Inspection on 24/05/06 for The Red House Residential Carehome

This inspection was carried out on 24th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Red House Residential... 17/12/07

The Red House Residential... 05/10/07

The Red House Residential... 17/10/06

The Red House Residential... 22/11/05

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 Residential Carehome 5 Conygre Road Filton South Glos BS34 7DA Lead Inspector Odette Coveney Unannounced Inspection 24th May 2006 09:30 The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 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 Residential Carehome DS0000065123.V296592.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 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 Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Red House Residential Carehome Address 5 Conygre Road Filton South Glos BS34 7DA 01454 774949 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) Mr Heron Moodie To be appointed Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 8 persons with Learning difficulties, aged 1864 years requiring personal care only. 22nd November 2005 Date of last inspection Brief Description of the Service: The Red House is registered as a private care home, and provides accommodation for eight adults with learning disabilities. Fees start from £440.00 per week. The home is located in the South Gloucestershire region in the residential area of Filton. The home is applying for a major variation in order to increase the home’s numbers from 8 to 10 to accommodate two residents in the house next door. The Red House is near to the main arterial road leading north from Bristol, which connects the main M4 and M5 motorways. It is close to a range of shops, a post office, library, pubs and Filton College. There is a GP surgery and Optician within close walking distance. It is close to the bus routes that go into Bristol, a journey of approximately three miles. The Red House is a large, mature, detached Victorian two-storey building of red brick construction, the house name was chosen by the original group of residents. There are two large communal areas, two single bedrooms and a staff room on the ground floor, with six single rooms on the first floor. Each bedroom has a vanity unit to provide en-suite washing facilities. There are gardens surrounding the house, with a range of mature trees, shrubs, a pond, and flower and vegetable beds. The garden is fully wheelchair accessible, and there is also a greenhouse and a summerhouse, which are widely used, in the warmer months. The laundry facilities are sited away from the main house in the garage. A wide range of leisure activities are available for residents, and the home has a large display of photographs which record activities and significant events. The home has a people carrier for outings and holidays. The Red House Residential Carehome DS0000065123.V296592.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 inspection that was conducted in order to look at the requirements and recommendations made at the last announced inspection that took place on 22nd November 2005 and also to monitor the care and services provided to those who live at the home. During this inspection time was spent examining care documentation, staff employment and training records, an examination of health and safety documentation, some areas of the home were viewed and also discussion took place with residents, the registered provider, the registered manager and staff employed at the home. Further discussion took place with the registered manager in respect of the Commission’s commitment to improving service’s through its ‘inspecting for better lives’ programme and how this would inform the inspection process and also the quality rating completed by the Commission about the service. An evaluation of the fourteen requirements made at the last inspection found that nine had been met. The home has been requested to forward further information to the inspector in respect of one of the requirements in order that this can be fully evaluated. Two of the three recommendations made at the previous inspection have been met. At this inspection a further eight requirements and one recommendation were made. There were a number of standards that were not reviewed at this inspection such as meals, staff supervision and quality assurance; these will be reviewed at the next inspection. Throughout the inspection process the registered manager, assistant manager and staff spoken with were informative and engaged fully with the inspection. Resident’s spoken with spoke favourably of the care and attention they receive from the staff at the home. The inspector received comment cards from those who live at the home, relatives and two care managers and the feedback given has been incorporated into the body of the report. What the service does well: The Red House is a comfortable, homely environment in which the resident’s live. Resident’s spoken with said they were happy at the home and were well cared for. A number of comment cards were received from visiting professionals and relatives of those living at the home and overall these said that individual’s needs were being well met by a caring and supportive staff team. It was clearly evident that the deputy, the registered manager and the staff team are committed to ensuring that all of the needs of individual’s at the home are met, this is done through consultation and observation and previous The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 6 knowledge and an understanding of individuals through a person centred individualised process. What has improved since the last inspection? What they could do better: Residents should be issued with contracts clearly outlining the services to be offered and the charges for these and the resident, or their representative, and someone from the home should sign them. Residents would be better protected and assured that staff had been appointed following robust recruitment and selection if the home ensured that criminal record bureau checks were in place for all staff before they commenced employment, the home must also complete two risk assessments to assess the safety and protection of residents whilst awaiting CRB disclosures. Further protection for residents would be evident if staff records were in place and the home made these available for inspection and if the home updated their The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 7 protection of vulnerable adults policy to ensure it reflects the responsibilities of staff should an incident be reported. Evidence of the quality and content of the protection of vulnerable adults training and confirmation of attendance for the registered provider must be forwarded to the Commission by 23rd June 2006. Residents would be assured of the ability of the manager when he is assessed for his ‘fitness’ to manage by the Commission for Social Care Inspection. Those living at the home would be confident that the registered provider is monitoring the quality of life for those living at the home and influencing the outcomes that affect their life if he undertook monthly monitoring visits to the home, these must be recorded and copies of this report must be forwarded to the commission, this had been a requirement at both previous inspections and Mr Moodie has been given one month to comply. Resident’s would be confident of staff ability in the event of a fire if they undertook sufficient fire safety instruction. Medication competency training and evidence of staff induction would ensure that staff were working in a safe manner and in accordance with the aims and objectives of the home. Residents at the home would be better respected if further consideration was given to the use of language and terminology in resident care records, this was a recommendation at the last inspection undertaken in November 2005 and will be reviewed at the next inspection. Residents and staff would be further assured of the management ethos and individuals responsibilities if both residents and staff meetings were recorded. 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 Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 8 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 Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3. 4,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including an evaluation of the documentation in place. Admission processes are sound and the home ensures that they are able to meet the aspirations and needs of potential new residents, however all residents must be given a contract of the terms and conditions of their placement. EVIDENCE: A recommendation was made at the previous inspection that the home’s statement of purpose is to be updated to include the current management status of the home. A review of this document found that this document had been updated to include details about the qualifications and experience of the manager and provided information about the arrangements for the staffing of the home. The statement of purpose, along with the homes service user’s guide sets out the aims and objectives of the home, its services and facilities and provides prospective residents with the information they need in order to make an informed choice about whether they wish to live at The Red House and if the home is able to meet their assessed needs. The admission process for the most recently admitted person to the home was reviewed, from recorded information seen and discussions with the registered manager it was clear that the person had been admitted following a full assessment involving the individual. The resident had been admitted with a The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 10 care plan completed by a care manager, this assessment covered areas of personal care support, personal relationships, emotional support and activities of daily living. The manager told the inspector that the admission process for the resident had been a gradual one involving short visits and a trial period at the home. The manager said that as well as the home ensuring they were able to meet the needs of the resident consideration was also given to the compatibility’s with others who live at the home. A comment card received from a care manager who had placed someone at the home said ‘Staff have been creative in finding ways to support the new individual in the home and are flexible in their approach and I have been impressed by the friendly and welcoming atmosphere.’ The contract for the most recently admitted resident to the home was requested, this was not in place. This must be in place in order that the individual has a written statement of the terms and conditions of their placement and that individual’s rights are outlined. A requirement was made that contracts between the home and the resident must be discussed and agreed with each resident and/or their representative and signed by all parties The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 11 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, 7, 8, 10. The quality outcome in this area is good. Care planning documentation at the home contains clear, detailed information to enable resident’s personal, emotional needs to be well met, with individuals being supported and encouraged to make decisions that affect their life. EVIDENCE: The care records for three individuals were reviewed as part of the inspection, one was for the most recently admitted person into the home, another was a resident who is being supported to live in a more independent way and another resident who has lived at the home for many years. Since the last inspection the home has introduced a new care plan, produced in the form of a booklet. Mr Orm said that this had been implemented in order that the information held would be more accessible to staff and would be easier to maintain and keep updated. The booklet covers a number of areas which included personal relationships, family history, ‘how can things in the individuals life be improved?’ social, leisure, physical and emotional wellbeing. A requirement was made at the last inspection that care plans must be reviewed on a regular basis, all of the care plans in place had recently been reviewed and it was noted that the home are reviewing these documents on a monthly basis which exceeds the National Minimum Standards and the home The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 12 are to be commended for this. The home also have in depth person centred information for residents that covers their like, dislikes, aspirations, their choices and decisions they have been supported to make. This information has been gathered over a long period of time and provides valuable guidance for staff to ensure that residents are supported on an individualised way, respecting the choices they have made. It was recommended at the previous inspection that consideration be given to the use of language and terminology used within resident’s records. This recommendation remains and will be reviewed at the next inspection. This was discussed with the manger. It was found that one staff member continues to write unnecessary subjective comments in resident’s records it is not acceptable and must stop. It must be noted that other records were informative and created a clear picture of the lives of residents at The Red House and enabled the inspector an insight into their preferred lifestyle and the choices they make on a day-to-day basis. Records were all dated and signed. A resident spoken with said that they are always asked what they would like to do and that they are given many choices about things which affect their life. It has been noted on previous inspections that residents meetings are held on a regular basis at the home and records of these have previously been seen. Mr Orm said that informal meetings are still being held regularly at the home; however, records of these have not been maintained. It is recommended that minutes of both resident’s and staff meetings be held in order to demonstrate outcomes for residents. Records are held securely in the home with confidentiality being respected. The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 13 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): 11, 12, 13, 15, 16. Quality outcomes in this area are good. Resident’s lifestyles match their expectations and preferences and satisfies their social and recreational interests and needs. Residents are supported to exercise choice and control over their lives. EVIDENCE: One the day of the inspection all but one of the residents were out for the day attending various day care activities such as day centre and club. Daily records recorded that residents participate in an array of activities which have been tailored to their individual choices, these have included a trip to Brean leisure park, a picnic, swimming, arts/crafts, church, local amenities, attendance at further education college and visits to the cinema. Mr Orm said that discussion will be taking place with residents in order to decide a location for a holiday to take place either later this year or next year. One of the residents recorded on a comment card prior to the inspection that they are not happy with their day care provision, and that the manager was dealing with this. Mr Orm confirmed that he had been in dicussion with the resident in order to find a more suitable alternative. The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 14 Comment cards received from residents prior to the inspection were very positive about the lifestyle they lead and the varied activities in which they participate. One resident said they enjoyed going out to discos and taking the dog for a walk. One of the residents enjoyed telling the inspector about the volutary work they do in a local charity shop, of the friends they have made and of the work they do. The level of family involvement varies to each indivdual living at the home. Mr Orm was able to give a number of examples in which the home support residents to maintain relationships with relatives and friends these include transporting residents to social events and visits to their relatives and also assisting residents with correspondence and telehone calls. Comments received from relatives prior to the inspection recorded that staff were welcoming and were friendly. Oservations and discussions with residents and staff evidenced that the daily routines and house rules promote independence, individual choice and freedom of movement. Mr Moodie has recently purchased a house next door to the home and his predominant reason for doing this was to provide a more independent, yet supportive enviroment for one of the residents to live in. The resident concerned has been encouraged to find a supported living environment with limited success. The resident was evidently very excited about the prospect of the move and told the inspector of their input into their new home, from chosing the décor to the arrangement of a house-warming party. Staff have been working wth this resident for a long period of time developeing new skills such as daily living skills, money management and confidence building and shall continue to support them in order to aid a smooth transition for a more independent lifestyle. The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 15 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): 18, 19, 20. The quality outcome in this area is good with clear information to show that residents are supported in the way they prefer with individual’s physical, emotional and medication needs being well met. EVIDENCE: Information seen recorded in care plans outlined the wishes and choices of residents in respect of the personal care support that is required by them and had recorded the ways in which individuals wished to be assisted. All rooms are single occupancy, bathrooms have locks ensuring privacy. The home operates a key worker system. This system ensures that each resident is allocated a named member of staff who supports them on a one to one basis and this staff member would participate in review meetings and is responsible for developing a relationship with the resident and for maintaining up to date records. The home ensures that the healthcare needs of residents are assessed, recognised and met. Two of the residents are supported to manage their own medication and all residents are supported by staff to attend healthcare appointments. Residents are offered annual health checks including optician and the dentist, and specialist services are also available to residents such as psychology and advice is sought if required from the community learning difficulties team. The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 16 Systems of medication administration, storage and recording were reviewed at this inspection. The inspector has seen at previous inspections that the home has clear policies and procedures in place to direct staff and provide instruction. Medication is stored in a locked cabinet with an additional facility for the storage of controlled medication. A monitored dosage system of medication administration is in place at the home and this appears to work well. A requirement was made at the last inspection that medication records must be fully completed, records seen had been sufficiently detailed and entries had been signed by staff. Through discussion with staff it became apparent that staff at the home have not received medication competency training, a requirement in respect of this was made at this inspection, see standard 35. The home has in place hospital admission forms these provide information about individuals general well-being, previous medical history and next of kin information should they be admitted to hospital. The information contained within this would provide a good overview for hospital staff. The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 17 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): 22, 23. The quality outcome in this area is adequate, residents are listened to and complaints are dealt with effectively, however the home’s adult protection policy must be improved to ensure it complies with the local authority procedure for the protection of vulnerable adults. EVIDENCE: The inspector reviewed the home’s adult protection policy as a requirement was made at the last inspection that this policy must be updated in order to inform the reader of the protocol for reporting incidents and notification of who would undertake any potential investigation. There have been no changes to this document and therefore the requirement remains and will be reviewed at the next inspection. The manager and two staff members spoken with were able to demonstrate a sound understanding of their role and responsibility in ensuring the protection of residents. One of the staff members told of the coverage of this subject during their completion of the National Vocational Qualification and of the value this had been. A requirement was made at the last inspection that the home undertakes a review of security within the home, this was due to the back door being left unlocked, keys being left in the medicine cabinet and residents monies not being kept securely. Security at the home has much improved. The home has installed a keypad entry system for entry into the office and a safe has been purchased for the safe storage of resident’s money Prior to the inspection a comment card was received from a relative of someone who lives at the home, their comments outlined concerns over decline in service and staffing levels. These issues, without divulging confidentialty were discussed with the manager who was aware of the The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 18 concerns of this person and gave examples of how he and the staff team have worked to resolve concerns with the well-being of residents being the priority. The manager is the appointee for all but one of the resident’s finances and was clear about ensuring the secuity of resident’s valuables. Three resident’s monies were checked and the money held was found to correclty correspond with records maintained at the home. The home’s complaints record was viewed with the last recorded complaint being made in May 2006.The issue was dealt wth appropriately and recorded the action taken to resolve the issue. It was noted that care plans recorded that the proceedure for making a complaint had been discussed with residents with a copy of the proceedure being on display at the home. Comment cards received from residents recorded that residents knew who to speak with if they had any concerns and this was confirmed when talking to residents during the day. No issues of concern were raised during the inspection visit. The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 19 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, 25, 28, 30. Quality outcomes in this area are good; residents live in a homely, comfortable and safe, clean environment. EVIDENCE: The Red House is located within a residential area of Filton and is within close proximitity of local amentities such as a college, libarary, shops, public houses and a church. Mr Moodie has recently purchased the house next door with the intention that this house will provide accomodation for two residents in order that they would be supported to lead a more independent lifestlye with the security of having a staff team available to support them. Mr Moodie has applied to the Commission for a variation in the homes registration status in order that the home can increase its numbers from 8 to accommodate 10 individuals. The home has received an application form to apply for a major variation in its registration staus and this will be dealt with by the Commission’s registration officer. The home has a spacious lounge and dining area, both of which are well furnished. All areas of the house were found to be clean and tidy with residents participating in daily living tasks such as keeping their own rooms tidy, preparing drinks and snacks and putting their own laundry away. Residents have large garden areas to the front and rear of the house. The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 20 The inspector viewed two residents private rooms this included the room of the most recently admitted person into the home. Both rooms were found to be well decorated and furnished appropriately. It was clear that residents had personalised their rooms in order to reflect their own taste and choices, rooms were homely. A requirement was made at the last inspection that residents must be consulted as to whether they would like to be able to lock their own rooms and their decisions should be recorded within their care documentation. The inspector saw that all residents and their representatives had been approached about this and their wishes were recorded and respected. It was found at the previous inspection that the television reception in one of the residents rooms was poor, it was required that this be addressed. Mr Orm said that the resident has since left the home and that the person in this room does not have a television. Mr Moodie confirmed that should this person want a television he would ensure that the television picture quality was good. Security at the home at the previous inspection was a concern as the back door was left open and unlocked, a requirement was made that the home must undertake a review of security within the home to ensure the safety of all. There were no concerns over security observed during this inspection. The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 21 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): 32, 34, 35. The quality in this outcome area is poor. The relationships between staff and residents are good, and this creates a warm, supportive environment, however the home fails to protect the residents due to poor record keeping and staff recruitment and selection practices. EVIDENCE: Since the last inspection there have been a number of changes within the staff team. There is a new home manager, assistant manager and support workers. Staff spoken with said they feel supported by the manager and that the team is working together to ensure a good quality of life for the residents. Staff spoke positively of training they had undertaken and future training planned. Staff spoke with confidence and knowledge about the individuals they support and told of the relationships that have been developed. There is two staff at the home that are working towards a National Vocational Qualification at level 2 and one is undertaking level 3. The assistant manager has achieved an NVQ at level 2 and has also achieved ‘training for trainers’ award. Future training booked to take place for staff includes protection of vulnerable adults, manual handling, fire safety, basic food hygiene and first aid. Staff are also in the process of completing a health and safety training pack, this is a distance learning course and staff are assessed for their competency by an assessor who visits the home on a monthly basis, the The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 22 chosen subjects to be covered are relevant to the setting and the service being provided at the home. A comment card from a relative prior to the inspection recorded I feel the Red House has declined in both personal and supportive care in the last twelve months I have a lot of contact with my relative and the staff changes have made their relative feel very insecure. This relative has relayed their concerns to the manager of the home.These comments were discussed with the manager at the inspection who confirmed they were aware of the issues and said that the staff team were committed to ensuring that residents choices and wishes were repected and that these may be different to those of relatives and that together resolutions would be sought. The inspector was unable to meet with the resident concerned as they were on holiday. Another comment card from a relative recorded The Red House and the staff are the best thing that ever happened to my relative, the staff are first class, my relative is very happy there, the place is always buzzing with fun Another comment card from a relative records due to changes in management and staff over the last 18 months I no longer know the names of the staff on duty and have never met the present manager, staff however always make me feel welcome and whoever is on duty is polite and friendly. Both Mr Moodie and Mr Orm said that they are considering holding a social event at the home in order that relatives can be assurred of the aims and objectives of the home and this will also provide an opportunity to introduce themselves to relatives. An immediate requirement was made at the last inspection that a review of the staffing arrangements must be undertaken to ensure that the needs of all are being met. This requirement was made due to the increased needs of an individual living at the home at the time, the inspector revisited the home a week later and found that staff levels had increased and were adequate to meet the needs of those living at the home. A review of the staff rota found that the current staffing levels were sufficient to meet the needs of residents. One of the residents has a support need at night and the placing authority are currently funding additional staff, this situation is being kept under review by the individual’s care manager and also the manager of the home in order that the individual is supported appropriately. The recruitment and selection documents for five staff members were requested, the information contained within these files varied with only one staff member having all of the required information in place. Three staff had no evidence of a criminal record bureau check or protection of vulnerable adult check having been undertaken. Mr Orm said that staff rotas ensured that staff without a CRB check did not work unsupervised; a staff member also confirmed this. It was noted that a staff member had disclosed criminal convictions to the manager however there was no evidence recorded to show what actions had been taken to ensure the protection of the residents. Four The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 23 requirements in respect of recruitment and selection and protection of residents were made at this inspection these were that all staff must have a CRB check in place before they commence work, that full recruitment and employment records must be in place and be available for inspection. It is further required that a risk assessment must be written in respect of a staff member’s disclosure of a conviction and that a risk assessment is completed to assess the safety and protection of residents whilst the home is awaiting CRB clearance. There have been new staff appointed at the home since the last inspection with no information in place to show what structured induction and foundation training had been undertaken, this should cover the principles of care, safe working practices, the organisation, the worker role and the influences and particular requirements of the residents. It is required that the induction for staff be recorded in order that it demonstrates that the programme meets the ‘Skills for Care’ workforce training targets and ensures staff fulfil the aims of the home and meet the needs of residents. The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 24 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, 38, 40, 42. The quality outcome in this area is poor with changes in the management team and staff not receiving sufficient fire safety instruction. Polices and procedures are sound. EVIDENCE: Since the last inspection the previous manager Teresa Hassell and the home’s deputy manager have left. The current manager in post is Mr Roy Orm who has many years experience within a management capacity within the care profession. Throughout the inspection process he was able to demonstrate a sound understanding of his role and responsibilities, he has got to know the residents and has developed relationships with other professionals. Mr Orm is required to register with the Commission in order that an assessment of his ‘fitness’ may be undertaken and therefore a requirement was made that the current manager must submit his application to the Commission by 23rd June 2006. A pre-inspection comment card received from a care manager who is currently supporting one resident at the home and a prospective new resident stated The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 25 that I am particularly impressed by this care home, especially as the home has a new manager in post Another comment card recorded the new management and staff are very helpful and caring I am pleased with my relative’s progress and how the home is operating Visits made by the registered provider must be undertaken on a monthly basis and these must be forwarded to the Commission, this requirement has been outstanding since May 2005. The registered provider was spoken with at this inspection and was reminded of his responsibility in this area. Staff spoken with said that Mr Moodie visited the home on a regular basis, that he participates in staff meetings, is available by telephone and approachable. Mr Moodie has been given a suggested report format to record his monitoring visits to the home and has been given until 23rd of June to comply. A condition of the registered providers registration was that the registered provider must undertake protection of Vulnerable Adults training, this requirement was reviewed, the inspector was told that Moodie would be undertaking this training internally within the home on June 1st. The home has been requested to forward confirmation of completion of this training as well as information about the content of the training in order that an evaluation of the quality of this training may be undertaken. A requirement was made at the last inspection that the home develop a lone working policy. The inspector saw that this is in place at the home; Mr Orm said that he intends to expand on this policy to ensure all areas are covered. The inspector has seen at previous inspections that the home has clear written policies and procedures in place, which comply with current legislation and cover the topics as set out within the National Minimum Standards. A requirement was made at the last inspection that the weekly fire alarm testing must be completed, that emergency lighting must be checked on a monthly basis and that emergency lighting must be checked on a monthly basis. Records of these were reviewed and it was found that the home is completing all of the required fire safety checks. Another requirement was made at the last inspection that staff must receive sufficient fire instruction. A review of instruction undertaken found that this requirement had not been met, although the inspector saw that fire safety training was booked to take place at the home, this would still not provide sufficient amounts of training and therefore the requirement remains and will be reviewed at the next inspection. It was also recommended at the previous inspection that the home’s fire risk assessment include what the procedure is at night, this had been incorporated and the recommendation had been met. The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 26 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 Standard No Score 1 3 2 3 3 3 4 3 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 1 3 X 3 X 1 X The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 27 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. 2. 3. Standard YA23 YA42 YA43 Regulation 13(6) 23(4) 26 Requirement The home’s adult protection policy to be updated. Staff must receive sufficient fire instruction. Timescale for action 24/07/06 24/07/06 Visits made by the registered 24/06/06 provider must be undertaken on a monthly basis and these must be forwarded to the Commission. The manager must submit their application for registration to the Commission. Full recruitment and employment records must be in place and be available for inspection. All staff must have criminal record bureau checks in place before they commence work. Risk assessments must be completed to assess the safety and protection of residents whilst awaiting criminal records bureau clearance for staff. A risk assessment must be completed in respect of a criminal records disclosure. Medication competency training must be provided for all staff. DS0000065123.V296592.R01.S.doc 4. 5. 6. 7. YA37 YA34 YA34 YA23 9 19 (d) 19 (d) 13 (4) c 23/06/06 24/07/06 24/05/06 23/06/06 8. 9. YA23 YA35 13 (4) c 18 (c) 23/06/06 23/08/06 The Red House Residential Carehome Version 5.2 Page 28 10. 11. YA35 YA5 18 (c) 5(1) b Induction for staff must be 23/06/06 recorded. Contracts must be in place for all 23/06/06 residents and must record who is acting as an appointee for their finances. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA38 YA6 Good Practice Recommendations Records of both residents and staff meetings to be maintained. Consideration to be given to the use of language and terminology used within residents records. The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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. Extracts may not be used or reproduced without the express permission of CSCI The Red House Residential Carehome DS0000065123.V296592.R01.S.doc Version 5.2 Page 30 - 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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