Inspection on 23/09/05 for The Red House

This inspection was carried out on 23rd September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Red House 26/08/06

The Red House 09/03/06

The Red House 25/01/05

The Red House 17/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Red House 65 Ruspidge Road Cinderford Glos GL14 3AW Lead Inspector Ms Tanya Harding Unannounced Inspection 23rd September 2005 11:15 The Red House DS0000043069.V251855.R01.S.doc Version 5.0 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 DS0000043069.V251855.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 Adults 18-65. 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 DS0000043069.V251855.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Red House Address 65 Ruspidge Road Cinderford Glos GL14 3AW 01594 822100 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) red.house@craegmoor.co.uk Park Care Homes (No 2) Ltd Miss Andrea Creed Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Red House DS0000043069.V251855.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25/01/05 Brief Description of the Service: The Red House is a detached residential care home situated 1.5 miles from the centre of the town of Cinderford. There is a shop and a pub close by. The home provides accommodation and care for up to eight adults with learning disabilities who may also have challenging behaviour. The accommodation is spread over three floors and the home is surrounded by attractive terraced gardens. The home has its own registered manager and is owned and run by Craegmoor Healthcare. The Red House DS0000043069.V251855.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 four hours. One resident was in the home at the start of the inspection. Other service users were out at day care and some assisting with the household shopping. The majority of the residents were met and greeted and two spoke to the inspector about their hobbies, interests and friendships. The atmosphere in the home was warm, friendly and relaxed. Staff appeared attentive and caring towards the residents. Comment cards have been completed by some residents and comments made were very positive about the care and support provided. One person said ‘ I like the staff treating me well’. Another person said they ‘ I love living here’. Several comment cards were also returned by relatives. These provided evidence that relatives are welcome in the home, are kept informed of important matters and are aware of how to make a complaint or raise concerns. A tour of the building was made and a number of records were inspected. What the service does well: What has improved since the last inspection? In response to the recommendations made in the last report, several staff enrolled onto the accredited medication course. The Red House DS0000043069.V251855.R01.S.doc Version 5.0 Page 6 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 DS0000043069.V251855.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Red House DS0000043069.V251855.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4 Information about service users assessed needs is obtained and considered as part of the admissions process to ensure that these can be accommodated in the home. EVIDENCE: A new resident moved in to the home in February 2005. There have been no other admissions at the time of this visit. The information about the persons’ admission was provided and showed that the necessary assessments and guidance have been obtained. The person was offered to ‘test drive ‘ the home at the time of the planned admission. The person has complex behavioural needs, some related to mental health. Staff were observed interacting with the person in an appropriate and caring manner. In their comment card the person said that they liked living at the Red House and felt well cared for. Specialist training may be necessary for staff to gain more skills in supporting people with mental health needs and this will be further discussed at the next inspection. An alternative placement is being considered for one person as it if felt that their needs can be better met in a smaller environment. The Red House DS0000043069.V251855.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9 Service users assessed needs are reflected in individual plans although evaluation of these could be improved to provide a better overview of any changing needs. Risks and behaviour challenges are identified and approaches to these are regularly reviewed. EVIDENCE: Files for two service users were examined as well as a number of incident records. Care plans seen had clear objectives and covered issues such as activities of daily living, support with finances and support with personal care. It is recommended that care plans which have been written over 12 months ago be revised and re-written to account for any changes which may have become evident. Care plans are reviewed monthly and evaluations for a number of care plans were examined. On the whole these commented that there was ‘no change’ and provided no other appraisal of progress or otherwise. Consideration should be given whether this system of evaluation is effective. There was evidence that where risk behaviours are identified, these are monitored with the input from the Community Learning Disabilities Team. The The Red House DS0000043069.V251855.R01.S.doc Version 5.0 Page 10 home also receives input from the behaviour therapist who is involved in putting together comprehensive behaviour management protocols. For the newest resident care plans from their previous placement were being followed to ensure consistency of approach which is important for the person. A risk assessment for a person with some mobility needs did not detail what support the person needs with managing the stairs and when using the bath or shower. Staff advised that the person does have some difficulties around this. The risk assessment needs to be reviewed to include these additional issues as appropriate. The Red House DS0000043069.V251855.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 16 Residents are supported to have a range of interests and experiences, which enhance their lives. EVIDENCE: Two residents talked in some detail about their interests and hobbies and how staff supported the individuals in pursuing these. Staff spoken with demonstrated good awareness of individuals’ needs in areas such as use of money. Residents are supported to budget the money they receive where this is necessary and have opportunities for spending their allowances as they wish. A number of residents were out on the day of the visit to colleges and trips out. There were no obvious restrictions in the home, and areas such as the laundry and kitchen are accessible to all residents. The Red House DS0000043069.V251855.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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 20 People’s health care needs are met effectively in the home and systems for administering medication are well managed thus protecting individuals from potential errors. EVIDENCE: A number of records were seen providing evidence that people are supported to access health care services when required. This includes routine health monitoring with opticians, GP’s and dentists. Records of weight, bruises and any accidents are kept as necessary. Medication administration records were examined and were found to be in order. Where ‘as required’ medication is administered, the reasons for this are recorded. This cross-references to a particular incident which is recorded separately. Following a recommendation made in the last report 5 shift leaders have enrolled on an accredited medication handling course. The deputy manager and two shift leaders have already completed the same training. The Red House DS0000043069.V251855.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Service users benefit from established strategies which offer protection from abuse. EVIDENCE: There are robust strategies in place for responding to aggression and violence which focus on diversion and de-escalation rather than physical restraint. Staff encourage one person to take control of their own anger through use of breathing exercises. There are systems in place by which impact of aggression on staff and residents is monitored and discussed. Adverse incidents are assessed for frequency and type. Then manager hopes to further develop the incident analysis form which will be used to identify any patterns or changes. It is recommended that use of physical intervention is also monitored in this way. The manager agreed to provide a copy of the incident analysis form to the inspector monthly so that a better assessment can be made about the behaviour challenges in the home. Significant incidents which compromise the wellbeing of the residents must still be notified to the Commission in line with Regulation 37. Staff spoken with demonstrated a good understanding of the physical intervention used in the home. Staff receive training in restrictive physical interventions from a trainer who has not been accredited by British Institute of Learning Disabilities. The manager advised that this is likely to change. In terms of best practice, such training should be provided by company / person who has adopted the BILD code of practice and been accredited through BILD. Adult protection training continues to be delivered in-house. The Red House DS0000043069.V251855.R01.S.doc Version 5.0 Page 14 The ‘take down’ or floor restraint is still being taught to staff although the manager said this technique has not been used for over 12 months. Restraining people on the floor carries significant risks, and the home is required to provide a written statement which sets out their intent on the use of this approach in the future. The Red House DS0000043069.V251855.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Parts of the environment look and feel less than homely and some present limitations and hazards to staff and residents. EVIDENCE: There are a number of improvements which are planned for the home including proposals to change the kitchen and dining room layout. At the time of the visit there was a dining table in the kitchen and another table in the area between the lounge and the hallway with an open plan aspect to the dining / kitchen and walkthrough areas. The table in the kitchen was next to the entrance to the laundry room and between the walkway and the fridge. The limitations for the residents and staff were quite obvious and as staff advised, there are also risks, which cannot be eliminated completely if the need arises. A specific example was if an incident was taking place, it would not possible to shut away the most hazardous areas, such as the kitchen. Because the necessary improvements to the dining/ kitchen area are already being planned, no requirements are made in this report with regards to this. However, the home needs to provide a planned maintenance schedule of as evidence of their commitment to carry out the necessary improvements. The Red House DS0000043069.V251855.R01.S.doc Version 5.0 Page 16 Some of the communal areas have been redecorated since the last visit. The lounges looked homely and were comfortably furnished. However, the entrance hall and the dining area detracted from the homely feel and are in need of redecoration. There were also a number of maintenance issues such as exposed plaster in places, wallpaper coming off and some exposed wires. The carpet in the entrance areas was stained and needs to be suitably cleaned or replaced. All residents are accommodated in single rooms. There are shared bathrooms and toilets. It was noted that one of the bathrooms was used by female residents and the other one by male residents. At the time of the visit there were four female residents in the home. Some residents have to walk a considerable distance through the home to get to these facilities. These bathrooms/ toilets are also used by care staff. The home should review the current arrangements and consideration should be given to providing additional facilities closer to people ‘s rooms. The manager has a separate office. Staff administration area is very small and this limits its use. There was a sink but no soap and towels in the laundry and staff advised that they would come back into the kitchen through the food preparation area to wash their hands. There were no disposable towels seen in this vicinity. Hand-washing and drying facilities need to be provided in the laundry room to prevent the spread of infection. The extraction fan in the kitchen was dirty and it was not clear whether this was usable. The home needs to consult with the Environmental Health Department about infection control practices and to review the laundry and kitchen facilities. The Red House DS0000043069.V251855.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed. EVIDENCE: Night cover has not changed since the last inspection and is still provided by one waking night staff and one sleep in staff. One comment card completed by relatives indicated that there may not always be sufficient staff on duty. Staffing levels will be assessed at the next visit. The Red House DS0000043069.V251855.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 Residents benefit from a well run home and are supported by a competent manager and staff team. EVIDENCE: There is an experienced registered manager in place as well as a deputy manager. At the time of the inspection the registered manager had just returned from a three months secondment to another Craegmoor home. There was evidence that the home continued to function to a good standard with the help of a committed staff team and the deputy manager. The Red House DS0000043069.V251855.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 Score x 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 x x 2 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 2 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 x 16 3 17 Standard No 31 32 33 34 35 36 Score x 3 x x x x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Red House Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x x x x x x DS0000043069.V251855.R01.S.doc Version 5.0 Page 20 YES 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 YA6 Regulation 13(4)(6) Requirement Timescale for action 31/12/05 2 3 YA23 YA24 37 23 4 YA24 23 Revise the risk assessment for a specified person to include details of the support they require with managing the stairs and bath/ shower. The Commission must be notified 30/11/05 of incidents which may have an adverse effect on the residents. Provide a planned maintenance 31/01/06 schedule for the necessary improvements in the dining and kitchen areas. 31/01/06 Address the following maintenance issues: 1.Repair exposed plaster on walls; 2. Redecorate entrance hall, dining/ kitchen areas; 3. Suitably cover exposed wires; 4. Clean or replace the stained carpet. 5 6 YA30 YA30 13(3) 23(5) Provide hand-washing and drying 31/01/06 facilities in the laundry room. Consult with the Environmental 31/03/06 Health Department about infection control practices and to review the laundry and kitchen DS0000043069.V251855.R01.S.doc Version 5.0 Page 21 The Red House facilities. 7 YA23 13(6) Formally notify the Commission of the intentions regarding the use of floor restraint in the home. 31/01/06 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 YA6 Good Practice Recommendations Evaluation of care plans should demonstrate whether progress is being made (if any) and what changes may be necessary. Care plans which have been written over 12 months ago should be reviewed and re-written. Physical intervention training should be delivered by a person or organisation accredited through BILD. Incidents which requires the use of physical intervention should be included in the incident analysis form and a copy of the completed form should be provided to the Commission every month. Consideration should be given to providing additional toilet and bathroom facilities closer to people ‘s rooms. Policies and procedures should be updated with the correct details of the Commission. 2 3 YA23 YA23 4 5 YA24 YA40 The Red House DS0000043069.V251855.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 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. 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