CARE HOMES FOR OLDER PEOPLE
The Red House Norwich Road Kilverstone Thetford IP24 2RF Lead Inspector
Jerry Crehan Unannounced 12th April 2005 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 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. The Red House I55s32102redhousev221264120405(4).doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service The Red House Address Norwich Road Kilverstone Thetford IP24 2RF 01842 753122 01842 760337 rclaxton@totalise.co.uk Miss Rachael Claxton Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Miss Rachael Claxton Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places The Red House I55s32102redhousev221264120405(4).doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: The home is registered to accommodate a maximum of 14 older people. There were 12 service users in residence at the time of the inspection. Date of last inspection 20th September 2004 Brief Description of the Service: The home is registered to provide accommodation and personal care to up to 14 elderly people. It is not registered to deliver nursing care.It is situated set back from a main road out of Thetford, near to a large supermarket. There is a gravel driveway to the main door of the home, with parking to the side and rear. The grounds are extensive, but parts are not easily accessible. Service users can access the garden, lawns and patio to the front of the home.Accommodation is provided in two main areas, leased by the registered proprietor. The older part of the home is on two floors, with bedroom accommodation on the first floor. There is assisted access via a stair lift. Communal areas (lounge and dining facilities) are provided in the ground floor. An extension provides additional ground floor bedrooms. The Red House I55s32102redhousev221264120405(4).doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 3.5 hours. Opportunity was taken to tour the premises, look at care records and policies, and talk to service users and staff. Most of the service users were seen and spoken to during the inspection. What the service does well: What has improved since the last inspection? What they could do better:
Individual care plans appeared to accurately reflect the needs of service users, and to be regularly reviewed, however, the assessment and review of risks requires equal prominence. A requirement has been made in respect of a service user who plays a significant part in the self-administration of their oral medication. A recommendation has been made that this is reviewed appropriately. Although not inspected on this occasion discussion took place about the advantages of developing a more systematic approach to testing the quality of the service provided. The Red House I55s32102redhousev221264120405(4).doc Version 1.20 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Red House I55s32102redhousev221264120405(4).doc Version 1.20 Page 7 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 Standards Statutory Requirements Identified During the Inspection The Red House I55s32102redhousev221264120405(4).doc Version 1.20 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 The home provides clear and accurate information that would assist service users in making an informed choice as to the home’s ability to meet their needs. EVIDENCE: The home has produced documentation including a Statement of Purpose and Service User Guide that is provided to every service user and was available within the home. One recently accommodated service user referred to having access to the home’s brochure prior to her moving to the home. The Red House I55s32102redhousev221264120405(4).doc Version 1.20 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10 Service users health and personal care needs are well attended to. Use of risk assessment should be expanded where service users self medicate. EVIDENCE: Comprehensive individual care plans were available and there was evidence that these are reviewed at least monthly. The quality of individual care plans was reflected in feedback from service users, who indicated that they felt extremely well cared for and that they wanted for nothing at the home. Care plans refer to the involvement of a variety of community health professionals. Service users confirmed access to, among others, the chiropodist and optician. Arrangements for the administration of medication were reviewed and considered to be safe. A number of staff had recently been trained in a new dispensing system (Monitored Dosage System) adopted by the home. Risk assessment is required for a service user who plays a significant part in the self-administration of her oral medication. This assessment should also indicate what medication is prescribed. Observation during the inspection showed that staff had an understanding of how to promote service users privacy and dignity. Communication between staff and service users observed was sensitive to the individual needs of
The Red House I55s32102redhousev221264120405(4).doc Version 1.20 Page 10 service users. A number of service users indicated that staff always respond very quickly to call bells if used. The Red House I55s32102redhousev221264120405(4).doc Version 1.20 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 14 Service users experience a variety of formal and informal social activities in conducive settings. Visitors are encouraged and made welcome. EVIDENCE: Service users confirmed that a number of organised activities are arranged regularly including a visiting pianist, a sing-a-long session, and a church service also takes place. One service user indicated that he enjoyed a walk around the grounds of the home each morning, another that she keeps occupied with knitting or quizzes. It was evident at the time of the inspection that service users experienced and enjoyed relaxed and unhurried conversations or discussions with staff. Service users indicated that their visitors were made welcome at the home at any time of their choosing, and that they usually saw visitors in the privacy of their own rooms. However, it was also apparent that communal areas were set aside at times too, as visitors were present at the time of the inspection. Portable telephones were available throughout the home to support the privacy of service users wishing to use the telephone. The Red House I55s32102redhousev221264120405(4).doc Version 1.20 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The arrangements for responding to concerns or complaints are satisfactory. EVIDENCE: No complaints have been received by either the home or CSCI. Consequently the complaints procedure remains untested in practice. However, a clear and accessible complaints procedure is in place. Furthermore, service users spoken to indicate that although they had no complaints about any aspect of their care, they were confident that any complaint would be properly addressed. The Red House I55s32102redhousev221264120405(4).doc Version 1.20 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 24 and 26 Comfortable, safe and well maintained accommodation is provided by the home. The interior has a noticeably homely feel, particularly service users individual rooms. EVIDENCE: The home is well maintained externally and internally. The grounds to the front of the home are well maintained and accessible for service users, either via the door and a path round, or from French doors in the sun lounge. This is clearly appreciated by service users who indicate that they enjoy the facility this provides, or simply enjoy looking at the grounds and garden. The interior is decorated and furnished to a high standard. Communal areas each offer a different ambience, which service users were making use of at the time of the inspection. The service users bedrooms were clearly personalised with their own furniture and possessions. Service users had clearly been able to create ‘a home’ within their individual rooms.
The Red House I55s32102redhousev221264120405(4).doc Version 1.20 Page 14 All areas of the home were cleaned to a high standard. An odour was present in one service users bedroom, and it was recommended that further investigation take place as to the cause, in addition to guidance from the continence advisor. The Red House I55s32102redhousev221264120405(4).doc Version 1.20 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Staff at the home were employed in sufficient numbers to comfortably meet service users needs. EVIDENCE: Despite some recent staff turnover the home provides a relatively stable staff group. Staffing levels were well above the minimum standard required with four staff usually available in the mornings, and at least two staff available in the afternoons. Service users indicated that there was sufficient staff available to meet their needs. This was apparent at the time of the inspection. The Red House I55s32102redhousev221264120405(4).doc Version 1.20 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 32 The home is well managed by a competent manager who is highly regarded by service users and staff alike. EVIDENCE: The registered manager is also the owner. She has a variety of care and management experience with a number of different service user groups. The manager was described as ‘honest and approachable’ by staff, and as ‘lovely’ by service users. This was reflected in an open and inclusive atmosphere within the home. The inspector observed interactions between service users, staff and the manager that were positive and respectful. The Red House I55s32102redhousev221264120405(4).doc Version 1.20 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 3 x x x 4 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 x x x x x x The Red House I55s32102redhousev221264120405(4).doc Version 1.20 Page 18 No Are there any outstanding requirements from the last inspection? 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 9 Regulation 14 Requirement The registered person must undertake and record risk assessments for service users wishing to self-administer medicines in order to assist in ensuring such medicines are safely managed. Risk assessments must be reviewed at regular intervals as appropriate. Timescale for action 30 April 2005 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 9.1 Good Practice Recommendations It is recommended that risk assessments of residents selfadministering medicines indicate both the medicines selfadministered and the planned period for review of the assessment. It is recommended that the advice of the continence advisor is sought. 2. 26 The Red House I55s32102redhousev221264120405(4).doc Version 1.20 Page 19 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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