Care Home: Red House, The

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What the care home does well As this was a random inspection focussed on examining staffing at night within the home, the strengths of the home were not examined in detail. At the previous inspection the following strengths were found: Satisfaction with the care and support people received, and a relatively low staff turnover so staff know the residents well and understand their needs. People advised that they liked the staff and that staff were kind and helpful. Supportive and friendly interactions were observed between staff and residents. What the care home could do better: Requirements are made regarding the need for sufficient staffing numbers to work within the home at night to meet people`s needs safely, and recommendations are made regarding ensuring that there are adequate provisions of cleaning materials for nignt staff to maintain a hygienic environment, sufficient stocks of incontinence pads for residents to protect their dignity and minimal disturbance to sleep, and a review of procedures for getting residents up in the morning, to ensure that their choices are respected. It is also recommended that further dialogue be encouraged between staff and management, to create an open atmosphere in the best interests of people living at the home. Random inspection report Care homes for older people Name: Address: Red House, The 423 West Green Road Tottenham London N15 3PJ two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Susan Shamash Date: 2 3 0 8 2 0 1 0 Information about the care home Name of care home: Address: Red House, The 423 West Green Road Tottenham London N15 3PJ 02088890097 02088880311 joyohiri@haringey.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Joy Ohiri Type of registration: Number of places registered: Conditions of registration: Category(ies) : London Borough of Haringey care home 35 Number of places (if applicable): Under 65 Over 65 17 18 dementia old age, not falling within any other category Conditions of registration: 0 0 These persons who are in the category DE (E) must be accommodated in the living unit identified for this purpose. Date of last inspection Brief description of the care home The Red House is a purpose built home located in the West Green area of Tottenham. The home is close to local shopping and transport facilities, and a short distance from the shopping and entertainment facilities of Wood Green. The home is provided and managed by the London Borough of Haringey Social Care Homes for Older People Page 2 of 10 0 5 0 8 2 0 0 9 Brief description of the care home Services Department with the aim being to provide care with dignity for up to 35 people who are elderly. The home is arranged over two floors, with two units on each floor. Each unit has its own lounge and kitchenette, and there is also a large communal lounge located on the ground floor. Some residents have additional physical disabilities and dementia needs associated with ageing. In addition to providing care for residents, the home employs of a full time activity co-ordinator. Inspection reports produced by the Care Quality Commission (CQC) are available upon request from the registered manager/provider. Placements at the home cost around 530 GBP for each person per week. Residents are expected to pay separately for some items and activities, such as hairdressing or eating out. Care Homes for Older People Page 3 of 10 What we found: I visited the home at 10pm on Monday 23rd August 2010 as a random visit in response to anonymous concerns raised about the staffing levels at night within the home. The week prior to the visit I had telephoned the manager of the home in order to ascertain the staffing levels and occupancy of the home. On arrival at the home, I had the opportunity to speak to the assistant manager on duty (on a sleeping-in shift) and four night staff who were on duty that night. The assistant manager provided me with the current and previous months rotas and shift plans, information about the occupancy levels over the last few weeks, and current incident/accident records. The vast majority of people were in their bedrooms when I arrived. Although there were a small number of residents in the lounge areas of the home, on the advice of staff members, I did not approach them, as staff advised that they were currently quite confused, and discussion with them might cause them distress. I observed supportive interactions between staff and residents during the visit, indicating that residents felt comfortable with the staff supporting them. At the time of the inspection there were four night staff on shift, in accordance with the homes rota, working from 9pm - 8am. Examination of the rota indicated that there had been four night staff on duty since 20th August 2010, however prior to that there had been three staff members on duty on 19th, 17th, 16th, 15th, 14th and 13th August (in addition to a sleeping-in assistant manager). At the time of the inspection the occupancy within the home was 32 people out of a possible 35 at maximum capacity, this had been reduced to 31 residents on 13th August, and 30 residents on the 11th August. There were however four staff on duty on the other dates excluding those mentioned above since 9th August. The assistant manager on duty was aware of some concerns raised by the night staff regarding the safety of residents. She advised that in her role she would generally sleep in at the home approximately 10 nights a month, and that staff would only wake her in the event of an emergency, as they are aware that she has worked the evening before, and will be working the next morning. She advised that there was one vacancy night staff position, but that to the best of her knowledge a new staff member would be undertaking this role from the next week. When asked about the reasons for the reduction in staffing numbers, she advised that these varied from not being able to get cover, to a management decision that less staff were needed when occupancy levels were reduced. She did not think that agency staff had been used on any night shifts recently, but thought that one agency worker assisted on a day shift in July. Otherwise the home relied on a bank of as and when staff to cover shifts. The shift plans for the last two weeks tallied with the rotas in terms of staff members on duty. On nights where three staff members were on duty, two staff were allocated to work on the ground floor, and one on the first floor. When four staff were on duty, one staff member was allocated to work on each unit, with two staff supporting each other on each floor. Care Homes for Older People Page 4 of 10 Examination of the accident records for the home indicated that there had been four falls occuring during the night shifts, since 14th August 2010. On two occasions (involving the same resident) staff completing the record accident record had indicated that they had been slow to respond to the resident due to insufficent staffing levels, noting due to one night staff managing two units no attention was given, and on the other occasion I was with another resident on another unit, and unable to hear X calling. Discussion with the four night staff indicated that they felt that four staff members were generally needed on duty in order to safely cover each unit due to the layout of the building. All four staff members had worked as part of a team of three in recent weeks. In addition to expressing their concerns about staffing the home with three staff members at night, staff members also advised of their concerns regarding practices for getting residents up in the morning, insufficient cleaning materials and insufficient access to incontinence pads for residents during the night. Two staff members described concerns regarding current procedures for getting residents up, which appeared to include an expectation that a certain number of residents would be washed, dressed and supported to get out of bed in the morning, even if some of them would have preferred to sleep longer. One person mentioned, that some residents would then appear to go back to sleep in their chairs, as they hadnt really wanted to get up in the first place. A certain number of residents apparently had to be awaken to give them their medication at 7am, as this needed to be administered one hour before breakfast, however staff did not feel this was right, as breakfast was not served at 8am. These concerns could not be explored in more detail at the time as it was night and the issues were raised with the provider following the inspection. Following the inspection verbal feedback was provided to the Area Manager for the home. He advised that he would be meeting with the night staff, and investigating the issues raised during the inspection visit. He later provided feedback indicating that the night staff procedures had been reviewed so that staff would be working as a team from a central point in the home, doing rounds from there, rather than sitting singly in the four lounges as had been the case previously. He advised that it should be the exception that there would only be three night staff on duty e.g. due to sudden notification of illness, with the duty manager being responsible for deciding whether to replace a missing member of staff, assessing the risk and the ability of the service to meet the needs of the residents, and taking into account the frailty and condition of those residents, as well as the number actually in the home. He advised that a meeting was held with the night staff on the evening of 31st August to brief them on the new patterns of working. We asked him to clarify how staff would be able to respond to the residents who call out for help or who wander, if they are not located on the individual units, and he noted that basing staff centrally was a general approach and would be flexible. Also as the resident population changes, the systems to support them would change to meet their care and support requirements, informed by their care plans. He advised that incontinence pads are kept in a locked cupboard to which night staff do not have access, and residents normally have a few spares kept in their rooms. However to avoid these running out, the manager will be putting out 12 pads for the use of night staff each night, and where these have been used, they will be topped up for the next night. The manager will also be consulting residents and their families regarding the tension between being woken in the night to be assisted to the toilet as against sleeping Care Homes for Older People Page 5 of 10 through to be resolved, with the outcome recorded in the relevant care plans. He advised that the management had not been aware of a problem regarding cleaning materials, and there were regular orders in place for these, with night staff having access to the domestic cupboard. However a box of cleaning materials will now be made available for night staff, and this will be checked at handover to make sure that sufficient are available. In addition, staff will be asked not to bring in cleaning materials from home due to the requirements of the Control Of Substances Hazardous to Health. He advised that it is not acceptable for night staff to get up residents in the morning, for the convenience of day staff, and that residents must be able to get up when they like, or indeed stay in bed should they so wish. He suggested that it was a possibility that, due to changes made to ensure that staffing is efficient, day staff may have been putting pressure on their colleagues in this area, and this is supported by some anecdotal evidence. He advised that he would be issuing formal guidance to all residential care units on this matter in the near future. He is also proposing to abolish the morning drinks round undertaken by night staff, and replacing it with an arrangement where residents who request a cup of tea will be supplied with one, but others can opt out. What the care home does well: 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 set out on page 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 12 The registered person must 30/09/2009 ensure that where a resident requires their health needs to be monitored that there is enough detail in their care plans so staff are aware of what signs to look out for. This should ensure that all staff respond to any potential health issues in a timely manner. 2 26 16 The registered person must ensure that systems for dealing with incontinent laundry are reviewed. This should ensure that any potential offensive odours at the home are reduced. 30/09/2009 Care Homes for Older People Page 7 of 10 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, 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 27 18 The registered persons must 10/09/2010 ensure that staffing numbers within the home are sufficient to ensure that peoples needs and choices are met effectively and safely at all times, during the day and night. . 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 8 It is recommended that the situation regarding incontinence pads is investigated to ensure that sufficient pads are provided at night to meet the needs of people who are incontinent, and ensure that their dignity is maintained appropriately, with minimal disturbance to their sleep. It is recommended that practices for getting people out of bed are reviewed to ensure that peoples choices of times for getting out of bed are respected as far as possible, enabling them to have control over their daily lives. It is recommended that that the supply of cleaning materials to the home be reviewed to ensure that sufficient Page 8 of 10 2 12 3 26 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 are provided at night to ensure that all areas of the home are maintained hygienically. 4 32 It is recommended that the management approach of the home is further adapted to create an open, positive and inclusive atmosphere where staff feel that their concerns are taken into account, in the interests of people living at the home. Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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