Care Home: Red House Nursing Home

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What the care home does well People living in this home told us they were well cared for by a committed and competent care team. They were very satisfied with the care, approach of staff and the overall service provided by the home. The management take care to ensure that each persons needs are assessed before entering the home. The assessment fully involves the resident and their family. There is a weekly activity programme available that people can choose to join in with and that they said they enjoy. People said they enjoy their food, which are fresh, varied, well presented and nutritious using fresh ingredients. There was a comprehensive programme of education and training provided for staff, which ensured that staff knew how to care and support the people who live at the home. What has improved since the last inspection? Since the last inspection there has been a decoration and refurbishment programme. This has included provided a new dining room table, installed a new call system, replaced all bedside tables and wardrobes, providing LCD digital televisions in all bedrooms and the lounge and provided new fire retardent soft furnishings. In addtion new colours have been used in bedrooms, toilets and bathrooms. The manager has introduced open visiting. The manager has increased the variety of training opportunities for staff to bring in external training. What the care home could do better: There were once again no requirements or recommendations from this inspection. The management carry out regular quality assurance monitoring audits and as a result of these already identify improvements, which need to take place. To improve the management arrangements consideration should be made to provide internet and computer facilities to enable the manager to communicate with us by email. CARE HOMES FOR OLDER PEOPLE Red House Nursing Home 11 Emlyn Street Stamford Lincs PE9 1QP Lead Inspector Tobias Payne Unannounced Inspection 19th June 2008 08:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Red House Nursing Home Address 11 Emlyn Street Stamford Lincs PE9 1QP 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) 01780 766261 s.j.upton@hotmail.co.uk Mr Dinesh Ambalal Patel Mrs Sandra Joy Upton Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only:Care home with nursing - Code N To people of the following gender - Either Whose primary needs on admission to the home are within the following categories:2. Old age, not falling within any other category - Code OP The maximum number of people who can be accommodated is 23. Date of last inspection 22nd June 2006 Brief Description of the Service: Red House Nursing Home is situated close the centre of the town of Stamford. The home is a three storey building with a two storey extension providing accommodation on ground and first floor levels. Rooms to the first floor are served by a shaft lift. The home is registered to provide care and accommodation for up to 23 people requiring nursing and personal care over 65 years of age. On the day of the inspection there were 16 people living in the home. The home is not on a bus route but there is limited car parking at the side and front of the home. There is a small patio area with a pond at the side of the home with access from the lounge/dining rooms. Most accommodation is single but the home provides 5 double bedrooms, which have en suite provision. The registered provider of the home visits the home every week and works closely with the manager. The fees at the inspection on the 19/6/2008 ranged from £398 to £600 a week. Extras were for hairdressing £4, chiropody £8, toiletries, personal newspapers and magazines. The statement of purpose and service user’s guide and information about the home can be obtained from the manager of the home. Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This key inspection was unannounced and started at 8.00 a.m. It was done using a review of all the information available to us about the Red House Care Home. The inspection visit took place over 5 hours. We also spoke with 7 people living in the home and one visiting community nurse. We spoke with 5 staff members and the manager. The main method of inspection used on our visit was called “case tracking”. This involved selecting 2 residents and tracking the care they received through the checking of records, discussion with them, the care staff and observation of their care. We also examined the annual quality assurance assessment (AQAA) that was sent to us by the manager before this key inspection. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the home. It was very clear and detailed. Before making our visit we asked the people who live there to send us comments about the support they receive. We received 6 comment cards. All comments were very positive. During our visit looked at records, spoke to staff, the people who lived in the home and one visitor and walked around the home. What the service does well: People living in this home told us they were well cared for by a committed and competent care team. They were very satisfied with the care, approach of staff and the overall service provided by the home. The management take care to ensure that each persons needs are assessed before entering the home. The assessment fully involves the resident and their family. There is a weekly activity programme available that people can choose to join in with and that they said they enjoy. People said they enjoy their food, which are fresh, varied, well presented and nutritious using fresh ingredients. There was a comprehensive programme of education and training provided for staff, which ensured that staff knew how to care and support the people who live at the home. Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3, 4 and 6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There is clear, up to date and detailed information to enable people to make a decision about whether or not to come into the home. People coming into the home receive an assessment and know their needs can be met. They are also involved in this process. EVIDENCE: The new certificate was clearly displayed. In addition there was a new up to date service user’s guide and statement of purpose. A copy of this was in the entrance hall to the home. These were clear and comprehensive and included the aims and objectives and philosophy of the home and residents’ rights. We observed that the address of the commission had been changed to our Cambridge office. We were told that on request information about the home could me made available in Braille or in other languages. The manager is introducing a service user’s guide in each bedroom. Where a new resident was admitted to the home they would be assessed by the manager using a preadmission assessment. Following this written confirmation would be sent to the person confirming the home could meet their needs. We spoke to one Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 9 person who was in the home for a short period. She confirmed she received a thorough assessment and received a warm welcome when she came into the home. She had fulsome praise for the home. Each person also had a detailed contract outlining the cost of the stay. Comments received were, “I have found the staff very kind and helpful, I have enjoyed the stay” and “we were made to feel welcome when we looked round”. Records showed that they had been involved in the process. This was shown by their signatures. The home provides intermediate care having signed an agreement with Lincolnshire Primary Care NHS Trust. Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from being fully involved in identifying their own needs and choices. Clear up to date care plans, created from assessments of need help to ensure that people’s health and welfare needs are fully met. Medication is safely given by staff who know what they are doing. EVIDENCE: Every person we spoke with was very complimentary about the care and approach of staff. Each person had a care plan. This included a photograph of the person, care plan assessment covering all aspects of daily living, service user agreement signed by the member of staff and the person themselves or their relative/advocate. In addition, there was a general risk assessment, manual handling assessment, weight charts, GP visits and care plan which indicated the problem/need, the nursing action required and the goal of the care and support. Records were dated, signed and well maintained and clearly showed how care was to be given. There was also a daily record which showed what care was provided for each person. Medication processes had been reviewed. A new system had been introduced and all the registered nurses who administer medication had received training. Records were Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 11 examined and found to well maintained and stock well controlled. Medication was audited and monitored by the deputy manager. Directions were clear. The last pharmacy inspection was on the 4/3/2008. It was noted that stock was quite high as a result of the previous provider. This was now being better controlled. No person was self medicating. We saw a medication round taking place. The nurse used a trolley, identified the person, checked the name against the record, gave the medication and signed for it. There were no concerns. We advised that the manager obtained a copy of the Royal Pharmaceutical Society of Great Britain’s the handling of Medicines in Social Care. She agreed to do this. Comments received included, “staff nurses were excellent when my father needed a change in medication”. Throughout our inspection visit we saw staff attending to the people in the home in a kind, calm and friendly manner. They spent time with them, talking and joking with them. We spoke to a visiting community nurse who commented “I received a warm welcome and having signed in explained why I had come to the home. The member of staff took me to see the person and introduced me to them. I found the home very relaxed”. Where required, people living in the home are referred to GPs, Community Nurse, Community Psychiatric Nurse, Tissue Viability Nurse, Continence Nurse, Physiotherapist, Opticians, Dentist and Chiropodist. The home has Link Nurses who specialise in continence promotion and palliative care. They meet up with other nurses and promote up to date practice in consultation with the Lincolnshire NHS Primary Care Trust. There has also been established a close working relationship with GPs and other professionals such as speech therapists who visit to assess people who may have swallowing difficulties as a result of a stroke. There is a key worker system operating in this home to give more personal approach to care. Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are encouraged and supported to make choices to take part in a variety of social activities, which ensures that individual, social and cultural needs are met at the home. People choose from and enjoy a wellbalanced nutritious diet. EVIDENCE: There was an activities organizer who was in the home during our visit. Information about activities is in the service user’s guide. There are 3 sessions a week. Activities can include gardening, Bingo, quizzes, creative writing, memory games, reminiscence, armchair aerobics, puzzles, singing, arts and crafts and cookery. There was also a monthly entertainment and social functions could be planned with the people in the home. Some people also have one to one contact. There was a separate activities folder with details of each person’s social profile and what they liked to do. Open visiting now took place to enable the people in the home to receive visits whenever they wished. People in the home were without exception very satisfied with the meals and catering service. We saw breakfast being prepared for those people who wanted it in their rooms. They were served on individual trays each having a card with details about what the person wanted to have for breakfast. This Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 13 was very individual. The home received an inspection by the Environmental Health Officer for South Kesteven District Council on the 12/2/2008. As a result it was awarded 4 stars (very good). We saw staff sitting with people who needed assistance doing this in an unhurried and sensitive manner. We saw staff taking care to serve the food. Comments were, “we get plenty of food, just the way I like it”, “good variety of portions. Always extra available if required” and “the food is very good, tasty and well cooked”. Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People know how to make a complaint and feel that staff will listen to their views. The care team know how to respond to a complaint and how to act in order to protect people from abuse. People are protected from abuse by the correct recruitment procedures. EVIDENCE: There was a detailed complaints procedure in the statement of purpose, service user’s guide. No complaints had been received by the home or us. A complaints register was being kept. None of the people or staff had any complaints about the home. We spoke to member of staff day who knew clearly what abuse was and what she would do if abuse was suspected. The home had a copy of Lincolnshire’s Adult Protection Procedures. Adult protection is included in the induction programme for all new staff. People felt they could approach staff if they had any concerns or worries. Comments we received included “I can’t imagine making a complaint”. Staff were correctly recruited including a Criminal Records Bureau check. Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 22, 23, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in well-maintained, comfortable, clean and safe accommodation. EVIDENCE: Since the last inspection there has been a decoration and refurbishment programme. This has included provided a new dining room table, installed a new call system, replaced all bedside tables and wardrobes, providing LCD digital televisions in all bedrooms and the lounge and provided new fire retardent soft furnishings. In addition new colours have been used in bedrooms, toilets and bathrooms. Everyone commented on how clean, tidy and odour free the home was. Alcohol hand dispensers had been provided at the front of the home. Comments we received included “the home is always clean, fresh and welcoming” and “I like my room”. We again received no negative comments. The home has a variety of hoists, pressure relieving mattresses and nursing beds. All staff had received training about how they Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 16 should be used and the equipment was serviced regularly. There were no infectious diseases or pressure sores in the home and there were comprehensive infection control policies and staff wore gloves and aprons when attending to people Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a safely recruited, well-trained staff team available who have the skills to meet the needs of the people living in the home. EVIDENCE: No one we spoke with had any concerns about the level or availability of staff in the home. We saw a handover between staff who had just completed a night shift and the day staff. It was done in a very professional manner. There an obvious good team relationship as staff were seen to greet one another in a warm, friendly and relaxed manner. Each person was recruited correctly. We looked at the files for 2 staff. These showed separate folders for each person with application form, Criminal Records Bureau check, 2 references obtained, interview check list, interview notes, terms and conditions and induction programme. The duty rota showed that there were enough staff for the needs of the people in the home. In addition there were separate staff for domestic, laundry, catering, activities, administration and maintenance. Comments included, “staff are excellent, nothing is too much”, “I am delighted with the care and support my father my father has been given since here – all staff make a point of chatting to him and know he likes to be smart and shaven” , “they look after me well here” and “everyone is so kind and helpful”. A wide range of training is provided which includes supporting staff to obtain a qualification in care to National Vocational Qualifications. Training has included health and safety, moving and handling, food hygiene, equal opportunities, infection control, adult protection, fire prevention, first aid, administration of Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 18 medication, palliative care, food safety, Mental Capacity Act 2005 and understanding visual impairment. In addition 90 of care staff have obtained NVQ level 2 and a further 3 have obtained NVQ level 3. The home remains a training placement for nursing students from Anglia Ruskin University and for local schools. There were extensive separate folders on adult protection, infection control, supervision, communication, role of the care worker, principles of person centred care and the Mental Capacity Act 2005 with a copy of the code of practice. We spoke with a person who was on one week’s placement at the home from a local college. She commented, “I have felt well supported and have found this an excellent placement”. Staff were positive about working in the home. Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People and staff benefit from the positive leadership of the management team. Management record systems show that residents’ health, welfare, safety and choices are promoted. The management team ensures that that residents, relatives and professional visitors have the opportunity to voice their views and opinions. Staff benefit from the support offered to them. EVIDENCE: The manager was registered by us in November 2007. She is a registered nurse with extensive care practice and had an educational qualification. She was studying for a management qualification. She was in the process of reviewing the policies and procedures for the home. Staff and people had confidence in the manager and staff and felt they could approach the manager if there were any concerns. Each member had 2 monthly supervision for and as well as an appraisal twice a year. She had regular meeting with the people Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 20 living in the home every 6 weeks and staff. There were comprehensive policies and procedures. These included clinical procedures as well as palliative care guidance. Records were up to date, well maintained and available. Personnel and health and safety policies and procedures had been provided by an outside consultancy. There were quality assurance systems established and care records and medication was audited. An annual survey was sent out to each person to obtain their views and the 2008 one was to be sent out in the future. There were health and safety procedures and records of maintenance of equipment were available, well maintained and up to date. Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 4 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 3 X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X X 3 3 3 Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Red House Nursing Home DS0000002638.V366568.R01.S.doc Version 5.2 Page 24 - 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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