Care Home: Red House

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What the care home does well People told us their needs were met at the home. They said "I am very happy with my care", and,"we`re well looked after". People told us "the home is satisfactory for me", "it is very well run", and, "I am very satisfied with everything". People told us the staff treated them with respect. They said the staff were "very kind", and, "always bright and cheerful". We observed that staff were positive and reassuring to people. People enjoyed a wide, varied range of activities and opportunities, and were actively encouraged to exercise choice and control over their lives. The home was clean, fresh, well maintained and suitably equipped so that people lived in a safe environment that met their needs and preferences. What has improved since the last inspection? The garden had been developed - with the involvement and assistance of people in the home - to be accessible and well maintained. The home won a gardening competition organised by Derbyshire County Council in 2008. A reminiscence room had been developed using furniture and other items donated by people in the home and visitors. A structured programme of activities had been developed to ensure that people in the home had access to activities and opportunities to meet their individual needs and preferences. What the care home could do better: The home should ensure the principles of the Mental Capacity Act 2005 are put into practice through admission procedures and care planning to ensure that people`s rights are promoted. The providers should consider upgrading the passenger lift as people in the home currently have difficulty in using the manual double doors. Key inspection report Care homes for older people Name: Address: Red House 93 Sheffield Road Chesterfield Derbyshire S41 7JH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rose Moffatt     Date: 1 1 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Red House 93 Sheffield Road Chesterfield Derbyshire S41 7JH 01629537520 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: louise.woodward@derbyshire.gov.uk www.derbyshire.gov.uk Derbyshire County Council care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Red House is situated on one of the main roads into Chesterfield, on a bus route and near to the town centre. The home is well set back from the road in secluded grounds. Red House is owned by Derbyshire County Council and provides personal care and accommodation for 20 older people. The home provides 15 long term care places, 3 respite or short term care places, and 2 places for assessment. People are accommodated on two floors. Fees are from £375.82 - £404.06 per week for people who are permanent residents, but a range of prices for short term care residents. Additional charges, e.g. hairdressing, chiropody, are clearly identified in the homes Statement of Purpose and Service User Guide. Copies of CSCI/CQC inspection reports are available in the foyer. 0 Over 65 20 Care Homes for Older People Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. The last key inspection of the home was on 13th August 2007. We looked at all the information we have received, or asked for, since the last key inspection or annual service review. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also Care Homes for Older People Page 5 of 26 has some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in the service; information we have about how the service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. We carried out an annual service review (ASR) of the home in November 2008. The ASR looked at all the above information. The ASR showed us the home continued to provide good outcomes for people living there. We carried out an unannounced inspection visit that took place over 6 hours on 11th August 2009. The inspection visit focused on assessing compliance with requirements made at the previous inspection and assessing all the key standards. We sent out 10 surveys to people living in the home and received 3 completed responses. We sent out 5 surveys to the relatives or representatives of people living in the home and received 1 completed response. We sent out 10 surveys to staff employed at the home and received 7 completed responses. There were 17 people accommodated in the home on the day of the inspection visit. People who live in the home, visitors and staff were spoken with during the visit. The manager was on leave, but the deputy manager was available and helpful throughout the inspection visit. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Case tracking was used during the inspection visit to look at the quality of care received by people living in the home. 3 people were selected and the quality of the care they received was assessed by speaking to them and / or their relatives, observation, reading their records, and talking to staff. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a good range of information provided and a satisfactory assessment process so that people were confident their needs could be met at the home. Evidence: People told us their needs were met at the home. They said I am very happy with my care, and,were well looked after. They said they were provided with enough information about the home to make decisions about living there. We looked at the records of 3 people in the home. All had an assessment of their needs that included all areas of their lives. People came to the home for a day before deciding if they wanted to move in, and also so the staff could assess their needs and ensure they could be met. The assessment process did not include any information about whether the person had a Lasting Power of Attorney (LPA) or Independent Mental Capacity Advocate (IMCA). Care Homes for Older People Page 9 of 26 Evidence: The information in the AQAA showed that the short-term care service at the home was well used. The AQAA said that they planned to improve by including comments from people in the home in the Service User Guide. Standard 6 did not apply as there were no people receiving intermediate care in the home. Care Homes for Older People Page 10 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a consistent, person centred approach to care planning so that people received care and support to meet their individual needs and preferences. Evidence: People told us they received the care and support they needed, including medical care. They told us staff listened to them and acted on what they said. Relatives told us they were always kept up to date with any concerns about the person. There was an individual care plan in each of the 3 records we looked at. The care plans covered all of the persons assessed needs and had details of the action required by staff to meet those needs. The care plans had been signed by the person to indicate their involvement and agreement. The care plans had been regularly reviewed. There were also details of the preferred daily routine for each person. The daily records for 1 person were detailed and informative. For the other 2 people, the daily records did not always have useful information about how the persons needs had been met. Care Homes for Older People Page 11 of 26 Evidence: People told us the staff treated them with respect. They said the staff were very kind, and, always bright and cheerful. We observed that staff were positive and reassuring to people. We found there were satisfactory systems in place for the storage, safe-handling and administration of medication in the home. Staff who administered medication had received appropriate training. Medication records were mostly correctly and fully completed. On 2 records, handwritten instructions were not signed by the member of staff who had written them or countersigned by another member of staff who had checked them as correct. There was no up to date reference book about medication, though the patient information leaflets from medication in use were kept for staff to refer to. The AQAA said that the care plans outline the way in which health and personal care will be provided, including respect for choice, privacy and dignity. The home planned to improve by ensuring all night staff had completed medication training, and by ensuring that peoples end of life wishes were met. Care Homes for Older People Page 12 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoyed a wide, varied range of activities and opportunities, and were actively encouraged to exercise choice and control over their lives. Evidence: People told us there were always activities that they could take part in. They said they could follow their preferred routines, such as getting up and going to bed when they wanted. There was an enthusiastic activities coordinator employed at the home. A copy of the weekly plan of activities was in each bedroom and activities were included in the homes quarterly newsletter. A range of activities was offered including trips out, music, entertainers, arts and crafts, baking, gardening, reminiscence, and gentle exercise. A reminiscence room had been developed with furniture and other items donated by people in the home and visitors. A sensory/relaxation room was being developed. People in the home enjoyed gardening and were proud of the garden created at the home. The garden had won a prize in 2008 in a competition run by Derbyshire County Council and the judging for 2009 was anxiously awaited. People had grown plants Care Homes for Older People Page 13 of 26 Evidence: from seed - including salad and vegetables, and had planted pots and hanging baskets. People were involved in a garden group that met regularly to discuss plans for the garden. People were encouraged to be involved in regular meetings to discuss the lifestyle offered in the home. There was also a forum of people from 3 local care homes who met regularly to discuss the services provided and to give ideas for improvements. There was some information available in the home about the Mental Capacity Act 2005, but this was not easily accessible to people in the home, their relatives and staff. Most staff had received training about the Mental Capacity Act 2005 and the implications for people living in the home. People were able to bring their own furniture and other items into the home to personalise their bedrooms. The lounges also had personal items displayed to give them a more homely atmosphere. People could have keys to their bedroom doors if they wanted to. We observed that people could move freely around the home and the gardens. We saw people using the small library room, and also sitting outside the front of the home enjoying the fine weather. There was also a quiet room where people could sit privately with their visitors, or could use the telephone. Visitors told us they were always made welcome and were able to visit at any reasonable time. They said that there were kept up to date with any concerns about the person in the home. People told us they enjoyed the meals provided at the home. People were consulted about the menus at regular meetings. Each of the 3 lounges had a dining area where meals were served. The dining tables were attractively laid with cloths, flowers and the menu for the day. Choices were offered at each meal. The AQAA said people had access to local advocacy services. The home had improved in the last 12 months by introducing more activities to meet the needs of people with dementia, and also by having a games console available for people to use. The home planned to improve by completing the relaxation room and having more training for the activities coordinator. Care Homes for Older People Page 14 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were satisfactory systems and good staff awareness so that people were protected and their concerns effectively dealt with. Evidence: People told us they knew how to make a complaint, but had never had to. People said they would go to staff if they had any concerns and were confident that appropriate action would be taken. The complaints procedure displayed in the home was a condensed version of the full procedure, but did not include the timescales by which action would be taken. Records were kept of any complaints made with details of the action taken and the outcome. The outcome for the last 2 complaints had not been recorded. There were suitable policies and procedures in place for safeguarding vulnerable adults. Staff at the home had all received appropriate training. Staff were aware of safeguarding issues and the correct procedures to follow where abuse was suspected. We had not received any complaints about the home since the last inspection and no safeguarding vulnerable adults referrals had been made. The AQAA said that they try to resolve any complaints as soon as possible. They planned to improve by having more training for staff about the Mental Capacity Act Care Homes for Older People Page 15 of 26 Evidence: 2005. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean, fresh, well maintained and suitably equipped so that people lived in a safe environment that met their needs and preferences. Evidence: People told us the home was always clean and fresh. They said the lounges were homely and comfortable. The external grounds of the home were accessible and well maintained - with the help and involvement of people living there. There were several lounges for people to use, including a quiet lounge and a small library room. The lounges were comfortably furnished. Bedrooms were personalised with peoples own furniture and belongings. Equipment was provided to help meet peoples needs, such as raised toilet seats and grab rails. The bathrooms had been refurbished since the last inspection and had baths with hoist seats. There was also a fully accessible shower. As noted at the previous inspection, the passenger lift had manual double doors that were too heavy for most people in the home to manage without assistance. Care Homes for Older People Page 17 of 26 Evidence: We observed that the home was clean and free from offensive odours on the day of the inspection visit. The laundry was suitably equipped. There was a sluice area separate from the laundry. Most staff had undertaken training about infection control in 2006. Since then, staff had received updates about infection control with other training. There was a policy/ procedure in the home for dealing with swine flu, but no other specific infection control policy. The procedures for the control of infection regarding laundry was referred to in the health and safety policy. The AQAA indicated that there was an action plan in place for infection control, but this could not be produced during the inspection visit. There were notices in toilets and other places reminding people about effective handwashing. Staff were aware of good practice in infection control. We found that an outbreak in of diarrhoea and vomiting in the home had not been notified to us as required. The AQAA said that people are consulted about the home, its decor and facilities through regular meetings. They planned to improve the garden paths and to provide new furniture in the lounges. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were satisfactory recruitment procedures and a good staff training programme so that people were protected and were supported by competent staff. Evidence: People told us that staff were available when they needed them. They said that staff were always bright and cheerful and very kind. They said that staff listened to them and acted on what they said. Staff told us I enjoy coming to work here and weve got a good staff team. The staff rotas showed that there were always 2 care assistants on duty during the day, plus a deputy manager and the manager. The care staff were supported by ancillary staff. We observed that there appeared to be sufficient staff on duty to meet the needs of people in the home. Staff said that staffing levels were usually sufficient to ensure peoples needs were met. Staff files were not available at the home for inspection as they were kept centrally by the providers. The AQAA said that all newly recruited staff had the relevant checks in place before commencing employment, such as a Criminal Records Bureau (CRB) disclosure. Staff confirmed this to us. Staff training records showed that all care staff had a relevant National Vocational Care Homes for Older People Page 19 of 26 Evidence: Qualification (NVQ), and had received all the required training, such as fire safety and manual handling. Most staff had received training about the care of people with dementia. The AQAA said there were good recruitment procedures and a comprehensive induction and training programme for staff. They planned to improve by recruiting laundry and clerical staff, and by further training. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well organised with satisfactory systems in place so that the health, safety and welfare of people was promoted and protected. Evidence: People told us the home is satisfactory for me, it is very well run, and, I am very satisfied with everything. The manager had been in post for several years and was suitably qualified and experienced to run the home. The manager was supported by a team of 4 deputy managers so there was always management cover for the morning and afternoon shifts. All of the deputy managers had achieved NVQ level 4 in care and a relevant management qualification. An administrative assistant had recently been appointed to provide support for the management team. We were told that the quality assurance system was in the process of changing to ensure people in the home had more opportunities to give feedback about the service Care Homes for Older People Page 21 of 26 Evidence: they received. In previous years, surveys had been used and a report produced of the results with details of any action taken to meet issues raised. There were monthly visits by the provider to check on the quality of the service received by people in the home. If people wanted the home to look after their personal money, this was dealt with by the manager or deputy managers. Satisfactory records were kept of all transactions and money was securely kept. We found that staff had received appropriate training in health and safety, manual handling, infection control and fire safety. Fire safety checks were recorded and were up to date. The AQAA showed that the maintenance and servicing of equipment in the home was up to date. As noted in the Environment section of this report, we had not received a notification about an outbreak of diarrhoea and vomiting in the home. The AQAA was completed by the manager and included relevant information supported by a reasonable range of evidence. Some parts of the AQAA gave limited details about how they plan to improve. The data section was fully and accurately completed. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 37 Notifications of all events listed in the regulations must be made to CQC. This will help to ensure people are protected and their health and safety is promoted. 30/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Admission processes should include: - asking about and recording whether the person has made an advance decision on receiving medical treatment - recording if the person has a LPA, IMCA, or Relevant Persons Representative (RPR) This will help to promote peoples rights. To ensure people are protected and medication is given as prescribed: - handwritten instructions on medication administration records should always be signed by the person who has completed them, and countersigned by another person who has checked the instructions are correct. - there should be an up to date reference book to ensure that staff have access to current information. Page 24 of 26 2 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 3 16 The complaints procedure displayed in the home should include the timescales of when action will be taken to address complaints. This will ensure people are fully informed about how complaints are dealt with. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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