Care Home: Redlands Acre

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What the care home does well Redlands Acre provides a relaxed and homely environment for residents. It is also welcoming to its visitors. Prospective residents are admitted to the home on the basis of a preadmission assessment, and before making their decision about the home are welcome to visit and view it whenever they like. Relationships between staff and residents were viewed as positive, relaxed and friendly. Residents, without exception, said they were happy with their care and the kind way in which they were looked after by the staff. There were some good social opportunities here for residents, with a variety of activities to suit different tastes. People were free to pursue personal choice, and levels of independence and autonomy were respected. Despite a very small concern about the presentation of the lunch on the day of this inspection residents all spoke favourably of the food they had, and said that there was always a choice of menu. New staff had been recruited in accordance with the required pre-employment safety checks. Staff have received training in safeguarding the interests and welfare of vulnerable people, and were knowledgeable about the issues and the home`s polices and procedures. There had been a good emphasis on staff training further to the identification of some knowledge gaps and competencies. In addition to in-house support, external training had been sourced in terms of increasing learning and development opportunities for staff. Good progress was being made with the National Vocational Qualification (NVQ) programme for care workers. What has improved since the last inspection? The key inspection for this home was carried out with a greater degree of priority due to the concerns that had arisen regarding the management of residents` medications. A pharmacist inspection was carried out as soon as the concerns were identified earlier this year, and several requirements and recommendations were made for improvement at that time. Since then much tighter controls have been introduced for the medication administration procedures here, and steps have been taken to ensure staff development, particularly in terms of competency and understanding. Improvements have also been made to aspects of record keeping in this area, although there still remained one area that needed further attention. The home has had a new manager this year, and further to one particular concern about how the home used to manage concerns and complaints, the home is now much more open and receptive to helping with such issues. Improvements to the arrangements for managing the home`s safe key have lead to tighter security in this area following an incident of concern last year. Some areas of the garden have been upgraded, and new blinds have been fitted to the conservatory windows. A bedroom has been refurbished with an en-suite shower installed. The new manager has made a very positive impact in this home, which has evidently been welcomed by the staff. Stronger professional relationships have evolved as a consequence. There has been a greater emphasis on quality monitoring, and this process has incorporated the views and experiences of residents and their visitors. The home`s fire risk assessment has been reviewed, and staff have received updated training, although it has been recommended that the home ensures that it records the actual content of such training. CARE HOMES FOR OLDER PEOPLE Redlands Acre 35 Tewkesbury Road Longford Gloucester Glos GL2 9BD Lead Inspector Mrs Ruth Wilcox Key Unannounced Inspection 21st July 2008 08:30 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 Redlands Acre DS0000016555.V364854.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. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Redlands Acre Address 35 Tewkesbury Road Longford Gloucester Glos GL2 9BD 01452 507248 01452 507248 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) CTCH Ltd Manager post vacant Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th February 2007 Brief Description of the Service: Redlands Acre is a care home providing personal care to 26 older people. Nursing care can be accessed from community resources if needed. The home is situated on a main route into Gloucester city, and is owned and managed by CTCH Ltd. The home has been converted from a large property, with the addition of some purpose built bedrooms on the ground floor. Access to the first floor is gained by the use of a staircase only; there is no stair or shaft lift in the home. However, the vast majority of bedrooms are situated in accessible locations on the ground floor. The home provides 26 rooms, 23 have en-suite facilities, which include a toilet and washbasin. The home provides an assisted bathing facility, and has a specifically designed shower room. The communal areas are situated on the ground floor and consist of two dining rooms, one large lounge and a lounge/conservatory. The home also has another lounge, which is used as a smoking room. The conservatory connects the main house to the rear of the property where there are eight attached bungalows, which provide unregistered sheltered accommodation. Residents from this accommodation are welcomed into the life of the home on a daily basis, in terms of a meal and social activity. Information about the home is available in the Service User Guide, which is issued to prospective residents, and a copy of the most recent CSCI report is available in the home for anyone to read. The charges for Redlands Acre range from £465.00 at the basic rate of funding from the local authority, up to £518.00 per week. Hairdressing, chiropody, toiletries and newspapers are charged at individual extra costs. Redlands Acre DS0000016555.V364854.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 star. This means the people who use this service experience good quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector carried out this inspection over one day in July 2008. A check was made against the requirements that were issued following the last inspection, in order to establish whether the home had ensured compliance in the relevant areas. Care records were inspected, with the care of three residents being closely looked at in particular. The issues of concern raised by a recent pharmacist inspection regarding the management of residents’ medications were reviewed. Survey forms were issued to a number of residents, visitors and staff to complete and return to CSCI if they wished. Two survey responses were received from residents and two were received from relatives and visitors, and comments from these feature in this report. Some residents and one visitor were spoken to directly in order to hear their views and experiences of the services and care provided at Redlands Acre, and some of the staff were also interviewed during the course of this inspection. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for safeguarding the rights of vulnerable residents were inspected. The arrangements for the recruitment, provision, training and supervision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. We required an Annual Quality Assurance Assessment (AQAA) from the home, which was provided, the contents of which informed part of this inspection. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The key inspection for this home was carried out with a greater degree of priority due to the concerns that had arisen regarding the management of residents’ medications. A pharmacist inspection was carried out as soon as the concerns were identified earlier this year, and several requirements and recommendations were made for improvement at that time. Since then much tighter controls have been introduced for the medication administration procedures here, and steps have been taken to ensure staff development, particularly in terms of competency and understanding. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 7 Improvements have also been made to aspects of record keeping in this area, although there still remained one area that needed further attention. The home has had a new manager this year, and further to one particular concern about how the home used to manage concerns and complaints, the home is now much more open and receptive to helping with such issues. Improvements to the arrangements for managing the home’s safe key have lead to tighter security in this area following an incident of concern last year. Some areas of the garden have been upgraded, and new blinds have been fitted to the conservatory windows. A bedroom has been refurbished with an en-suite shower installed. The new manager has made a very positive impact in this home, which has evidently been welcomed by the staff. Stronger professional relationships have evolved as a consequence. There has been a greater emphasis on quality monitoring, and this process has incorporated the views and experiences of residents and their visitors. The home’s fire risk assessment has been reviewed, and staff have received updated training, although it has been recommended that the home ensures that it records the actual content of such training. What they could do better: Although there was a range of assessments and care plans for each resident that provided direction to staff for delivering personalised care, there were some recording shortfalls and omissions that could pose a risk in this regard. There was no evidence that these recording shortfalls were negatively impacting on residents’ health and wellbeing at this time however. The home had not yet complied with the requirement to fit a compliant drug cupboard for storing particular types of medications, but this was being addressed with a cupboard already on order. The kitchen showed very obvious signs of long usage and fatigue, and would benefit from some upgrading. There should also be some level of restriction on who is free to enter this area, in the interests of health and safety. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 8 There were isolated concerns about the cleanliness of some of the en-suite bathrooms, and there was also a more serious concern about an infection control risk posed to someone’s catheter bag that required attention. There had been an increase in the number of housekeeping hours deployed in the home, but care staff continued to be involved in catering at breakfast and suppertime, when there are just three people on duty for the twenty-six residents. The manager appeared confident that this was meeting the needs of the home at this time, and said that he would continue to monitor this for its suitability. The home is now required to ensure that risk assessments are carried out and recorded for those residents who live on the first floor, and have to use the stairs. 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. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 9 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 Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 10 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): 3 & 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A satisfactory assessment process prior to admission to the home gives prospective residents an assurance that their needs can be met. EVIDENCE: We inspected two examples of pre-admission assessments, both of which were for residents more recently admitted to the home. Each had been conducted prior to admission to the home having been agreed. One had been recorded on the home’s designated tool for the purpose, and one had been recorded on the home’s post-admission assessment form, which was based on the activities of daily living. Copies of the assessment and care plan that had been carried out by the placing authority had been obtained in each case. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 11 We spoke to one resident’s relative who confirmed that his relative had been fully assessed prior to her admission, and that they had been free to come and view the home, ask any questions, and had been issued with a copy of the home’s service user guide. The manager was witnessed assisting an interested party by telephone, and was heard to be welcoming, helpful and informative. The prospective resident and their family were invited to come in to look around the home, and spend time with staff and residents if they wished, to see if they liked it. The AQAA stated that all residents received the same level of care, regardless of their funding source. Redlands Acre does not provide intermediate care. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 12 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): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Despite the need for greater consistency in recorded care planning, the care and ongoing improvements to medication practices mean that people living in this home have their health and personal care needs met. EVIDENCE: Each resident had their own personal plan of care that had been drafted on the basis of a detailed assessment of their needs, and had been done in consultation with them or their representative. Three were selected as part of the case tracking exercise to be inspected in closer detail. These records contained some good direction for staff to deliver care to the residents. However, there were some parts where documentation was not wholly meaningful, where it was not entirely reflective of the person’s circumstances, and where there were omissions in recorded planning. Examples of this included an assessed short-term memory loss and an assessed risk of falling not featuring in the plans of care. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 13 Due attention had not been given to the correct completion of a pressure sore risk assessment in another case, resulting in the person being placed in a lower risk category than they actually should have been. Despite the potential risks that these isolated shortfalls in recording were posing there had been no direct negative impact on the residents concerned, with each being well cared for in practice, and each very happy with the care and attention they were receiving. One person more recently admitted to the home had not been weighed, meaning that there was no baseline weight recording to contribute to the nutritional risk assessment. There were some examples of care planning and documentation that were good, but the inconsistencies indicated that staff had been less than conscientious when completing certain elements of assessment and care plans. Residents clearly had easy access to all health care services whenever required. Residents who responded to surveys confirmed they were satisfied with their care, and those spoken to directly during this visit wholeheartedly said the same. Without exception, all of those spoken to said that the staff were caring and helpful, and that staff were respectful towards them at all times. One resident said that ‘her health had improved a lot since coming here’. Several said that they were ‘looked after very well’. Staff practices associated with managing residents’ medications gave us cause for concern earlier this year. Some drugs went missing and ultimately remained unaccounted for. A joint investigation with police and a subsequent in-depth inspection by the CSCI pharmacist were carried out at that time. These poor practices had evolved prior to the current manager being in post, and there was no definitive outcome to the investigation. Since then the new manager has introduced tighter controls, particularly for the administration procedures, with staff responsible for managing medications undergoing further instruction and competency checks. Additional accredited training is planned for them also. Records in relation to the use of medicines prescribed ‘to be administered when needed’ were more detailed, demonstrating how the wishes of the resident had been taken into account. The receipt of medication stock for those residents choosing to self-medicate was recorded on a medication administration chart, but this still needed an Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 14 additional entry which clearly indicated when and how much stock was handed over to the resident concerned. The medication policies and procedures were under review further to advice and recommendations by the pharmacist. We previously required that the home provide storage for controlled drugs that complied with the Misuse of Drugs (Safe Custody) Regulations 1973 by 31/07/08. Although steps had been taken to comply with this they had not done so in full at the time of this visit. A revised compliance date was agreed in this regard, as we subsequently received confirmation that a compliant cupboard had been ordered. One person’s care plan directed staff to apply creams to their back. The prescription for this had not been printed on the latest medication administration chart, and neither had staff noticed this or transcribed it by hand for the interim. This was rectified immediately. We observed staff to be pleasant, polite and respectful to the residents, delivering care and attention appropriately. Care was delivered in the privacy of residents’ own rooms. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 15 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): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home have the opportunity to remain socially active and exercise choice. Despite some concern about the presentation of the meal and the kitchen during this visit, people living here generally have a nutritious diet that offers choice and variety. EVIDENCE: Redlands Acre does not have a designated coordinator for social activities, with allocated staff taking responsibility in this area as needed. Staff said that social opportunities for residents had increased more recently, and residents themselves spoke positively about the level and type of provision. Records of activity included a record of the participants. Staff confirmed that although some residents chose not to participate, they make a point of trying to include everyone in the option. There was a variety of social opportunities available, which would suit differing tastes and interests. Special occasions had been celebrated, and there were regular social gatherings for residents and their families. Some of the residents Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 16 had been involved in art and craftwork, and had produced some wonderful ceramic ware. A lively and interactive music and exercise session took place during the afternoon of this visit. Some residents were seen talking short walks outside. A religious service was held in the home each month, and a minority with diverse religious needs were being accommodated. The home imposed no restrictions on visitors, and a visitor who responded to our survey wrote that ‘the home had a friendly atmosphere’. A visitor spoken to directly confirmed that they always felt welcome and could visit any time they wanted. We saw that residents had been supported to personalise their own rooms, and many rooms were very individual, containing personal effects. There was a relaxed, homely and informal atmosphere in the home, and residents were moving around freely, spending time as they wished. Residents themselves said that their ‘choices were respected by the staff’, and that they ‘felt able to make choices in their daily life’. Some told us they were appreciative of the respect shown towards their independence. Residents were also offered a choice with their meals. A variety of breakfasts were served, and there were at least two main choices offered for lunch. There were readily available snacks around the home at all times. Meals were served in pleasant surroundings, and residents all spoke very favourably about the quality and quantity of the food. One person told us ‘the food is very good and suits me very well’. Another said ‘the food is excellent with good choices’. The meal at lunchtime did not appear particularly appetising, with an odd selection of food items put together. Very large, uncut boiled potatoes and mashed swede was served alongside omelette or fish fingers. The home’s AQAA said that the cook used fresh ingredients in cooking, but the omelettes, which several residents had chosen to have, were not freshly made, but were pre-packed ones from the deep-freeze. However, despite this, residents all said they enjoyed their food, and staff said that the quality of the meal was normally much better than on this particular day. We visited the kitchen during the breakfast preparations, and found it cluttered and untidy. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 17 Although functional, the room and its contents show signs of long usage and wear and tear. Fly screens were fitted to open windows, but flies had infiltrated the food preparation area. We were told that food storage containers were regularly cleaned, but these were old and worn, and had unreliable homemade date expiry labels attached to them. Oven trays were old and badly marked. One of the refrigerators had not been cleaned over the weekend, leaving it slightly dirty on the interior. There were no restrictions imposed on care staff, and they were permitted to walk in and out of the kitchen. The cook maintained a record of temperature checks and a cleaning schedule for the kitchen. She also had information regarding residents’ dietary needs, including those requiring a special diet. One particular relative commented that their relative was being ‘well supported with their special dietary requirements’. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 18 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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home have confidence in the staff to help resolve their concerns, and can be reassured regarding the policies to protect their rights and prevent abuse. EVIDENCE: A copy of the home’s complaints procedure was displayed, and had been issued to residents in their information brochure. A record of complaints was maintained. This contained evidence of concerns raised earlier this year by one family, which the manager, who was new to the home at the time, had helped to provide a satisfactory and reassuring resolution. The complainant had contacted CSCI at the time, saying that prior to the new manager arriving it had been difficult to achieve this to their satisfaction, but that the new manager was more open and approachable in this regard. The manager demonstrated a positive and open attitude towards any concerns, and was evidently very available and approachable to all in the home. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 19 The home had policies and procedures for safeguarding the vulnerable residents, which included whistleblowing procedures and other local agency contacts should the need arise. Staff confirmed they had received training in safeguarding vulnerable adults. Each of those spoken to directly was able to discuss the recognition and types of abuse, and was able to discuss the safeguarding protocols to follow should the need arise. The manager and deputy were also due to attend the Enhanced level of the Alerter’s training course for safeguarding vulnerable adults. The home had obtained information about the Mental Capacity Act, and the manager and deputy had received training in it. Other staff were scheduled to attend this training in the near future. Tighter controls had been implemented around the security of the home’s safe and its key, where some residents place items for safekeeping. A theft from it occurred last year after staff had adopted some careless practice around safeguarding the key. Appropriate actions were taken in response to the incident at the time. Residents were ultimately reimbursed, and can be reassured that security is now better. Some of the residents spoke to us about having ‘confidence’ and ‘trust’ in the staff and the home. One said that she ‘felt safe’ here. A relative told us that the manager was ‘very approachable’, and that they had ‘trust and confidence in the home to address any concerns’. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 20 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): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People in this home are provided with a reasonably maintained and clean environment to live in, although isolated lapses in hygiene standards could pose a risk to the health and welfare of certain residents. EVIDENCE: The home had a relaxed and welcoming atmosphere. The environment was reasonably maintained in most areas, and was generally safe, although certain safety aspects in relation to the staircase are reported under standard 38. Improvements had been made to the garden path and patio in order to improve resident safety, and a raised flowerbed had been constructed for them. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 21 New blinds had been fitted to the conservatory windows, and one of the bedrooms had been refurbished with an en-suite shower installed. The home provided a designated room for smokers, but this was enclosed and was not impacting on residents in other areas of the home. In the ground floor assisted bathroom three out of the six ceiling lights were not working; the manager resolved to address this straight away. Another ground floor bathroom was being used for storage and as such was not fit for its purpose, with residents unable to access the facilities in there. It was reported that this bathroom had not been used for a long time, and as such was not impacting on the lives of residents at this time. As reported under standard 15 the kitchen had a generally fatigued appearance, and would benefit from refurbishment. On a previous visit to the home we have had concerns about the ambient temperature of the conservatory, it being very cool in winter months. It was not possible to assess this on this occasion, as the visit was conducted on a very warm day. However this is an issue that the home will have to remain mindful of for the forthcoming winter months if residents are to use this space in comfort. We found the environment to be generally clean, fresh and odour free. However, at least two of the en-suite bathrooms were unclean, with each containing dirty flannels and towels. One of the rooms contained a catheter bag, which had been left without the tube cap in situ on the floor. This had posed a significant infection control risk, with the bag having to be discarded when pointed out to staff. Residents’ laundry was being appropriately laundered. The laundry room however, was not entirely clean, with splash staining evident around the walls, and damage to the plastered walls evident in a number of places. Staff were provided with gloves and aprons, liquid soaps and paper towels. The home had liaised with the local council regarding disposal of incontinence waste, and was continuing to double bag it and put it out for household collection, having not been advised to the contrary by the council. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 22 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): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Despite slight concern about the minimum level of staff deployed here, people living in this home receive care from a competent work force, who undergo full pre-employment checks, and who are supported to train and develop professionally. EVIDENCE: Staffing provision had been under review, with additional housekeeping hours deployed as a result. This meant that care staff were now less involved in noncare duties than on previous occasions. However, they continued to be involved in catering duties at breakfast and suppertime, and were still responsible for the laundry. Three carers were on duty during all day time hours, with the manager working supernumerary on five days and the deputy manager on three days. One carer plus a sleep-in carer provided cover overnight. We considered these numbers to be absolutely minimal for the twenty-six residents, particularly in view of the catering and laundry duties that inevitably detracted from the care hours available for the residents. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 23 The manager was confident that this currently met the needs of the home and its residents, and said that he regularly monitored the ongoing suitability of the staffing levels. Residents themselves all spoke very positively about the staff group, saying that they were kind and helpful. We found staff were evident around the residents throughout this visit, with no-one particularly kept waiting for anything. Residents appeared comfortable around them, with positive and friendly interactions witnessed. Some of the staff told us that as a result of the improvements in the home under the new manager, much stronger relationships had developed between them and the residents. The home was making good progress with the National Vocational Qualification (NVQ) training programme for care staff. Seven carers were qualified to level 2, two of whom had achieved the higher award at level 3. Two staff were currently on a level 2 NVQ course, whilst a third was on a level 3 course. We inspected two staff files of recently recruited carers. In each instance, the prospective employee had completed an application form providing details of their employment history, with evidence that any gaps in it had been explained. Interview notes were recorded. Two written references had been provided in each case, with at least one of each of these having been obtained from the previous employer. Proof of identity and medical statements had been obtained, but copies of photographs of the workers had yet to be put onto file. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person. Training records confirmed that these new workers had undergone a structured induction-training programme in accordance with the Common Induction Standards for care workers. One of them was interviewed, and she confirmed that she had worked under direct supervision in the beginning, and had felt very well supported as she underwent induction training. Training records showed that there were a variety of training opportunities available for the staff to ensure their continued professional development. These included mandatory areas such as health and safety related subjects, and supplementary training in topics relevant to their role as a care worker and the needs of the residents. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 24 Updated instruction had been delivered in medication management, and further training in this area was planned. The manager had provided some inhouse instruction to staff in order to improve the standard of care planning. The diabetic specialist nurse had provided some training to staff in the care of residents with diabetes. The home had been working in conjunction with The Partnership for Older People Project (POPPs), with a view to sourcing appropriate learning and development for staff, and training had been delivered in nutrition, management of falls and dementia care. Staff were enthusiastic about the training they had undertaken, and knew where future learning opportunities lay for them. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 25 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): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management systems in place here generally ensure that the interests, and health and safety of the residents living in the home are safeguarded. EVIDENCE: The manager is an experienced care home manager. He has achieved the NVQ level 4 in Adult Health and Social Care, and has the Registered Manager Award. He also has a postgraduate certificate in Management Studies in Health and Social Services. An application to register him with CSCI is currently being processed and is near to completion. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 26 Since coming to Redlands Acre he has successfully identified priorities for his attention and improvement, and has clearly adopted a very open, inclusive and approachable management style. His quality monitoring had largely focussed on care records, medications and staff issues to date. Survey questionnaires had been sent out to residents, their families, and visiting healthcare professionals to complete, as part of a quality monitoring approach. Responses had been minimal, but those received had been analysed in preparation for an action plan to be drafted. Residents’ meetings and a Relatives’ Forum had been set up. Records of meeting minutes demonstrated that people’s comments, ideas and views regarding the home were sought and welcomed. Information sharing at staff handover times between shifts had been expanded to include a greater level of comprehensive information for them, and staff themselves told us that this had been hugely beneficial. A number of residents had chosen to place personal money with the home for safekeeping. We carried out random checks on two such arrangements, and each proved to be accurate. Clear and transparent records were being maintained in these cases. A regular programme of staff supervision had been implemented. Issues in relation to previous performance and training needs were being discussed. The manager said that he was trying to motivate staff through this means, and was gaining more cooperation from them. Staff themselves clearly welcomed these regular sessions with the manager, finding them helpful and supportive. They said that they all appreciated the manner in which supervision was given to them, feeling confident and trusting in the manager’s approach towards them and the confidentiality of the session. The home had compiled an Emergency Procedure folder, which was readily available for use and reference in such eventualities. The fire safety risk assessment had been reviewed to incorporate evacuation procedures in the event of a fire, and staff had received some in-house instruction in these procedures. Fire Safety training had been delivered earlier this year, to encompass all staff, and although the actual content of this was not recorded, it was reported to have encompassed the safety procedures; there was also a record of fire drills. Regular checks had been carried out on the fire alarms, smoke detectors, fire extinguishers and emergency lighting. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 27 Safety checks had been carried out on the gas boilers, the hot water temperatures, the portable electrical appliances, and the wheelchairs and variable height assisted bath to ensure safety. Evidence of the recommended five yearly safety check on the electrical installation since 2001 was not available. A recommendation to carry out an updated safety check in this area was issued at the last inspection. It was agreed that the General Manager would advise CSCI following this visit about this, and has subsequently confirmed that an updated safety check is scheduled, with certificated evidence to be provided to CSCI upon completion. The staff had received training in basic first aid, although this was due to be updated with a date set for refresher training to be delivered. We gave advice to the manager regarding risk assessing the suitability of this basic level of first aid provision for the needs of this home. A small number of residents were accommodated on the first floor, to which there is no lift, with each person able to manage the stairs at the present time. One of the rooms opens directly at the top of a flight of stairs, and although the occupant had been deemed as safe under these circumstances, we advised that any resident accommodated on this floor be fully risk assessed for the use and safety of the staircase. Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 28 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 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement Timescale for action 30/09/08 2 OP9 13(2) The Registered Person must ensure that care plans are written so as to clearly show how residents’ needs in respect of all aspects of their health and welfare are to be met; this is with reference to assessed mental health issues and risks of falling on this occasion. 31/08/08 The home must make sure the storage arrangements for controlled drugs comply with the Misuse of Drugs (Safe Custody) Regulations 1973. This is so that these medicines are stored in accordance with the law. This requirement was issued at the last pharmacy inspection, and the date for compliance has been revised further to this visit. The Registered Person must ensure that there are arrangements to prevent the spread of infection in the home, and specifically that the maintenance of catheter bags does not pose infection control risks to residents. DS0000016555.V364854.R01.S.doc 3 OP26 13(3) & 12(1a) 31/08/08 Redlands Acre Version 5.2 Page 30 4 OP38 13(4a) The Registered Person must ensure that risk assessments are carried out and recorded, and that appropriate risk reducing measures are taken in order to ensure the safety of the residents accommodated on the first floor who are using the stairs. 31/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP7 OP8 OP9 Good Practice Recommendations Staff should be more conscientious and vigilant when completing risk assessments for residents, ensuring they take account of all factors. Staff should record resident weights as soon as possible after their admission to the home, in order to have a baseline reading when monitoring nutritional needs. Where staff support people to look after and administer their own medication the medicine records should also include when each medication and quantity is actually given to people to look after as well as records of regular monitoring checks that staff make that people are using their medication correctly. This is to make sure that people receive the correct levels of medication. The Registered Person should give consideration to upgrading the kitchen facilities • There should be restrictions imposed on who enters the kitchen, so that this is kept to a minimum in the interests of health and hygiene. A designated laundry assistant and evening catering assistant should be employed. • A record of the actual content of fire safety training delivered to staff should be kept • The suitability of the basic level of first aid training for staff should be risk assessed to ensure it can meet the needs of the home. • 4 OP15 5 6 OP27 OP38 Redlands Acre DS0000016555.V364854.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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