Inspection on 23/06/08 for The Red House

This inspection was carried out on 23rd June 2008.

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

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

The Red House 17/07/06

The Red House 17/10/05

The Red House 02/06/05

The Red House 18/11/04

The Red House 15/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOMES FOR OLDER PEOPLE The Red House Bury Road Ramsey Cambridgeshire PE26 1NA Lead Inspector Lesley Richardson Unannounced Inspection 23rd June 2008 10:50 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.V369040.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. The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Red House Address Bury Road Ramsey Cambridgeshire PE26 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 www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd Lorna Jean Smith Care Home 60 Category(ies) of Dementia - over 65 years of age (4), 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.V369040.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age range of the three residents in the Physical Disability (PD) category is 60 - 65 years only 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. Fees for the home range between £680 and £798 per week and a more accurate quote is available from the home. The most recent inspection report is available in the foyer of the home for people living at the home and visitors who wish to read it. The home has 58 single rooms and one double room, 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-six rooms 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.V369040.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key inspection of this service and it took place over 9 hours as an unannounced visit to the premises. It was spent talking to the manager and staff working in the home, talking to people who live there and observing the interaction between them and the staff, and examining records and documents. Three requirements from the last inspection have been met; one requirement has not been met. There has been two further requirements and one recommendation made as a result of this inspection. Information obtained from the Annual Quality Assurance Assessment and from returned surveys was used in this report. Seven surveys were returned from people who live at the home, and two were returned from visitors to the home. We received two surveys from staff members. Information from an expert by experience, who visited the home with us, was also used in this report. What the service does well: The home is a combination of a large purpose built building and a converted house. It is situated in its own grounds. There are lounge areas in each building, plus other quiet areas for people to use if they wish. Staff members are polite and talk to people with respect. We talked to people during this inspection and they said the staff are nice, respect their privacy and one person said, “the staff are on the whole willing and pleasant to me”. Assessments are completed before people move into the home, they have contracts with the home and they say they have enough information before they move in. The home does not provide rehabilitation or intermediate care. People have access to health care professionals, like specialist nurses, and the information and most of the advice they give is written in care records. This means that staff know what they should be doing to properly look after medical needs. People can have visitors when they want and there are places where they can meet in private. Visitors said the home helps people keep in touch with then and relatives told us they are kept up to date with issues that come up. There have been 10 complaints made to the home in the last year. These are looked at properly and information to show why the home has taken action, if The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 6 it needed to, is also kept. People said they know who to talk to and how to make complaints and visitors said the are dealt appropriately. A quality assurance survey is carried out every year at the home, where people are asked what they think of the care and the environment in which they live. An action plan is written to look at issues that are found. Money that is kept and transactions that are made on behalf of people at the home is documented on a central computer. Interest is paid on this money and this is also recorded. The whole system is audited every year. Records are also kept of the health and safety checks that are carried out, which means the home can show if things are in good working order and what they have done to repair problems. What has improved since the last inspection? What they could do better: The amount of personal information written in care plans is good and this gives staff members’ details about how people like to be looked after. For example, when they like to go to bed and whether they like to door open and the light on or off. This same level of detail must also be put into plans for personal care and meeting medical needs. There is not enough guidance about how staff should do things and what they need to do, e.g. giving medication in a specific way, helping people to give their own medication, or how often people need to change position if they are in bed or a chair for long periods of time. There are still a lot of issues with medication. For example, there must not be two medication records for the same medication, as this can lead to people The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 7 being given the medication twice. Staff must still record when creams and inhalers are given, even if people have taken it themselves. Medication recording and administration must improve as we also found issues at the last inspection and poor practice puts people at risk. Although staff are polite and respect the people they care for, there are some things they do that shows they don’t always think about how they are doing things. Staff put medication straight into people’s mouths, even though they can hold things themselves and could do this. One person had to ask three times to go to the toilet while we were visiting before staff helped them. This person said choice is available in theory, but she doesn’t always get to choose in practice. There is an activities co-ordinator who organises trips, activities and events for people in the home. There are activities available and we saw people taking part in them during the inspection. But, most people we spoke to or received comments from said there isn’t anything they are able to join in and staff are not able to spend time with them. There is a new meal planning system and a ‘nite bites’ menu for snacks. Despite this most people we spoke to or received comments from are not happy with the food that is provided. One person in a group of other people said the evening meal is the “interminable soup and sandwiches” and that they could not have a snack after hours, although crisps are available. The group was in agreement with these statements. Staff help people to eat if this is needed and do this well, but meals are not given out in an ordered way and people eating together don’t get their meals together. On paper staffing levels appear adequate and there are some days where there are more staff on duty than other days. But people living at the home don’t all think there are enough staff. They say staff are always in a hurry and they have to wait for drinks, for meals and to go to the toilet. We saw this during the inspection too. However, one person’s bell was ringing for 5 minutes before staff sitting at a desk opposite the room answered it. 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. The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. People have enough information before moving into the home, which means they are able to decide if they would like to live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Almost three quarters of the people living at the home and both of the visitors we received surveys from said they had enough information before moving to the home. Although, less than half of the people who returned surveys said they have received a contract from the home. Staff members told us that assessments are completed before people move into the home and assessments by health and social care teams are also obtained to provide more information. We looked at the care records of three people who had moved into the home since the last inspection. There are written assessments completed by the home, which give staff members enough information to know how to care for the person. Assessments from The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 10 previous care providers, and health and social care assessments, are also obtained before the person moves into the home. The home does not provide accommodation specifically for intermediate care or for rehabilitation purposes. The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. Medication administration records are not completed or kept well enough, which puts people at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who commented in surveys said they get the care and support they need from staff members and during the inspection people told us care staff are nice, are polite and treat them with dignity and respect. We saw this during the inspection and that staff knock on doors before entering rooms. People we spoke to said staff are nice and one person commented, “the staff are on the whole willing and pleasant to me” and another person said, “well looked after, well fed, and get a good nights sleep, can’t ask for any more”. One visitor said, “My mother was admitted into the home a year ago. With special thanks to the home manager and her staff. Mum settled well and enjoys her peaceful environment. Once well enough Mum was encouraged to eat in Main dining room and she visits the hairdresser and sometimes participates in activities”. The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 12 However, other comments from people living at the home show that not everyone is happy with the care they receive, “staff are not always prompt when called for and when they do come, do not deal with request there and then” and “some members of staff could be more considerate”. We saw some practices that show staff do not always consider people before acting. Medication was given to one person during lunch, and although the person was able to hold a knife and fork and eat without help, the nurse put the medication pot to the person’s mouth before tipping the medication into her mouth. The expert by experience spoke with one person who told her that she often has to wait a long time to go to the toilet. This person also said she had been told by a staff member to use the incontinence pad, even though this was only in case of accidents. Care plans for six people were looked at as part of this inspection. They show that each person has a plan that gives staff members’ information about what they need to do to meet most of the identified needs. Risk assessments, for things like falls and moving and handling, are completed and reviewed regularly, although care plans for individual risks are not always completed. Staff members need to show why people cannot do things before saying they cannot do it. We found the care plans give staff members’ most of the information they need to meet most of people’s needs. But, they don’t all give enough information about how care is to be given, what help people need or updated when there are changes. The plans are written in a clinical style and set out the care to be given as a set of tasks to be completed. We looked at two care plans specifically for people that spend a long time in one position, either in bed or in a chair. One person is spending more and more time in bed, but doesn’t have a care plan to prevent pressure sores. The other person has got a plan for this, which had been written when a pressure sore had started, but it had not been reviewed since although the sore has healed. It also doesn’t give enough information about how often this person’s position should be changed to prevent another pressure sore. One person has a care plan for medication that says she is able to give her own injections, but that she needs help and support. It doesn’t tell staff what help and support that is. There was also no information about giving an ‘as required’ medication. Another person’s has no plan for medication, even though that person has medication given through a PEG (Percutaneous Endoscopic Gastrostomy) tube. Care plans have information that tell staff how each person likes to be cared for and what their preferences are. For example, two people’s care records show what times they prefer to go to bed and to get up at, whether the light is put out and the door closed or not when the person goes to bed. They also show other preferences like the crockery that one person likes to have tea in, how food needs to be presented and special aids that are needed to help The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 13 people keep their independence. However, as mentioned above care plans are written in a clinical style and don’t give any information about how people feel about procedures they undergo. We spoke with staff at the home, and one staff member in particular, about how they care for people. They told us about how people like to cared for and what they do for each person. This showed us that most staff members have a good understanding of people’s needs and how they like to be looked after. They have up to date knowledge of changing needs, for example a visiting physiotherapist has lowered the amount of support one person needs to be able to walk safely every time she has visited. The staff we spoke to knew what support they needed to give this person, even though the care plan had not been updated for some time and the support had changed several times. Everyone who returned surveys said they receive medical attention when they need it. There is information in care records to show health care professionals, such as specialist nurses, opticians and chiropodists, are contacted for advice and treatment. We spoke with a visiting health care professional who said usually staff at the home are helpful and carry out tasks that are requested, although there have been problems with them having time to walk with the person mentioned above. We looked at medication administration records (MAR) and we found that these are completed. There are very few records with entries missing, except for one day in particular when the MAR sheets for 9 people were not signed. As the remaining medication numbers tallied with the medication having been given but not signed for, this is what we think happened. There are some medications (inhalers and creams) that have no signatures at all, which indicates the medications have not been given. This may not be the case if these medications are kept in people’s rooms, but the person giving the medication must still sign to show it has been given or taken by the person (if they are still responsible for their own medicines). Prescriptions are clear, but entries for variable dosage medication don’t always show the dose that has been given. Although prescriptions are clear, we found three people with two MAR sheets for an anti-blood clotting medication and one person with two MAR sheets for two other medications. There was no evidence to show that any of these people had received more medication than they should have done, but it is not safe practice to have two prescriptions for the same medication. Prescriptions for antibiotic medication for three people show they were all given in a time frame of 9 hours. This means that therapeutic levels are not maintained over a 24-hour period. Medication fridge and storage room temperatures are taken and recorded as being at the limit of acceptable levels for the safe storage of medication. The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 14 Fridge temperatures were regularly recorded at 0oc or just below, with maximum of 0oc and room temperatures at 26-27oc. We talked to one of the trained nurses about the safe temperature ranges for medicine storage. The Red House DS0000024304.V369040.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 and 15 Quality in this outcome area is adequate. Although activities are available and people can choose what they do, this isn’t available to everyone and means they don’t have control over their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an activities co-ordinator in the home who arranges for activities and events in the home, and entertainers to visit the home. There is a notice board in the foyer that displays the activities available and photographs of trips and events that people have taken part in. Only one person out of the seven who returned surveys to us said there are activities that they can take part in, but 71 (five) said that activities are only sometimes available to them, and one person said never. One person told us, “I don’t like Bingo, which is once a month here, now I see that they have cancelled for the month of May anyway. There is no mental stimulation whatever…”. A lot of people we spoke to during the inspection said they didn’t or were not able to join in activities, although we did see these taking place. The activities co-ordinator sat in the garden with three or four people after lunch doing word puzzles. The expert by experience also saw another staff member sitting with The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 16 people doing crosswords. Another person told us that she continues to knit and some people have newspapers to read. During lunch we talked to a group of people who all said they don’t know what one to one time is. When this was explained they said they have never had staff spend time with them and don’t think there are enough staff for this to happen. They also said they didn’t think the activities co-ordinator would have time to do this. There was little information in care plans about peoples social interests, what they would like to continue doing and how staff help them do this. The home has an open visiting policy and people can have visitors at any time of the day. One of the two visitors who returned a survey said the home helped people keep in touch and they both said they are kept up to date with issues concerning that person. People are able to make everyday choices about when to get up and go to bed, how to spend their days, whether that is in their own room, in the main lounge/dining area, or another area in the home. We saw and listened to how staff members interact with people and found they ask what people would like and how they would like it rather than telling people or giving limited options. Staff members we spoke to know the people they care for and were able to tell us their preferences and how they like to be cared for. One person told the expert by experience that in theory choices are available but this doesn’t always work in practice. She had to ask three times while we were there before she was taken to the toilet. Another person said she gets up when the care staff come to get her up, but that she can get up earlier if she wants to. The main meal is served at lunchtime and there is a choice of two hot meals every day, and alternatives are also available. We saw lunch being served in the main dining room and another dining area on the first floor. In the main dining room food was served appropriately in a relaxed and unhurried way and drinks were offered throughout the meal. Staff help people if they need this and we saw them being attentive and concentrating on what they were doing without being distracted. However, in the small dining room upstairs meals were served haphazardly. Two people received their meals when other people at the table had almost finished theirs and one person didn’t receive her meal until all the other people had been given by dessert. Even though staff delivered desserts and took empty plates away the last meal was not delivered until we asked for it. The home introduced a new meal planning system that offers people more choice and identifies foods that could be included in different diets, like those that are high fibre. This is accompanied by a ‘nite bites’ snack menu that gives people a choice of hot or cold snacks at times other than main meal times. When we talked to people at lunch they said the evening meal is, “the interminable soup and sandwiches” and they cannot get meals after hours, but they can get “crisps and quavers”. The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 17 Only two of the seven people returning surveys said they usually like the meals, the other five people said they only sometimes like them. There was a mixed reaction when we asked people at the home if they like meals. People said it depended on the meal; one person said there wasn’t much fish in the fish pie. We saw this was the case, and also that although there was mashed potato on top of the fish pie, there was also another scoop of mashed potato on the plate. There were two vegetables served with the meals, broccoli and tinned peas, both were very soft. Comments were received in surveys and during the inspection include, “I am not usually very hard to please but I do like fish in parsley sauce which I never get here”, “In general the food is not bad. However, the sweet courses are too sweet and there is not enough fruit offered”, the food is “Good and hot” and “I like the breakfasts best, Bacon and egg and toast and marmalade. Things like that. The other meals are really for older people”. There were a number of people who commented about not being able to get hot drinks, and although one person said it was good she could have a late breakfast if she wanted, another person said, “I don’t mind breakfast at 10 but when it is 11.30 with lunch at 12.30 it is far from ideal!”. People who commented about hot drinks said they would like more, they don’t get one before breakfast or after tea and if they ask they sometimes have to wait for it. The Red House DS0000024304.V369040.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 and 18 Quality in this outcome area is good. People know how to make complaints and concerns known and can be confident that these will be listened to. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All seven of the people returning surveys said they know who to speak to and that they know how to make a complaint if they have to, and five of them said staff listen to what they say and act on it. Most people we spoke to during the inspection also said they know what to do if they’re not happy about something. One person made this comment about making a complaint, “usually verbally to person in charge of unit. If not successful, to person in charge of establishment in writing”. Another person said that there are, “some good, some poor” when we asked whether staff listen and act on what is said to them. Both of the visitors who returned surveys said know how to make a complaint and they are appropriately dealt with. The home has a complaints procedure and keeps a complaint log to show how they have looked at and the outcome of complaints that have been made. We were told before the inspection there have been 10 complaints made to the home in the last 12 months. All complaints have been investigated and all were responded to within the correct timeframe. Five of the complaints were upheld. We were told directly of one persons concern about staffing. This was looked at as part of a safeguarding issue. The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 19 The staff training matrix shows that all staff members, care staff and housekeeping staff, have received training in safeguarding (adults protection) within the last year. We talked to care staff who said they had received training in safeguarding people. One staff member told us what should be done if abuse was suspected and gave a good clear answer, but didn’t say it should be referred to the local safeguarding team. We talked to the manager about this and she will discuss it with the head of care who is responsible for giving this training. Information provided to CSCI before the inspection shows there has been one safeguarding referral and two investigations in the last 12 months. The outcome of the most recent investigation is that if staff morale and training do not improve there is a risk to people living at the home. As can be seen from the ‘Staffing’ section in this report, adequate training of staff is given and staff are able to complete further training. However, staff members feel they don’t have enough time to spend with people and there are examples where people have told us they have to wait. Two comments from staff members show that communication is not always effective, which means the home must continue to work to improve this area. These comments are, “events that occur on my days off are sometimes not mentioned at the next handover” and “maintain staffing levels. Communicating better through the various departments”. The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 20 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 and 26 Quality in this outcome area is good. The home is clean and provides a safe environment, giving people a pleasant place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home comprises of two parts. A large purpose built property situated at the back of the property and a large converted house at the front. People living at the home have access to a number of communal areas inside both buildings. There are gardens surrounding the house at the front and an enclosed garden in the centre of the building at the back. The general décor within the home is satisfactory, and it was clean and tidy. We did notice the carpet in the main foyer has been discoloured from the sun. We also noticed one person’s room that had a strong offensive smell, but otherwise there were no unpleasant odours. The manager said this person’s The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 21 room is cleaned and the carpet shampooed everyday. The smell lessened as the day went on. Everyone returning surveys said the home is always or usually clean and tidy and people at the home said the home is clean. Information provided before the inspection shows there is a refurbishment programme planned to carry out routine works and maintenance. The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. There are not always enough staff members to be able to care for people properly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The training matrix shows new staff members are given induction training, which includes mandatory health and safety training. We spoke with staff members during the inspection who told us they have received mandatory training and can complete other training that is relevant to their role. Information provided before the inspection shows 62 of non-nursing care staff have a National Vocational Qualification at level 2 or above. One staff member told us she has completed a 3-day dementia course and found it changed her outlook on how to care for people with dementia. Additional training is given to staff so that they are able to properly meet people’s needs, such as training in the care of PEG tube and training about Motor Neurone Disease has been scheduled. The deputy manager has completed a train the trainer course for safeguarding people. Staff members returning our survey said they receive training that helps them understand people’s needs and keeps them up to date with new ways of working. Visitors who returned surveys said staff members usually have the skills and experience to care for people. The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 23 There were mixed reactions when we spoke to people about staffing levels at the home. People said the care staff are polite and they don’t usually have to wait too long for help. But they also said staff members are not able to spend time with them and several people we had lunch with said they did not know what one to one time is. When this was explained to them, they said they had never had one to one time with staff and didn’t think there are enough staff for this. When we asked these people if there are enough staff members available, there was an emphatic “no” in reply. They said staff are always in a hurry, especially at times when demand is high, like mornings and lunch time. Six out of seven people who returned surveys said staff are usually available when needed, although one person said they are sometimes told about staff shortages. We had lunch with people on the first floor and the expert by experience saw lunch being served in the main dining area on the ground floor. The expert by experience commented about there being enough staff in the ground floor dining room. However, that was not the experience of people eating on the first floor and as described in the section on Social Activities and Daily Lives, there were not enough staff available for people to eat together. One person that the expert by experience spoke to said she has had to wait a long time to go to the toilet and during this inspection she had to ask three times before she was helped. The staff rota shows that staffing numbers vary between ten and fifteen staff in the morning, and eight and eleven staff in the evening. However, at the lowest point this still gives a ratio of one staff member to every seven people in the evening and one staff member to every 5.5 people in the morning. There are adequate numbers of staff on night duty. There is always at least one registered nurse (RN) on duty at all times, usually there are two and occasionally three RNs on duty. Although the staff rota shows staffing levels are adequate, we saw three RNs at a desk while a call bell rang for 5 minutes before it was turned off. The call bell was from a person’s room opposite the desk. The home let us know that they had low staffing numbers in March this year. At the same time, a person told us of their concerns about the low staffing numbers. From the above information we think that there are times when staffing numbers are low enough that people have to wait for help. Staffing levels alone may not be the reason for people having to wait, as it appears to take some staff some time to answer call bells. One comment we received from a staff member shows the effect staffing has, “very often at the weekends we work short staffed so I feel we cannot do out job properly because we have to rush”. However, we didn’t find staffing numbers varied a lot at weekends compared to during the week. While some weekend shifts had lower staff numbers, so did week day shifts. The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 24 We looked at recruitment records for two staff members employed since the last inspection and they contained the appropriate recruitment documents including references, application forms, and POVA/CRB checks. One person had written their employment dates in years only and had given a reason for leaving their last job. But, the home had not looked any closer at when employment in each job had started and ended or what the person was doing between jobs. This is important so that any issues are identified before the person starts working with vulnerable people. There was no explanation on this person’s file about recent employment with BUPA and although both references were satisfactory, neither were from a person the previous employer or someone with a management position. Obtaining preemployment checks has improved and so the requirement made at the last inspection has been met. But, the manager must make sure that all the required information is obtained, and in enough detail, before people start working so that people living at the home are safe. The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is good. Health and safety checks are completed and records are kept to show people are safe living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been working at the home for a number of years and is registered with the Commission for Social Care Inspection as manager. She is a nurse registered with the NMC and completed an NVQ level 4 qualification in management in March 2007. She also has qualifications in the care of older people. An annual quality assurance survey was carried out by the home in 2007, a report has been written and shows the issues that were found. There was a big drop in the satisfaction of the overall service people had in the home. The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 26 People we spoke to during the inspection said they attend meetings but are never told what has been done and that it seems nothing is done. We asked the home to complete and return an Annual Quality Assurance Assessment (AQAA) before the inspection. They did this within the time we asked for it and they gave us the information we asked for. People going to live at the home are given written information about how their money is taken care of and the procedures involved in debiting an account. Statements are sent on a monthly basis, which shows the incoming and outgoing transactions, and any interest earned. Although individuals’ money is all placed into the same account, each person using the system has a separate written account and record on computer. Information provided before this inspection shows equipment, like hoists, lifts and fire-fighting equipment has been serviced or tested as recommended by the manufacturer. We looked at fire equipment around the home and fire safety records for checks of alarms and lighting. These show that the equipment has been tested within the last 12 months and checks are completed and recorded. The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 27 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 28 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(1) Requirement Care plans must show how all assessed needs are to be met. This is so that all staff members are aware of how care is to be given. Medication administration records must be completed accurately to show medication administered, the correct amount of medication available and the amount of medication received into the home. This is so that medication is safely and correctly administered. This requirement had a timescale of 30/09/07, which has not been met. Enforcement action is now being considered. 3 OP27 18(1)(a) There must be enough staff on duty to make sure people do not have to wait for personal care or have to rely on repeated requests. This is so that people get the care they need when they need it. DS0000024304.V369040.R01.S.doc Timescale for action 31/10/08 2 OP9 13(2) 31/10/08 31/10/08 The Red House Version 5.2 Page 29 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 OP15 Good Practice Recommendations People should be able to eat together, if that is their wish, and receive meals and drinks they want. The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: 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 © 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 The Red House DS0000024304.V369040.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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