CARE HOMES FOR OLDER PEOPLE
The Red House Bury Road Ramsey Cambridgeshire PE17 1NA Lead Inspector
Lesley Richardson Unannounced Inspection 17th October 2005 11:40 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 The Red House DS0000024304.V259870.R01.S.doc Version 5.0 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. The Red House DS0000024304.V259870.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Red House Address Bury Road Ramsey Cambridgeshire PE17 1NA 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) 01487 813936 01487 711504 BUPA Care Homes (CFCHomes) Ltd Care Home 60 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (60), of places Physical disability (3), Physical disability over 65 years of age (60) The Red House DS0000024304.V259870.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Two named individual with category DE(E) That the age range of the three residents in the Physical Disability (PD) category is 60 - 65 years only. 2nd June 2005 Date of last inspection Brief Description of the Service: The Red House is a large converted house and a second purpose built building to the rear, situated on the main road into the market town of Ramsey. It is owned by BUPA Care Homes and provides care and support, including nursing care for up to 60 residents over the age of 65 years. The home has 60 single rooms, all with en suite facilities. Service user accommodation is on two floors in both buildings, the upper floors being accessible by stairs or lift. Forty-seven beds are located in the purpose built premises that were opened in May 1996 and 12 beds are in the older, original house, which was refurbished in 2000. There are a variety of communal areas available to service users, the smaller areas being on the upper floor. The home is set in its own grounds and is a ten-minute walk from Ramsey town centre. The Red House DS0000024304.V259870.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 5½ hours and was carried out as an unannounced inspection on 11th October 2005. It was the second inspection of this home for the 2005-2006 year. Three hours were spent examining records and documents and two and a half hours were spent with service users and staff. A tour of the building was also undertaken during this time. The manager was present during the inspection. Six people who were living at the home and three of the staff on duty were spoken to during the inspection. Not all service users were able to express their views. Information given in a questionnaire completed by the manager before the inspection was also used in the report. What the service does well:
The home completes an assessment of people who want to live there before they go into the home, and assessments from hospitals and/or social service departments are also asked for. This makes sure the home has enough information to judge whether it can look after that person properly. People who live at the home said staff members are always polite and will do anything for them if they ask. The home is clean, tidy and suitable for looking after older people. There is a pleasant atmosphere and it looks comfortable and homely. The home makes sure staff members have proper training so that people who live there are safe. People who live at the home said they felt they would be able to tell a staff member if they weren’t happy with something. The home has had one incident since the last inspection concerning a staff member. That person now no longer works at the home and has also been referred to the Protection of Vulnerable Adults list. A survey to find out what people who live at the home, and their relatives, think of it is completed every year. This is then produced as a report that is available in the home. The manager is told of issues that arise from the survey and these are passed on to relevant people to do something about. Checks that must be completed to make sure people who live at the home and staff members are kept safe are completed properly, and recorded to show this is done. This includes keeping records of any money the home looks after for service users. On the whole this home provides a good standard of care and people who live here are happy with the care they receive.
The Red House DS0000024304.V259870.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: 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 Red House DS0000024304.V259870.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection The Red House DS0000024304.V259870.R01.S.doc Version 5.0 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 the following standard(s): 3 A pre-admission assessment of prospective service users ensures the home is able to meet service users needs. EVIDENCE: A pre-admission assessment of prospective service users is completed to ensure the home is able to meet all of their needs. Assessments and reports are also obtained from health and social care professionals to give the home an overall picture of an individual’s needs. However, the home needs to follow up all references to assessments in pre-admission information. There was no mental health assessment obtained about one service user’s dementia care needs, although references had been made to this assessment having been undertaken. The Red House DS0000024304.V259870.R01.S.doc Version 5.0 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 the following standard(s): 7, 8 and 10 Limited progress has been made on improving arrangements to ensure that the personal and health care needs of service users are identified and met. These shortfalls have place service users at risk. EVIDENCE: Care plans are written for needs identified from pre-admission assessments and risk assessments completed after a person has entered the home. These enable staff members to meet each service user’s needs appropriately and should be reviewed at least monthly to make sure any changes to the care needed are documented. One of the three care plans seen was well written and give good descriptions of how care should be delivered. One of the other care plans showed staff how to care for only two elements of all of that person’s care needs and was written 2 weeks after that person had been admitted to the home. No reviews of the care had taken place for this service user, except for one review page written before the care plans had been written and with no information about which care need it related to. In the third service users care records there were two risk assessments for falls risk with entries on the same dates but with differing
The Red House DS0000024304.V259870.R01.S.doc Version 5.0 Page 10 scores. The scores for other risk assessments also differed when written on different forms, which means the recommended action to reduce the risk may be different. Service users said staff members are polite, always nice and will do anything for them. Staff members were polite to people who live at the home and spent time with them making sure they were happy with the care that had been given. The Red House DS0000024304.V259870.R01.S.doc Version 5.0 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 the following standard(s): 12 Social activities provide stimulation and interest for people living in the home, but as service users are not consulted about their interests’ individual preferences may not be catered for. EVIDENCE: People who live at the home said they are able to take part in a range of activities, which includes visiting entertainment such as a dance couple and access to a mobile library. Trips outside the home are organised to a local museum, churches, garden centres and an older people’s club. These trips tend to be local or of a short duration only at service users request. The manager said activities are usually discussed at residents meetings. A monthly activity diary is placed in the foyer and informs people of the activity, the venue, date and time. However, there was no evidence in care files to show service users had been consulted about their social interests. This was a requirement at the last inspection and has not been met. The Red House DS0000024304.V259870.R01.S.doc Version 5.0 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 the following standard(s): 16 and 18 The home has a complaints and protection from abuse system with evidence that service users and staff are able to confidently raise concerns and action is taken. EVIDENCE: Service users said they would be able to tell someone if they weren’t happy with something at the home, and would go to a carer in the instance and then possibly to the manager. Information from the manager and a pre-inspection questionnaire sent to the Commission for Social Care Inspection shows the home has received 21 complaints in the last 12 months, 8 of which were received in 2005. 7 of these complaints have been substantiated and 10 partially substantiated. Details of the last 2 complaints showed they were investigated and responded to within 28 days, and gave information of action taken following this. The home has a protection from abuse policy and procedure and service users say they feel safe living there. A former staff member has been referred for inclusion on the PoVA list. The Red House DS0000024304.V259870.R01.S.doc Version 5.0 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 the following standard(s): 19 and 26 The standard of the environment within this home is good, providing service users with an attractive and homely place to live. EVIDENCE: The home is well decorated and maintained, and all areas are accessible and safe for people who live there, with large open communal spaces. It was clean, tidy and all areas were free from offensive odours. The laundry is placed well away from the kitchen and dining areas, which minimises the risk of spread of infection. The Red House DS0000024304.V259870.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Staffing levels are sufficient to meet service users needs but improvement is required to ensure this is the service user’s experience. EVIDENCE: Some people who live at the home said there is not always enough staff members on duty for them to receive the care they would like and that sometimes they have to wait longer than they should for help with care. The manager acknowledged there had been lower staffing levels during some weekend shifts, although attempts are made to ensure adequate staff numbers through the use of bank and agency staff. Information given prior to the inspection shows the home is not adequately staffed with permanent staff members and had to use bank and agency staff was used on 196 occasions in 8 weeks. This averages 3.5 staff members per day, which is enough to cover the shortfall of permanent staff. However, as some service users experience differs to this a recommendation has been made that the home should check to ensure staffing levels are adequate to meet service users dependency levels. The Red House DS0000024304.V259870.R01.S.doc Version 5.0 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 The systems for service user consultation are good with a variety of evidence that service user views are both sought and acted upon. EVIDENCE: An application has been submitted to register a manager with the Commission for Social Care Inspection. An annual service user satisfaction survey is conducted and the results are available in the home. The manager said that although the results are an overall corporate view and do not contain specific actions, individual feedback is given and then passed to relevant people within the home for action. Actions from the 2005 survey include delivery of hot meals in the evening and the home has responded to this by ensuring there is something available. The annual survey includes views of service users relatives and stakeholders in the
The Red House DS0000024304.V259870.R01.S.doc Version 5.0 Page 16 community. The home also conducts separate relatives and residents meetings as an another way to gain the views. Service users entering the home are given written information about how the home takes care of their money and the procedures for debiting an account. Statements are sent on a monthly basis, detailing incoming and outgoing transactions, and any interest earned. Although all service users funds are placed into the same account, each service user using the system has a separate written account and record on the computer. Checks are required to ensure the health and safety of service users and these must be recorded. Records were seen for fire safety, hot water temperatures, gas safety, lift and hoist checks, and equipment checks. These were all recorded as acceptable. The Red House DS0000024304.V259870.R01.S.doc Version 5.0 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. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 3 3 The Red House DS0000024304.V259870.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? YES 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) 13(4)(c) Requirement The registered person must keep the service user’s plan under review. The registered person must ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. Service users must be consulted about their social interests. (31st July 2005 timeframe from previous inspection not met.) Timescale for action 30/10/05 2 OP12 13(2)(m) 30/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP27 Good Practice Recommendations Care records should be dated with day, month and year for auditing purposes. Records should be checked to ensure staffing levels are adequate to meet service user dependency levels. The Red House DS0000024304.V259870.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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