting with them and from monitoring any waste. Food stocks are plentiful and fresh fruit and vegetables are delivered daily. The chef is satisfied with the budget available to her although provides butter herself in preference to the cheap alternative provided which she sees as unacceptable for use on homemade scones etc. The Inspector told the chef that one relative’s comment pre inspection was ‘could provide afternoon biscuit or cake on a plate and not on the table as at present’. The chef acknowledged that such snacks are served on serviettes as Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 17 residents find it difficult to balance cups and plates but agreed to review this and to look at providing all residents with appropriate portable tables where necessary. Praise however for the quality and quantity of the meals provided was consistent both from information provided to CSCI before inspection and on the day of inspection. The Inspector observed residents enjoying their meals. Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. There is an open atmosphere where people can make suggestions for improvement, which are responded to before they become complaints. There have been no incidents where residents have been vulnerable, and staff and managers have a good understanding of how to protect people in the event of their being a concern. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A range of policies is available to guide staff about how to protect residents’ interests. The local interagency adult protection policy and procedure is not available however and as in the event of a concern the manager would be expected to adhere to this, a copy should be obtained. The Manager and most staff have undertaken adult protection training in 2005, which is due for renewal in 2008 according to the home’s schedule. Staff spoken to had a good understanding of the nature of abuse and their role if they were to have any concern. There is no firm plan to provide training to those staff who have not received training in recognising and reporting abuse and this must be addressed. However there have been no complaints, no allegations, no staff disciplinary action, no restraints, no incidents, people know how to complain should they need to and financial risks are minimised, as the home does not handle residents’ monies at all. Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. Quality in this outcome area is good. People living at the home are comfortable and recent improvements provide a very homely and clean living environment. Some areas of the premises especially communal bathing facilities are not to the same high standard, do not provide a welcoming place in which to relax and carry out personal care. However, the Provider and Manager have demonstrated a commitment to making improvements to the environment This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Inspector observed the premises to be decorated and furnished to a high standard particularly in communal living areas, which have been updated recently, and in the newly registered bedrooms. The premises are tidy and safe with additional measures taken recently to improve safety such as the provision of additional radiator covers. All are now covered reducing the risk of Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 20 burns. Residents are happy and comfortable in their bedrooms, which were seen to meet need. Older bedrooms are a little dated now and do not compare to the new ones but are acceptable. One relative’s comment was that ‘room, décor and furnishings could be refreshed’. Two further relatives commented on dusting needing to improve with the second person including the need to improve vacuuming. Other relatives have referred to ‘a cosy and clean environment’, and the house being ‘spotlessly clean’. This inspection found the house to be spotlessly clean but the manager did explain that they had had difficulties managing the quantity of dust during the building works. The Inspector noted whilst touring the environment that wardrobes are secured to prevent the risk of their falling and windows too are restricted. Restricted windows reduce the risk of intruders and the risk of residents accidentally falling from them. Not all bedrooms have en suite facilities and communal bathing facilities are in the most need of refurbishment as they do not meet modern standards and do not provide a place in which to relax and carry out personal care. The toilet on the ground floor has flooring, which requires replacing as it is lifting around the edges and is heavily marked. The Manager explained that this is in hand. A relative had commented that several residents use this ground floor toilet but that there is no water supply. The Inspector found this to be the case. The Manager explained she had had it disconnected due to flooding. However no steps have been taken to control the risk of cross contamination in the absence of no hand washing facility. This must be addressed. Residents are satisfied with the laundry service and the laundry facilities are clean and well supplied. The home has a clinical waste contract and waste is managed appropriately. Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. All parties have consistently praised the qualities of the staff team. People who live at and visit the home, feel that the staff are very competent and staff feel appropriately trained and supported on a day-to-day basis. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is registered to accommodate a maximum of 28 but self imposes a maximum of 27. At the time of inspection 20 residents were accommodated. Residents do not appear to have high dependency levels and a staff member spoken to is very happy with the staffing levels. She said that staff are not rushed and still have time to sit and chat with residents. Action has been taken to meet concerns identified at the last inspection about supervision available to residents over the tea time period. A staff member told the Inspector that training is good as they get a lot of training. Most staff have done or are doing a nationally recognised care qualification and the target for staff qualified to this level has been exceeded. A significant amount of expected training has been delivered to staff to date in 2007 although the quality of the training could not be assessed as the course content and certification, indicating course content were not available. However staff competency indicates that training is acceptable. Training Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 22 undertaken by the key worker of the resident case tracked was assessed and was sufficient to help to meet the residents’ needs. One staff member has not undertaken sufficient training (moving and handling, food hygiene, infection control) and it is essential that this is addressed as the nature of her job makes it particularly essential that she is fully trained to minimise risks to residents. A new staff member has not undertaken induction training, as the new format is not familiar to the manager. A relative gave a good example of how staff competency contributes positively to the well being of residents. S/he said: ‘When mum becomes agitated staff run through a list of potential reasons to try to eliminate any stress – this shows in the calm and happy disposition she now shows. They explain everything to her before they carry out a task. This makes a huge difference.’ Staff feel supported on a day to day basis but did not fully understand the concept of supervision. Records of supervision indicate that formal supervision is insufficiently frequent and does not accord with either the function of supervision or the national minimum standard. The culture of formal supervision does not appear to be established or role modelled as the Manager confirmed that although she feels supported, formal supervision is not provided to her. She may benefit from receiving training in the role and function of formal supervision processes. Recruitment documentation for a staff member was largely in place although the home had chosen to start the new staff member on a POVA first check rather than wait for the Criminal Record Bureau check. Procedures in place following self-disclosure of convictions or receipt of a check with disclosures must be reviewed. The Manager explained that head office carries out the risk assessment (upon receipt of the disclosure), which she had not had sight of and which was not on the premises. The Manager is managing any arising risk (which in this case were perceived as minimal) and should be aware of any control measures determined. A copy of the documentation should be available on the premises. Redwood House Residential Home DS0000018478.V341580.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38. Quality in this outcome area is mixed but generally good. At the time of inspection it was clear that the management of the home is ensuring that outcomes for residents are good on a day-to-day basis. However the Manager must ensure that time is dedicated to improving systems which underpin care outcomes to improve accountability and minimise the potential for risk and error. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager is appropriately qualified and has undertaken a range of recent courses to update her skills and knowledge. Although the manager is not receiving formal supervision, as she should be, she feels well supported. There are new plans to carry out appraisals of managers and this would be a Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 24 good time to introduce formal supervisions to complement and support the appraisal process. The Manager is supernumerary to the rota to enable her to carry out her management function 2 or 3 days per week and she feels that this is ‘manageable’. Evidence of staff meetings was requested. The Manager had said there had not been a staff meeting in 2007 to date but that one was booked. Minutes were not available to evidence staff meetings having taken place in 2006 either. Certification to evidence the maintenance of the premises and equipment was well organised and available and reassures that measures are in place to minimise any risk arising from fixtures and fittings. Measures are in place also to reduce environmental risks arising from wardrobes, radiators, windows, external doors and water temperatures. Door alarm risk assessments and fire risk assessments require review following a change in risk. Bed rails are not used and nobody is assessed as currently being at risk of falling from bed. The manager attended a recent course about the safe use of bedrails so she is prepared should the need arise for their use. The chef is fully aware of ways to reduce risk arising from food borne routes and checks cold storage temperatures, hot food temperatures and the temperature of provisions upon delivery. A recent food safety visit by Environmental Health identified a few miner actions for attention. Risk assessments for the premises are in place but the manager was advised to seek advice from Environmental Health as data sheets rather than full COSHH assessments are in place. The Manager was also advised to seek advice from Environmental Health as although staff have basic first aid awareness nobody is fully trained to appointed person status. Until advice can be sought and implemented first aid arrangements should also be subject to a full risk assessment. Quality assurance audits based upon feedback are carried out by the Provider who in March 2007 summarised the results as ‘excellent’ based upon 1assessed none compliance and 9 partial compliances out of 638 assessment criteria. The audit summary states residents ‘love the food and feel staff would do anything for them. No issues with laundry. The residents know who to speak to if they have any concerns’. Feedback to CSCI from relatives has been overwhelmingly positive ‘I think this is an exceptional home where staff are well trained, happy and rarely leave’ and ‘I cannot think of anything this home could do better’. A resident wrote ‘I am more than happy with the place, the conditions and especially the staff’ At lunchtime a resident told the Inspector that she ‘can’t fault it’ and that it is ‘excellent’. Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 25 A staff member told the Inspector that she thinks Redwood House is ‘‘managed very well, brilliant, best home I’ve worked in. It’s like a home. My Nan came here for respite for 8 weeks. I’d say it’s excellent definitely. I can’t think of anything that could be better’. The Manager’s strength appears to be managing people and to have such a happy and effective team is to her credit. Many outcomes for residents are good and therefore the omissions found at inspection are perplexing particularly as she feels that time allocated to management tasks is ‘manageable’. Steps must be taken to make the necessary improvements but on the basis that most requirements arising from the last inspection have been met, management overall has been judged to be good. Redwood House Residential Home DS0000018478.V341580.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 2 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 2 2 Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes. These have been changed to recommendations. 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 OP7 Regulation 15 (2) (b) 14(2) 13(4) Requirement Assessments of residents’ needs (and risks) must be kept under review and revised at any time when it is necessary to do so having regard to any change of circumstances. Care plans must be updated to reflect any assessed changes in need or risk New requirement arising from this inspection. Timescale for action 30/09/07 The registered manager must ensure that care plans are sufficiently detailed to ensure that care needs can be identified and met. This will ensure that changes in need and circumstance are identified, known and responded to appropriately. Previous requirement not met at this inspection 2 OP9 13 (2) The registered manager must ensure that Medication Administration Record (MAR) DS0000018478.V341580.R01.S.doc 13/09/07 Redwood House Residential Home Version 5.2 Page 28 sheets are completed correctly. This will ensure that they provide an accurate legal record of medications administered as prescribed to promote residents’ health. Previous requirement with target date of 1.2.07 not met at this inspection 3 OP9 13(2) Steps must be taken to improve systems for the recording, handling and safe administration of medicines received into the care home. This must include: Ensuring that staff sign for the administration of medicines after administration to each person. More robustly checking medications delivered to the premises. More robustly auditing medication practice within the home. This will ensure that medication is administered safely as prescribed to promote residents safety, health and welfare. New requirement arising from this inspection. 30/09/07 4 OP26 23(2J) Hand washing facilities that meet 30/09/07 the needs of residents must be restored to the ground floor ‘disabled’ bathroom and in the meantime steps must be taken to reduce the risk of cross infection. New requirement arising from this inspection. 5 OP30 18 Steps must be taken to ensure that appropriate training is DS0000018478.V341580.R01.S.doc 31/10/07 Redwood House Residential Home Version 5.2 Page 29 provided to staff that have not undertaken training appropriate to the work they are to perform to ensure residents welfare and safety. New requirement arising from this inspection. 6 OP38 23(5) The Environmental Health Authority must be consulted about the sufficiency of first aid training available to staff. The Environmental Health Authority must be consulted about the sufficiency of steps taken to assess the risk of hazardous chemicals stored and used on the premises. This will enable the Manager to identify any shortfalls and to take action as necessary to meet legal requirements to keep residents safe. New requirement arising from this inspection. 30/09/07 7 OP38 18(c)(1) Staff employed at the care home 30/09/07 must receive structured induction training to equip them for role to meet residents’ needs. New requirement arising from this inspection. Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 30 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 OP1 Good Practice Recommendations The service users guide and if necessary the terms and conditions must be amended in line with recent changes to the regulations (and recent changes to the homes registration September 2007). This was a requirement previously, which at this inspection is not met. 2 OP1 The Statement of Purpose should be reviewed and updated. New recommendation arising from this inspection. 3 OP2 4 OP15 5 6 7 OP18 OP32 OP36 8 OP37 All residents including those funded by Care Management arrangements should be issued with a contract outlining the terms and conditions of residency that accord with the new regulations. Arrangements for the serving of snacks to residents should be reviewed to ensure that cakes and biscuits can be served with dignity whilst maintaining independent eating for as long as possible. A copy of Worcestershire’s Multi Agency Adult Protection policy and procedures should be obtained and held on the premises for reference. Staff meetings should be held regularly and a record of them should be taken and retained. The Manager and all care staff should receive recorded formal supervision at least 6 times per year and should cover all aspects of practice, the philosophy of care at the home and career development needs. Records relating to the care and treatment of residents e.g. hair and chiropody appointments should be held on their individual records rather than in a communal record book. Redwood House Residential Home DS0000018478.V341580.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Worcester Local Office The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries.worcester@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. 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