Care Home: Redcliffe House Residential Care Home

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Redcliffe House Residential Care Home Redcliffe Road Mansfield Nottinghamshire NG18 2JP two star good service The quality rating for this care home is: 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: David Litchfield Date: 3 0 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. They reflect the things that people have said are important to them: 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 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Redcliffe House Residential Care Home Redcliffe Road Mansfield Nottinghamshire NG18 2JP 01623635599 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): redcliffehouse@btconnect.com Redcliffe House Limited Name of registered manager (if applicable) Mrs Yana Susan Whitehouse Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 8 0 care home 8 learning disability Additional conditions: Redcliffe House Residential Care Home is registered to provide accommodation and personal care to a maximum of 8 men and women whose primary care needs fall within the following category: Learning Disability (LD) Date of last inspection A bit about the care home Redcliffe House Residential Care Home is situated in Mansfield and is close to local amenities. It is a residential building offering accommodation and personal care to eight people who have a learning disability. The building is not wheelchair accessible, which the provider has discussed with the Disability Rights Commission. At the time of this inspection the weekly fees are between £1261 and £1710 and are set according to peoples support needs. Our previous inspection took place in 2006. 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home We visited the home in October 2008 and we met the manager, staff and people who use the service. We asked people who use the service what their experience is like. We asked the manager and staff about what they do for people. We asked them how they learnt to give this support. We looked at peoples records. We wanted to know if people agree with the information about them. We wanted to see if people are happy with their service. We also looked at staff files to see if it is safe for them to work with people. We looked at other paperwork the service keeps. What the care home does well The manager gets lots of information about people before they move in. They make sure they can provide people with a good service first. They involve people in writing plans about their own care. The plans show what each person thinks is important. People can do lots of different activities. What has got better from the last inspection What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact David Litchfield 33 Greycoat Street London SW1P 2QF 02079792000 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 . People have their needs and expectations assessed when they are choosing and their wishes when they choose the service. Evidence: The service is required to produce two different documents, a statement of purpose which has lots of details about the service and a service user guide that has information aimed at the people who are thinking of moving in. The service has combined this information into one pack and we saw it has lots of useful information about the aims and services provided. There is no date when the information was written or updated. We asked the manager about this and were told it hasnt been updated since the service opened in June 2006. We noticed that some of the information was not correct any more as they now have more staff on duty than they used to. The manager said she would update the information. We also asked the manager if the style was right for the people who use the service and we were told it was hard for them to understand. The manager said they read it to people when they are interested in a service. We saw that there is other information available to people in the entrance hall, including a copy of our last inspection report and information about how to make a complaint that was easy for people to read with pictures to help them understand. We saw that the service found out all about people before they provide a service. They try to keep the person and others important to them fully involved. We saw records showing they ask for very detailed information about the persons needs and expectations. Information is recorded about peoples health, personal care needs, Evidence: communication and lots of other information staff need to know to support people. They hold meetings with the person and others important to them, so they can plan what they will do when the person moves in, including the activities they would like to be involved in. One person who uses the service told us that they asked me if I wanted to move and said that although he found it difficult at first, now I like it and I think Redcliffe house is the right place for me because I met new people. Others told us that they were happy there saying its a nice place, and I think its alright. In unusual circumstances the manager says they have accepted people in an emergency. However, we saw that they still gather as much information as possible to make sure they are able to support them correctly. We also saw records that they gathered any missing information very soon after the person had moved in. We looked at how the service can meet the specialist needs people have. All the staff have received training around autism. The manager is qualified to give training in this area, and she is working toward full recognition of the service by the National Autistic Society. Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Peoples plans of care focus on the peoples individuality and their right to make choices. However, some do not have enough detail, especially about how people are supported with behaviours that are challenging for staff. Evidence: We looked closely at some individual plans people have about the care they receive. We could see they are based on peoples recorded needs and expectations. The plans are written in the first person, with a section entitled All about me where it tells staff about things important to the person, and the way they want staff to care for them. It covers things like the way people communicate, the personal care they need and their bedtimes routines. There is also plenty of information about the activities they want to be part of and the people important to them in their lives. We saw that that each person had a member of staff assigned to them, who took responsibility for keeping their information up-to-date, and we saw that each page had a recent date. One member of staff told us how they involve the person in these checks, and that they make sure they only write down what the person feels, not what I think. Old plans are stored away, but it is not easy to see when changes have been made, and what these were. We asked the manager about this, who said she would start to keep a record of changes made. The manager then carries out six monthly audits of these plans to make sure they are complete and appropriate. We saw records of these checks. We also saw records of meetings held with social workers and people important to the person like family members to check that the service was still meeting their needs. However, while most Evidence: of the plans we saw were very detailed and very individualised, one plan did not have enough information to be able to care for the person. It said that the person needed support with personal care but it was not clear exactly what help staff were to provide. We asked the manager about this and she agreed more information was needed in this particular plan. We heard that this person did not have a special member of staff assigned to them, as they had difficulties with forming appropriate relationships with staff. However, the manager did say that she would ensure the plan was completed. We saw that people were encouraged to make choices in their lives, and we saw this in the plans and in the way staff were working with people. We observed people choosing their breakfast, with staff actively encouraging people to take as much control as possible. We also asked one service user who bought her clothes and she told us I buy them. We saw that the service is working toward the use of a new law called the Mental Capacity Act that supports people who may experience difficulties around choices in their lives. We saw that staff had received training, and that there was paperwork in peoples records relating to this. We saw that peoples files record detailed information about any risks in their lives, and shows staff how to support them with these risks. Some of these covered areas where people present behaviours that are difficult for staff and gave guidance about what to do. Staff told us that the plans tell them how people react to things and what we can do. There are records kept when there have been difficult situations, and the manager told us that these are used when peoples care is reviewed. We heard from the manager that there are times when staff need to restrict people movement by using physical restraint. We saw staff have received some training around challenging behaviours, but there are no individual procedures about exactly how staff should respond when people present these behaviours and might harm themselves or others. There is no documentation that justifies when restraint is the right course of action or any clear definition of what constitutes restraint, and what is or isnt acceptable for staff to do with each person. There are records of when staff have carried out restraint, which refer to minimal restraint used but they do not clearly show exactly is meant by that or information to suggest it was the last option available. We saw the service does have a general policy mentioning restraint, but the policy also requires a plan to be formed for each individual that needs support in this area. The manager confirmed that restraint is not planned on an individual basis but that a number of people do receive this kind of support. She said they would develop peoples plans to ensure staff have the knowledge and skills to support each person appropriately and safely. Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 . People who use services are able to make choices about their lifestyle, and supported to develop their life skills. Evidence: We saw that people have lots of activities that they can take part in. These include life skills like shopping and cooking, and leisure activities like games and relaxation. On the day of the visit a person told us they were about to go to Sherwood forest and we also saw people making pumpkins for Halloween. We also heard that they do gardening and sometimes play bingo. The service has good facilities for the activities including a kitchen designed to be easier for people to use, and we heard from people that they use this to make cakes and flapjacks. We saw records that showed peoples activities are planned before they move into the service. We also saw that the manager and staff regularly check that these activities are still appropriate and are still meeting the needs and expectations of the people who use the service. We also saw notes from staff meetings reminding staff to stick to the activities planned and there was a notice board helping people who use the service know what is happening. Some people also attend educational services, and one person told us about becoming more independent with them says he was having meetings with the manager and college about coming on my own to college and about whether its good at college. Evidence: People have the opportunity to go on holiday with the service. We saw photos from holidays and were told by a staff member that there had been three different holidays so people could go away with people they liked best. A person who uses the service told us he had been to Wales, stayed in an apartment and went to Snowdon on a train. We saw that there is information in peoples files about family members and about how they maintain relationships. We saw that people visit their families, and one person told us hed been on holiday with them. The service also support people to develop relationships with others using the service; one person told us that they had got lots of friends here. We saw a three-week menu used by the service showing a wide variety of nutritious food, and a member of staff told us that it had been written together with the people who use the service. We asked people who use the service about the food and were told foods nice and that on Thursday we have take away. We also asked them what happens if they want something different and were told if I dont like it have something else. The manager and staff told us that people are free to eat where they choose with different locations like the kitchen or dining room available to people who prefer their own space. Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 . People receive health and personal care based on their needs and are treated with respect and dignity. Evidence: We saw that people plans reflected the support they need with personal and health care, and also those areas where they are independent. The plans also showed the way people wanted to be supported. We saw that people being supported around the home in a respectful matter. A staff member said Im here for them. People using the service told us staffs alright to me and help me get up and run my bath. We saw a thank you card from a family member saying Thank you for looking after my son so well We saw that peoples health needs are supported, with appointments to doctors, dentists and other professionals recorded. Peoples health is monitored and there are record kept of peoples weight and the food they eat to help staff know if people are healthy and well. We saw that people are supported around medication, which is all administered by the service at present. A staff member told us that they are preparing to support a person to look after his own medication, and we saw that he has a safe place to keep this in his room once he is ready. We observed medication being given out, and there are checks in place to make sure things are done well with two staff present at all times and both signing record sheets. However, there were no records of how much medication was kept in stock at any time so the manager was unable to confirm that all peoples medication could be accounted for. We saw that unused medication is returned from time to time, and this is Evidence: recorded. We were told that medication that is not taken every day is counted and checked on but these records were not available on our visit. There is no additional information provided to staff about this type of medication to help them know exactly what it is for and when people need it. Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 . People who use the service are able to express their concerns, and are safely protected. Evidence: The manager showed us that they have a system to responding to any complaints. There have not been any complaints made to the service or to us since the last inspection but we saw that people are provided with information about how to do this. There is information with pictures in the entrance hall to tell people about how to do this. A person who uses the service told us that if they were unhappy they would speak to a member of staff. The staff told us that the manager has an open-door policy. We looked at how the service keeps people safe from abuse. We saw that all staff had received training around how to recognise signs of abuse and what to do and we asked them about this. We heard about how they learn how to protect them and not infringe on their rights. They told us they would report any concerns. There have been no reported incidents since the service started but we saw they had all the information needed to be about to do this. 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 . People live in a homely and safe environment. Evidence: There is lots of space for people to use including is a large living room, a kitchen, and a dining room. There is a special room next to the lounge for people to go to if they want to listen to music and relax. We saw there are plenty of bathrooms and a second kitchen that is easier for people to use. The building is clean and tidy. A person who uses the service told us that the lounge is always clean. Each person has a good sized bedroom. We saw some of these, and each is personalised to their own taste with different pictures and personal items. We saw each also had different furniture, depending on what they wanted. We saw that the home is homely and well-maintained, and that there is a maintenance person who makes checks around the building to ensure it is safe. We saw some records showing these checks are made. 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 . People receive support from well-trained and supported staff. Evidence: We looked closely at records about how staff are appointed. We saw that people have all the checks necessary to ensure they are recruited safely before they begin. We spoke to staff who confirmed that is the case. Staff then receive comprehensive training when they first start. We saw that they record the things they learn about their work such as their role, health and safety, and how to communicate with people. Staff told us that the induction covered everything. We also saw a staff handbook that they are given to help them understand more about their responsibilities. We saw staff continue to receive lots more training. We saw they are trained in autism, which is the specialist area of the service. They are also trained in health and safety, first aid and other areas including managing challenging behaviours and record keeping. Staff told us that the manager encourages a lot of training and that there is always someone on training. We saw that some of this training is for nationally recognised qualifications from a local college and we saw the college had thanked the manager for the support shes given the staff. We were told that staffing levels is based on the needs of people using the service, and we saw that there was enough staff to support people appropriately. Staff told us they feel well supported and that they can discuss any worries or concerns and one told us about meetings with the manager to talk about what I need to do. We saw they have frequent staff meetings around twice a month and we saw Evidence: these meetings covered lots of things about how to best support people using the service and staffing matters. Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 . People received a well-managed service. Evidence: We saw that the manager maintains her qualifications and skills to help her continue to improve the service. We saw that she is still working toward accreditation by the National Autistic Society for the work the service does with people with Autistic Spectrum Disorder. There are detailed and updated policies for the service, and the manager showed us that policies are regularly discussed at a senior level within the organisation. The manager showed us she plans to develop one of the policies in regard to peoples sexuality, which she feels is not adequate to meet the requirements of the National Autistic Society. We saw that the service has regular internal inspections, where a senior person in the organisation checks different aspects of the home, like the records and plans. We saw that these are recorded, but there is no clear record of what actions were taken and when to show that changes are made following the visits. Staff told us that there is an open door policy with the manager and that they are lucky to have a fantastic manager who is open and approachable. People who use the service told us they can talk to Yana and that they sometimes have meetings with her. We saw records that the manager and staff do seek the views of people using the service and respond to these. However, they do not have a formal system for Evidence: gathering this information from from staff, people who use the service and others important to them to help make improvements to the service as a whole. We saw the home keeps records around keeping things safe such as an accident book and a record of weekly fire tests. Since a recommendation at the last inspection, the service now records monthly fire drills. Are there any outstanding requirements from the last inspection? Yes  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, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 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 Description 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 Description Timescale for action 1 1 6 The registered person must keep the statement of purpose and service user guide under review. 30/12/2008 This will make sure that people are given accurate information to make a choice about the service 2 6 13 No person should experience 30/12/2008 physical restraint unless it is the only way to secure that persons welfare under exceptional circumstances. This will ensure staff use restraint appropriately and that peoples human rights are protected. 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 1 The service user guide should be available in formats suitable for the people who use it. This would help people make better choices about the service. A record should be kept of when changes are made to planned care. This would mean the manager is able to ensure that all changes are appropriate and meet peoples needs and expectations. Every persons plan of care should fully describe all the support people need from staff. Checks should be made on the amount of any medication held by the service to ensure that peoples medication is being administered correctly. There should be information about medication that is only taken occasionally to help staff know what it is for and when it is needed. This will ensure that peoples health needs are fully met. There should be systems to record positive and negative feedback from people who use or are connected with the service. This would ensure that people receive a service that is continually developing and improving. When internal systems highlight that an action needs to be taken, there should be record that this was done. This would ensure people receive a well-managed and responsive service. 2 6 3 4 6 20 5 20 6 39 7 39 Helpline: 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 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 © (2008) Commission for Social Care Inspection (CSCI). 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