Inspection on 12/10/06 for The Red House Nursing Home

This inspection was carried out on 12th October 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Red House Nursing Home 23/05/07

The Red House Nursing Home 04/07/05

The Red House Nursing Home 25/05/05

The Red House Nursing Home 22/10/04

The Red House Nursing Home 10/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE The Red House Nursing Home London Road Canterbury Kent CT2 8NB Lead Inspector Mrs Susan Hall Key Unannounced Inspection 09:30 12 & 13th October 2006 th 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 Nursing Home DS0000026112.V302042.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 Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Red House Nursing Home Address London Road Canterbury Kent CT2 8NB 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) 01227 464171 01227 788084 The Red House Nursing Home Limited Mrs Susanne Elizabeth Williams Care Home 31 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (31) of places The Red House Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th July 2005 Brief Description of the Service: The Red House Nursing Home is a large, detached property which used to be a Victorian vicarage in previous days. It is set in it’s own grounds, with large attractive gardens at the front of the property, and overlooking one of the main roads into Canterbury. The home has just celebrated 20 years as a nursing home. It is a family owned business, and the Provider and her son and daughter are actively involved in overseeing the running of the home. The premises have 2 lounge areas and a dining room, and most bedrooms are for single use. A passenger lift enables easy access to the first floor. Many bedrooms have en-suite facilities. The home is situated near to the city centre with all it’s accompanying resources. There are good transport links, and on site car parking for several vehicles. The home provides nursing care for up to 31 older people, and can also take up to 8 older service users who have dementia. The Manager checks the suitability of the placements prior to admission, to ensure that service users will be compatible. The fees range from £525 - £610 per week, depending on the room available and the dependency needs of the service user. This information was provided by the Manager in pre-inspection documentation, in September 2006. The Red House Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced Key Inspection, which included an assessment of most of the National Minimum Standards. The Inspector carried out the visit over 2 days, with a total of 11 hours in the home. The inspection included information gained since the previous inspection, and included survey forms sent to service users, care managers and GPs. Four survey forms were received back from service users (and some had asked their relatives to assist them with these); four were received back from GPs, and one from a care manager. All the GP survey forms had positive comments, such as “ good standards overall”, “The Red House gives a very good standard of care” and “ the level of care, and relationship with me as GP, are excellent!” Service users’ forms were unanimous in their praise of “kind and caring staff”, and “the home always smells fresh and clean”. However, some concerns were expressed about the numbers of care staff available during the afternoons/evenings. One relative commented on a form “it is a very good home, I would recommend it to anyone.” The home had just celebrated 20 years as a nursing home in July 2006, and the Mayor and “Miss Canterbury and Princesses 2006” had joined in with the celebrations. The front entrance hall contained collages of photos showing service users, staff and visitors enjoying a barbecue and entertainment on the front lawns. The Inspector found that the home was clean in all areas, and generally well maintained. She spoke with 10 service users, 3 visitors, and 10 staff during the 2 days, and observed staff attending to other service users. The inspection included reading documentation such as care plans, medication charts, training records, recruitment files and maintenance records. The manager was available on both days of the visit, and the Provider’s son was available on the second day to discuss feedback with the manager and the Inspector. What the service does well: The manager has worked in the home for 9 years, and provides a good lead to nursing and care staff. They have benefited from her nursing skills, and her ability to train them in providing good quality care. The Red House Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 6 The home was clean in all areas, and there were no offensive smells. The building and gardens are well maintained. The home provides detailed information to enable service users and relatives in making an informed choice about the home. What has improved since the last inspection? What they could do better: Some additional details are needed regarding care plans, including the importance of obtaining consent for any photographs of wounds/sore areas. Medication administration and auditing need some improvements. The home was cluttered in some areas, and this could compromise health and safety of staff /service users if it was allowed to get worse. Some discussion and attention is needed to providing suitable storage for spare chairs, commodes, wheelchairs etc. Ongoing staff training could not be evidenced for some subjects such as Protection of Vulnerable Adults (POVA), health and safety and infection control; and a new training programme is needed for moving and handling. Staff recruitment procedures did not include a full employment history. Formal staff supervision had recently lapsed due to the Deputy Manager moving on to another home. A recent electrical check had shown the need for some work to be done to meet the Regulations for electricity management. The Red House Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 7 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 Nursing Home DS0000026112.V302042.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 Nursing Home DS0000026112.V302042.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 The quality for this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home provides clear and detailed information, enabling service users to make an informed choice about moving into the home. EVIDENCE: The statement of purpose and the service users’ guide contained all the required information, and are well laid out and easy to follow. There is also a separate brochure with coloured photographs, showing the front of the premises, one of the lounges, the dining-room, and some special events. These documents include practical advice about bringing in personal possessions, checking of individual electrical items, terms and conditions of residency, and what is included/not included in the fees. This home includes hairdressing (except for perms) in the main fees. Individual contracts are The Red House Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 10 agreed between the home and the service user (or representative), and these show a clear breakdown of the fees, with the RNCC banding (nursing contribution) taken off the overall amount. Pre-admission assessments are carried out by the manager, and the Inspector viewed 4 of these. They include details of medical history, medication, the reason for the placement, and activities of daily living (e.g. personal hygiene needs, maintaining skin integrity, nutrition, continence, medication and pain management). Relevant details were included, such as a mobility assessment showing the need for a hoist for all transfers; and a nutrition assessment showing the service user needed cutlery with large grip handles. Nursing data such as the management of diabetes, or prevention of pressure sores, was clear and detailed. The manager assesses any equipment needed for individual service users, and ensures that this is in place prior to the service user moving into the home. Service users and/or relatives are invited to visit the home and view any available rooms. There is a trial period of 4 weeks after admission, and a review is held at the end of this time to check the suitability of the placement. The Red House Nursing Home DS0000026112.V302042.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 The quality for this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home provides good personal care, with sufficient attention to meeting nursing needs. Some improvements are needed with documentation. EVIDENCE: The Inspector viewed 4 care plans, including 2 for recently admitted service users. Admission details had been well completed, and included all aspects of daily living. Admission assessments are carried out for mobility, nutrition, continence, pain, dependency, skin integrity and cognitive behaviour. Risk assessments are included for items such as the risk of scalding (with hot drinks), risk of choking, or risks of going out of the home unattended. The Inspector saw that detailed nursing plans were in place for care needs such as insulin-controlled diabetes, management of pressure sores/wounds, The Red House Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 12 and supra-pubic catheterisation. Wound care was well documented with details of each change of dressing, and photographs showing the progress of the wounds. However, some of these had been documented together (e.g. left and right knee on the same form), and this made it difficult to follow the pathway for each individual wound. There is a recommendation to ensure that all wounds are documented separately. Photographs were clearly marked with the date and time, but the Inspector did not see any consent forms signed for these, and this is a requirement. Care staff write the daily records, and nurses add any extra comments. There are tick lists to show that assistance has been given with personal hygiene (including bed bath, bath, shave, teeth/denture care, nail care etc.), and daily bowel charts to be completed. Some of these had not been adequately completed in the care plans, and the Inspector pointed this out to the manager. Some care plan auditing is carried out, and the Inspector and the manager discussed ways of doing this more consistently (e.g. monthly). Only one property list was seen, and there is a requirement to include one of these for each service user. Visits by health professionals such as GP, dentist, chiropodist were well recorded, and details of blood tests, and phone calls from doctors. The records showed that the next of kin are appropriately notified of any changes in the service user’s condition. A carer escorts service users for any hospital transfers or out-patient visits. Medication is stored in a small clinical room which is barely adequate. The Inspector noted that there is insufficient space in the drugs trolley to store daily medicines, and these have to be transferred to the trolley before each medication round. This is time consuming, and could lead more easily to errors. There is a recommendation to review the type of trolley in use, as a different shaped trolley may enable better storage of medication, and still fit in the clinical room. The clinical room and drugs fridge temperatures are recorded daily. The room temperature was at the top of the recommended level for safe medication storage (25 ° Centigrade), and this needs keeping under review, and action taken if needed. Controlled drugs were properly stored, but the Inspector found one bottle of tablets (temazepam) which had not been entered into the CD register, despite having been in the home for some weeks. This showed the need and the importance of carrying out regular drug audits, (especially for controlled drugs) and the Inspector suggested a timescale such as monthly. The Red House Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 13 Medication Administration Records (MAR charts) were quite well completed, but handwritten entries had not been signed. This was brought to the manager’s attention, and there is a requirement to ensure that all handwritten entries are signed by 2 nurses for safety purposes. Service users appeared well groomed, with attention to detail for their appearance (even though the hairdresser was on holiday). They said that they are well cared for, and that staff show them respect – such as knocking on doors before entering. Service users are addressed by their name or title of choice. Several prefer to be called Mr./Mrs./Miss and do not want their first name used by staff. This is strictly adhered to. Service users who are dying are enabled to stay in their own rooms if possible, and cared for by staff that they know. The staff make every effort to keep them comfortable, and to provide support and help for relatives. The home does not admit service users in need of terminal care, as the staff are not trained to provide the specific needs for service users with long term palliative care needs. The Red House Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 14 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 –15 The quality for this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home provides a range of activities for service users to choose from, and are looking at ways to increase this range still further. A satisfactory and nutritious menu is provided. EVIDENCE: Service users are able to join in with any activities if they wish to do so. A range of different activities is provided by an activities organiser, who works part-time hours in the home from Mondays to Fridays. She spends time with each service user, each week, giving one to one time to those who do not wish to join in with organised activities, and records an individual list for each service user. Some service users expressed their enjoyment of recent craft activities (card-making, flower arranging) while others were not interested in these. The home has a library area in the quiet lounge, and some service users appreciate this. The Red House Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 15 Entertainment afternoons such as bell ringers and singers are popular, and service users said they had enjoyed the celebrations in July to mark the home’s 20 years as a nursing home. The photos in the front entrance hall show that there is a family atmosphere in the home, and that staff work with the manager to promote this. The activities organiser is hoping to start a shopping trolley service soon, as several people have expressed a wish for this. She was in the process of working out how to manage this, and itemising practicalities to discuss with the Provider and the manager. There are no organised outings for service users, but some go out with family and friends. One service user said that she knew that if she asked to go out then “matron would arrange it”. The manager and the Provider’s son were discussing possible ways to enable 1-2 service users to go out at a time, and how to ensure they receive sufficient care and attention while out of the home. Service users are escorted on a one to one basis to dentist or optician visits, and out shopping if requested. Visitors are welcome at any time, and can stay for meals/snacks for a nominal charge. Some relatives like to take service users to the pub restaurant next door, which is ideally situated for them to visit easily. Service users are able to bring in personal possessions, and some rooms had personalised pictures, photos, ornaments etc. Most service users do not manage their own finances any longer, but have a relative or representative to assist them with this. Each service user has a lockable facility in their room for any personal items, and there is an ongoing programme for locks to be fitted to all doors. If a service user did not have someone to speak up for them, advocacy would be arranged. The Inspector visited the kitchen and noted that it was generally in good order. The assistant cook was on duty, and showed the Inspector the menus, and the temperature records for fridges and freezers. Breakfasts are prepared by the night staff as most service users want this before the cook comes on duty at 8.a.m. However, service users can have breakfast later if they wish, and the cook is then available to prepare it. Service users can have a cooked breakfast on request. A choice of menu is available for lunch and teatimes, although some service users were not fully aware of this. A record is kept of how well service users eat, and the type of meal chosen. Staff assist service users who need help with feeding before other meals are taken out, so that they can give specific time to those service users. Meat is delivered from a local butcher’s which has a high reputation locally, and fresh fruit and vegetables are delivered several times per week. The Environmental Health Officer had inspected the kitchen in July 2006, and recommendations made at that visit were being followed through. The Red House Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 16 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): 16,18. The quality for this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Any complaints are taken seriously, and are acted on appropriately. Staff have an understanding of the prevention of adult abuse, but the home needs to be able to provide evidence for ongoing training. EVIDENCE: Concerns and complaints are generally documented by trained staff in a hardback notebook, but the manager keeps a separate record for any serious complaints which require investigating. A copy is kept of any letters or meetings held as a result. All complaints are taken seriously, and the complaints log showed that the manager ensures that action is taken for each one. The complaints procedure is included in the service users’ guide, and is on display in the entrance hall. All required details are included. The manager agreed with the Inspector that it might be helpful to include the details for the local Social Services department, for anyone who would like to consult their care manager. Staff are aware of the different types of abuse, and recognition and prevention are included in the induction process. However, there was no ongoing The Red House Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 17 programme for delivering this training, and the Inspector recommends that the home should ensure that this is done, and should be able to provide evidence for ongoing training. The Red House Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 18 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): 19-26 The quality for this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home has an ongoing programme of maintenance and redecoration, and is generally in good order. EVIDENCE: The Red House is beautifully situated in it’s own grounds, with sweeping lawns at the front leading down to the main road. Seating outside the home provides an attractive area for service users to sit and watch the world go by. One service user said that they liked being able to view the main road, as it helped them to “keep in touch” with the area. Several service users sat out during the 2 days of the inspection, as they were fine and warm October days. There is a smaller garden area at the side of the property, and a separate building for office facilities. The Red House Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 19 The home was suitably warm and ventilated, and was clean in all areas. The décor and furnishings were satisfactory, except for one identified bedroom. This one was quite unattractive, with no pictures etc., a badly stained carpet, and poor quality curtains. There is a requirement for this room to be refurbished as soon as possible in line with the wishes for the service user in this room. Bedrooms are usually redecorated when vacant, and according to client choice where possible. Bedroom doors have not yet all been fitted with locks, but there is an ongoing programme for this. The home employs a full time maintenance man for the upkeep of the premises. Communal areas were satisfactorily decorated. There is a large lounge, and a smaller quiet lounge, which is ideal for family members to meet in together, or for service users who want somewhere to sit quietly. There is a separate dining room with space for about 10 service users. As most prefer to eat in their own rooms, or in the lounges, this does not pose a problem. There are an adequate number of bathrooms and toilets, and most baths have assisted hoisting facilities. 15 of 23 single rooms have en-suite toilet facilities, but these are not all big enough for service users who are wheelchair bound to use. One of the bathrooms has a separate shower unit. This has poor drainage, and there is no shower surround, so it is not very practicable for staff to assist service users with a shower. There is a recommendation to review this situation. The home is provided with suitable equipment for providing nursing care, including mobile hoists (which had been recently serviced), airflow mattresses, grab rails, raised toilet seats, and bed rails (and covers). There is a call bell system in every room. The call bell in the lounge is usually managed by a service user who is happy to ring it on behalf of others. On one of the 2 days, this had not been plugged in, and the Inspector brought this to the manager’s attention. The home has a small laundry area with 2 commercial washing machines and 1 tumble dryer. There is a sluicing facility on the washing machines, and a red alginate bag system is used for soiled items of clothing. The home had adequate stores of bed linen and towels, and these were in reasonable condition. There is a laundry assistant on duty every day for several hours. The home is fitted with 2 sluices, including one with a sluice disinfector. These rooms were in good order. The home has a separate hairdressing room, but this was cluttered with items of furniture. A small store room for wheelchairs was cluttered with old walking frames, and there were 3 armchairs and a recliner chair, cluttering other areas. One of the baths had 2 commodes standing in it, and a disabled toilet had hoovers stored in it. The home needs some attention to tidy up these areas, and to ensure that store areas do not become over cluttered and possible safety risks. The Red House Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 20 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): 27-30 The quality for this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Staffing levels are generally satisfactory, but need to be kept under review in line with the dependency levels and numbers of service users. Some further arrangements need to be made for ongoing staff training. EVIDENCE: There is always at least one nurse on duty throughout the 24 hour period, in line with requirements for the home’s registration. Staffing rotas showed that sometimes there are 2 nurses on duty in the mornings or afternoons. The manager’s hours are mostly supernumerary during week days, but she sometimes works weekend shifts or helps to cover nursing duties in the home. This has been especially difficult in recent weeks since the deputy manager has left, and the manager is in the process of recruiting a new deputy. The home had 4 care staff on duty for the mornings of the inspection, and 2 or 3 in the afternoons/evenings. The home had several vacant beds, and numbers of care staff are arranged in accordance with numbers of service users. However, this does not always take into account that some service users may have higher dependency levels than others, and the home then needs more staffing hours. The Inspector discussed care staffing levels, and made the point that the home needs 3 care staff on duty as a minimum in the day time, as there are always service users who need 2 staff to give care. There must The Red House Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 21 therefore be another carer available for other service users, as the nurse on duty may be busy attending to dressings or health needs. Service users’ perception was that staff do not always have time to check the lounge, and they are waiting for a staff member rather than ringing the bell. At this inspection, the home had 19 service users who needed help with personal hygiene, and 12 who needed assistance or supervision with meals, so 3 care staff is barely adequate to provide this level of care. This situation must be kept under review, to ensure that there are always sufficient numbers of care staff on duty. There is a good team of ancillary staff, so that care staff are able to concentrate on caring, and do not have to carry out other tasks. The housekeeper oversees the domestic staff and household management. There are usually 2 cleaners on duty each day, and 1 laundry assistant. A kitchen assistant helps the cook on duty. The home currently had 5 care staff with NVQ 2 or 3 training. This is 33 and so is below the target of 50 . Staff recruitment files are kept in good order by the administrator. The Inspector viewed 3 of these, including one for a nurse, and one for a staff member from abroad. A POVA check, CRB check, 2 written references and proof of identity are all taken prior to confirmation of employment. Work permits and nurses PIN numbers are checked where applicable. Application forms showed details of employment for up to 10 years, and the Inspector informed the manager that this has now changed, and applicants are required to complete a full working history. Staff induction training showed clear details of the subjects covered. Mandatory training in safe working practices is carried out at induction, but there was a lack of evidence for ongoing training and updating training, in some areas. Moving and handling training was previously carried out by the deputy manager who had left, so the manager was identifying a new source for this training. Mandatory training in health and safety and infection control could not be evidenced, and this needs to be addressed. The Red House Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 22 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, and 35-38 The quality for this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The manager provides good leadership to staff, and promotes a welcoming and caring atmosphere. Some aspects of management have lapsed while the manager is without a deputy manager to assist her. EVIDENCE: The manager is a competent level 1 nurse, with many years of experience for nursing older people. She has worked in this home for 9 years, and is highly regarded by service users, staff and relatives. She commenced the Registered Managers’ Award (RMA) training in 2005, but has not been able to complete this. She provides an effective lead for staff to follow, and is committed to ensuring good care for service users. The Red House Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 23 Formal staff meetings are held in the home, and separate meetings for trained staff. Meetings for residents and relatives have been held in the past, but were not always well attended. The manager has found that informal coffee mornings or chats after meals are often more productive in respect of obtaining feedback from service users as a group. The home produces questionnaire surveys from time to time, and service users and relatives know that the manager is available at any time if they wish to raise concerns or have individual chats. Most service users have an appointee to manage their finances, and the home only looks after pocket monies for one or two service users. These accounts are stored individually, and a record is kept of all transactions. All receipts are retained. The manager said that informal staff supervision is ongoing, but formal staff supervision had not been kept up to date. The home has a good format in place for supervision, and for appraisals. Formal supervision needs to be implemented again. Records in the home were generally well maintained, and suitably stored. Policies and procedures had been reviewed during the year, ensuring they were up to date. The maintenance folder showed that a fire risk assessment had been carried out in July 2006, and fire systems including fire extinguishers and emergency lighting had been serviced. Satisfactory contracts and records were seen for gas servicing, hoist servicing, lift inspections, management of clinical waste and servicing of the sluice disinfector. The electrical system had just been checked at the end of September 2006, and a requirement had been given regarding the need for supplementary earth bonding in bathrooms. The Inspector was informed that this matter was being addressed. Accident records are well completed and well maintained, and are stored in accordance with the Data Protection Act. The Red House Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 24 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 2 3 3 2 3 3 STAFFING Standard No Score 27 3 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 2 3 2 The Red House Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO 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 OP8 Regulation 17 and Schedule 4 13 (2) Requirement A list of personal property items must be kept on record for each service user. To keep a check on the temperature of the medication storage room, and take appropriate action if the temperature is consistently high. To ensure that all medication is receipted into the home. Handwritten entries on MAR charts must be signed by 2 nurses. To obtain consent for any photographs taken of service users’ wounds or pressure sores. Timescale for action 01/12/06 2 OP9 01/12/06 3 4 OP9 OP9 13 (2) 13 (2) 12/11/06 12/11/06 5 OP10 12 (4) (a) 01/12/06 6 OP19 23 (2) (l) To provide suitable storage areas 01/02/07 for equipment, and ensure that these are kept in good order. To ensure that one identified bedroom is refurbished, including replacing the carpet. DS0000026112.V302042.R01.S.doc 7 OP24 16 (2) (c) 01/01/07 The Red House Nursing Home Version 5.2 Page 26 8 OP30 18 (1) (c) The registered person must ensure that all mandatory training needs for staff are being met. 01/12/06 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 OP8 Good Practice Recommendations Wound care should be documented separately for each wound, so that a clear pathway of progress can be followed for each wound. To consider the purchase of an alternative style of medication trolley, in order to assist with medication storage, and to prevent the need for moving medication in and out of the trolley for each drugs round. To carry out regular audits (e.g. monthly) for medication. The home should be able to show records of ongoing training for staff, for the prevention of abuse for older people. To review the shower facility, and consider how to make this more suitable for staff to assist service users. To continue the ongoing programme for fitting locks to bedroom doors. To keep numbers of care staff under review, ensuring there are sufficient numbers of suitable staff on duty at all times. To ensure that formal staff supervision is re-implemented for all staff. To ensure that there is compliance with other legislation, in respect of the identified need for electrical work to be done in bathrooms and shower rooms. i.e: the electrical DS0000026112.V302042.R01.S.doc Version 5.2 Page 27 2 OP9 3 4 OP9 OP18 5 6 7 OP21 OP24 OP27 8 9 OP36 OP38 The Red House Nursing Home company wrote: “Bathrooms must have supplementary earth bonding between electrical equipment and exposed metallic pipework. This is not present in any of your bath or shower rooms”. The Red House Nursing Home DS0000026112.V302042.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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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