Inspection on 02/08/05 for The Redhouse

This inspection was carried out on 2nd August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Redhouse 09/11/07

The Redhouse 03/01/07

The Redhouse 30/11/05

The Redhouse 19/01/05

The Redhouse 21/07/04

The Redhouse 14/01/04

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

CARE HOME ADULTS 18-65 The Redhouse Wharncliffe Road Ilkeston Derbyshire DE7 5GF Lead Inspector Claire Williams Unannounced 02 August 2005 at 01:30pm 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 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 Stationary 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 Redhouse C52 C02 S52210 The Redhouse V242640 020805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Redhouse Address Wharncliffe Road, Ilkeston, Derby, Derbyshire, DE7 5GF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0115 9447869 0115 9447869 Voyage Limited Gordon Mark Robinson Care Home 8 Category(ies) of LD Learning Disability (8) registration, with number of places The Redhouse C52 C02 S52210 The Redhouse V242640 020805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 19/01/05 Brief Description of the Service: The Redhouse is a listed building, which used to be a hotel prior to becoming operational as a Care Home. The Redhouse was registered on the 18th September 2003 by the National Care Standards Commission, and is owned by Voyage Ltd. The home has been refurbished and is managed as a smaller family type unit. The home was first registered for seven people, but following an application to vary the registration the home is now registered for 8 indivduals with a learning disability between the ages of 18 - 65 years old. The home is situated close to the centre of Ilkeston and the shops and facilities are within walking distance. The Redhouse C52 C02 S52210 The Redhouse V242640 020805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 1.30pm. The visit lasted 6 hours. The Inspector spent time examining care records, and associated documents, speaking with the service users and observing service users and staff interactions. A partial tour of the building was undertaken. The inspector spoke with the staff members on duty and the Registered Manager. The inspector used “case tracking methodology” which involves the examination of records/documents, discussion with (the individual service users, staff and where appropriate relatives) and evidence in relation to individual service users to determine how the National Minimum Standards work for them in practice. Three service users were case tracked during this inspection visit. What the service does well: What has improved since the last inspection? What they could do better: The Registered Manager needs to ensure that some of the staff member’s medication practices are improved, due to some errors in the recording and administering of medication. The medication practices should be monitored on The Redhouse C52 C02 S52210 The Redhouse V242640 020805 Stage 4.doc Version 1.40 Page 6 an ongoing basis to ensure all staff practices are in accordance with the homes policies and procedures, and in order to ensure that all service users receive their medication as prescribed. The staff team would benefit from some training on how to complete behaviour analysis forms, and a system should be implemented in order to monitor and implement strategies as result of these incidents. 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 Redhouse C52 C02 S52210 The Redhouse V242640 020805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Redhouse C52 C02 S52210 The Redhouse V242640 020805 Stage 4.doc Version 1.40 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 standard(s) 2, 3, 4, and 5 Information and opportunities are provided to enable service users to make an informed choice about moving into the home. Assessments are undertaken to ensure individual needs and aspirations are met. EVIDENCE: Service users are provided with a copy of the Statement of Purpose and service user guide, which enables them to have the information they require to make an informed choice about where to live, and to be informed about the facilities available at this home. The inspector spoke with a service user who moved into the home a month ago. The service user confirmed that he had visited the home for tea visits, in order to meet the service users and the staff at the home. The service user also confirmed that the Registered Manager had visited him at his previous placement to undertake an assessment of his needs. The service user stated that he was ‘settling in well’, and starting to get to know his fellow tenants. The service user confirmed that the staff team were able to meet his needs and aspirations. The documentation examined confirmed that the Registered Manager and the individual’s Care Managers had undertaken pre-admission assessments for all three new admissions to the home. The Redhouse C52 C02 S52210 The Redhouse V242640 020805 Stage 4.doc Version 1.40 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 standard(s) 6, 7, 8, 9 , 10 Care files reflect individual aspirations and needs, and details how these should be supported. Service users are consulted about their lives and about the running of the home. EVIDENCE: The inspector examined the service user files for the two of the individuals that had recently moved into the home. Both files contained support plans; the topics covered within these plans were varied but included aspects of personal and healthcare needs specific to individuals. The risk assessments indicated key areas of concern and ways in which staff could minimise or eliminate any problems arising from these risks. The files also contained an information sheet concerning the behaviours that each individual could present, which could be deemed as challenging to the service and the staff team. Within this information is a list of key triggers that the individuals may present before any challenging behaviour may occur. Staff commented that this information enabled them to be informed about individual’s behaviour and assisted them to provide consistent and individual support to each service user. Staff complete behaviour analysis forms to record information when significant incidents occur, however these forms are not then analysed in order to highlight patterns of behaviour so that strategies can be implemented. The Redhouse C52 C02 S52210 The Redhouse V242640 020805 Stage 4.doc Version 1.40 Page 10 Service users confirmed that they are actively involved in the development of their care plans. There was evidence in both files to support that the service users have been consulted about their plans. Each support plan has been developed with each service user who has signed their plans in agreement. One service user informed the inspector that he has not yet signed his plans, as he “wants some changes to be made”. The staff team have commenced in completing individual person centred plans entitled “this is my life”. The inspector examined one of these documents, and it gives a holistic overview of the journey and the life of individuals until present day, enabling staff members to have a more in-depth in-sight into individual’s experiences and previous history. Within the documentation there was clear indications that the action plans, risk assessments and overall arrangements for care had been reviewed regularly. Each service user has a keyworker who is responsible for completing a weekly and monthly summary, giving an overview of any significant events and achievements in that time period. A service user informed the inspector that she enjoys her keyworker sessions as it enables her to “have a private talk about things”. Service users are actively encouraged to be independent in their lives and observations confirmed that service users are consulted on a daily basis concerning aspects about the running of the house. Service users were aware of information that is held about them, and that the files are always locked away securely. The Redhouse C52 C02 S52210 The Redhouse V242640 020805 Stage 4.doc Version 1.40 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 standard(s) 11, 12 , 13, 14, 15, 16, Service users have access to varied opportunities, and life experiences in order to develop independent living skills. Opportunities were tailored to individual interests and abilities. EVIDENCE: The service users discussed with the inspector what they do within the week and informed the inspector that they have developed a structured weekly programme with their keyworker. Within this programme there is time allocated for leisure activities of the service users choice, and development activities to enable the service user to develop independent living skills. Each service user has been allocated some one to one funding to enable them to access community facilities and to achieve their aspirations. Some service users attend college and school, and one service user is currently looking for paid employment, but discussed the difficulties of this due to the stigma attached with the label of having a Learning disability. The Redhouse C52 C02 S52210 The Redhouse V242640 020805 Stage 4.doc Version 1.40 Page 12 All service users spoken with confirmed that they enjoy the opportunities and experiences provided at the home. Service users informed the inspector of recent trips out and the short breaks they have had, and enjoyed. Service users were planning a trip out the following day to the park for a picnic. Service users confirmed that the daily routines of the home are flexible and promote their independence, choice, and freedom of movement, in accordance with their individual support needs. Service users confirmed that contact with their family and friends is encouraged by the staff team, and the records confirmed this. The Redhouse C52 C02 S52210 The Redhouse V242640 020805 Stage 4.doc Version 1.40 Page 13 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 standard(s) 18, 19, and 20 Service users are supported in accordance with their individual needs and preferences in all aspects of their health and personal care needs. Medication practices need to be improved to safeguard service users from potential risks. EVIDENCE: Service users confirmed that the staff team supported them in their personal care tasks in a manner, which is in accordance with their individual preferences. The examination of records and discussions held with service users confirmed that service users physical and emotional health needs were being met at the home. Service users are supported to attend health care appointments by the staff team, and information about specific medical conditions was available in service users files. The inspector examined the medication cabinet and associated documentation, and observed the staff practices. Unfortunately the practices in this area was not in accordance with the medication polices of the home. The inspector observed a new staff member administering medication to a service user and signing the Medication Administration Record (Mar chart) before the service user had taken the medication. This practice puts both the service user and the staff member at risk. This staff member had not been assessed as competent to administer medication independently, and his signature was not recorded on The Redhouse C52 C02 S52210 The Redhouse V242640 020805 Stage 4.doc Version 1.40 Page 14 the signature sample list, which includes the signatures of all the staff deemed competent to administer medication. The inspector examined the Mar Charts and there was a few gaps in some of the service users charts that had no explanation. The inspector examined the medication communication book, and this listed various mistakes made by staff in relation to their medication practices, i.e. Signing medication before administration, signing the wrong day or time for the medication, taking a tablet out of the wrong blister pack. There was evidence recorded in this book of staff being unsure of what codes to use and how to record or order medication although staff have been assessed as competent, and some staff have completed credible medication training. These discrepancies and observations were brought to the attention of the Registered Manager at the time of the inspection, and he confirmed that he would organise further training. The Redhouse C52 C02 S52210 The Redhouse V242640 020805 Stage 4.doc Version 1.40 Page 15 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 standard(s) These standards were not checked during this inspection. EVIDENCE: The Redhouse C52 C02 S52210 The Redhouse V242640 020805 Stage 4.doc Version 1.40 Page 16 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 standard(s) 24, 25, 26, 27, 28, 29, and 30 The home is equipped, furnished and maintained to a good standard and offers homely and spacious facilities for service users to enjoy. EVIDENCE: The home is decorated to reflect a homely domestic environment. The inspector was invited to look at service users bedrooms by the individual service user. The bedrooms was personalised to reflect the interests of that service user. Service users have keys to their room, although one service user was waiting for a new one at the time of the inspection. Service users stated that they “ liked their bedrooms” and the facilities available as each bedroom have an en-suite. The environment was well maintained and was comfortable and service users stated that they liked the way the home was decorated. Service users have access to various rooms for recreational activities, or in order to get some privacy. The home was found to be clean and hygienic at the time of the inspection. The Redhouse C52 C02 S52210 The Redhouse V242640 020805 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, The deployment and numbers of staff appeared satisfactory to meet the needs of the current service user group. Some qualified staff supports the service users. EVIDENCE: A copy of the duty rota for week ending 31/7/05 was provided. The staffing levels provided enabled staff to provide some one to one support as well as group support to service users both inside and outside the home. Additional staff members are on duty to provide support for any planned activities or when the needs of the service users require additional support. Although the staff files was not examined on this occasion the Registered Manager confirmed that the application form now requests the reasons for leaving previous employment and requests written explanation of any gaps in employment. The inspector and the Registered Manager discussed the status of the staff team in relation to achieving National Vocational Qualification (NVQ). The inspector was informed that currently there are 7 staff members who have completed or are working towards an NVQ level 3 or above. The Registered Manager stated that a further 4 staff will be enrolled in September 2005. This means that 11 staff will be qualified or receiving training by December 2005, and therefore the home will be on target to meet the legal requirement of having at least 50 of its staff team qualified or undertaking training by this date. The Redhouse C52 C02 S52210 The Redhouse V242640 020805 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 and 38 Service users benefit from a well run home. EVIDENCE: The staff team felt that the home is well run and commented that the Registered Manager was approachable, and supportive and gave clear leadership. The staff felt that the Registered Managers approach has created an open, positive and inclusive atmosphere. The service users also commented positively about the Registered Manager stating that he was “easy to talk to and helpful” The Redhouse C52 C02 S52210 The Redhouse V242640 020805 Stage 4.doc Version 1.40 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 3 3 3 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 2 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 2 3 3 3 3 x Standard No 31 32 33 34 35 36 Score x 3 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Redhouse Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x x x x C52 C02 S52210 The Redhouse V242640 020805 Stage 4.doc Version 1.40 Page 20 NO 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 9 Regulation 12 (1) (a) Requirement Timescale for action 31st November 2005 31st November 2005 31st November 2005 31st September 2005 2. 9 3. 20 4. 20 5. 20 6. 20 7. 20 The Registered Person must ensure that the staff team are given guidance on the use of Incident Analysis Charts in order to complete them accurately. 12 (1) (a) The Registered Persons must ensure that when regular incidents occur a strategy is implemented to reduce the risks to service users and staff. 13 (2) The Registered Person must 17 (1) (a) ensure that a record is kept of Schedule medication administration or a 3 coded reason for nonadministration. 18 (1) (c ) The Registered Person must (i) ensure that only competent and trained staff adminster medication in accordance with the homes polices and procedures. 12 (1) (a) The Registered Person must ensure that staff only sign the Mar chart after the service user has taken the mediaction 12 (1) (b) The Registered Person must ensure that eye drops are dated on opening and disregarded after 28 days or as the guidance states on the label. 18 (1) (c ) The Registered Person must C52 C02 S52210 The Redhouse V242640 020805 Stage 4.doc 31st September 2005 31st November 2005 31st Page 21 The Redhouse Version 1.40 (i) enusre that when medication discrepancies occur the staff members responsible, receive additional training to improve their practices. An assessment of competence should then be repeated to ensure their practice has improved October 2005 8. 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 20 Good Practice Recommendations The Registered Person should ensure that the staff member responsible for medication, undertakes regular audits of all the sytems in place, and takes appropraite action when practices are not in accordance with the homes policies and procedures. The Registered Person should ensure that all staff responsible for medication, understand all of the medication systems including the re-ordering of the medication The Registered Person should ensure that each service users doctor is consulted concerning what homely remedies the individual can take depending on their perscribed medication. 2. 20 3. 20 The Redhouse C52 C02 S52210 The Redhouse V242640 020805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection South Point Cardinal Square Nottingham Road Derby, DE1 3QT 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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