Care Home: Redlands Rest Home

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What the care home does well The pre admission assessment is very thorough to make sure that people are only admitted to the home if their needs, requirements and wants can be met. Care plans, that tell staff what a resident can do independently and what sort of help or assistance may be required are very detailed. This provides staff with good information to make sure that resident`s needs and expectations are consistently met. The registered manager is very experienced and qualified and provides clear leadership throughout the home. This helps residents and staff to feel secure and well supported. There is a very good relationship between residents and staff that makes people living at the home feel comfortable, safe and relaxed. Privacy and dignity is well respected. The staff team work well together and showed a good understanding of the needs of individual residents. What has improved since the last inspection? The registered manager has now successfully achieved the Registered Managers Award qualification. This qualification helps to make sure that the registered manager has the skills and abilities to manage the home well on a regular day-to-day basis. As recommended at the last inspection, a risk assessment is now in place regarding the lock to the front door. This helps to protect people living at the home. The recent pharmacist random inspection report recommended that medication audits take place on a regular basis. This would make sure that any medication recording mistakes are quickly identified and staff advised accordingly. A written format for the mediation audit has now been developed and medication audits are about to be introduced. What the care home could do better: A letter should be sent to a prospective resident confirming the outcome of the pre admission assessment. There was no evidence that this had been happening. The registered manager will now confirm in writing, that the home can meet the assessed needs and requirements of each prospective new resident.All records required by regulation, including staff files must be kept in the home and available for inspection at all times. At this inspection, some information could not be evidenced because the written record had been taken out of the home. This is to be returned as soon as possible. The pharmacist inspector recommended that any hand written entries in the drug administration record should be signed and countersigned by a second member of staff to ensure accuracy of the recording. This is not always happening and could put residents at risk. There were still the occasional medication recording that had been completed incorrectly. Care must be taken to ensure medication records are always accurate. CARE HOMES FOR OLDER PEOPLE Redlands Rest Home 44/46 Park Road Lytham Lancashire FY8 1PN Lead Inspector Denise Upton Key Unannounced Inspection 7th October 2008 09:15 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 Rest Home DS0000009765.V372749.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 Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Redlands Rest Home Address 44/46 Park Road Lytham Lancashire FY8 1PN 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) 01253 725835 F/P 01253 725835 redlands44@fsmail.net Mrs Victoria Islam Mrs Susan Guy Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 23 Date of last inspection 20th December 2006 Brief Description of the Service: Redlands is a care home providing personal care and accommodation for up to 23 older people who do not require nursing care. The registered provider does not live in the area although her appointed representative visits the home on a regular basis. In consequence a registered manager is appointed who undertakes day-to-day management responsibility at Redlands Care Home. The majority of residents currently accommodated are male who have previously lived a transient lifestyle. Staff are responsive to individual needs and requirements with social stimulation and activity determined by the individual and tailored in the main on a one to one basis with a member of staff. Redlands Care Home is situated in a convenient location close to the main shopping area of the Town and local resources and amenities. The home is arranged over three floors and offers individual bedroom accommodation for the majority of residents. Although bedroom accommodation does not provide an en-suite facility, bathing and toilet facilities are sufficient in number, conveniently situated and provided with appropriate aids. A passenger lift is provided for ease of access throughout the building. Redlands Rest Home DS0000009765.V372749.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 3 star. This means that people who use this service experience excellent quality outcomes. This unannounced site visit took place during the course of a mid-week day and spanned a period of approximately nine hours. Twenty-one core standards of the thirty-eight standards identified in the National Minimum Standards-Care Homes For Older People were assessed along with a re-assessment of the recommendations identified in the last inspection report and the truly random pharmacist inspection report. In the recent past, a truly random pharmacist inspection took place. This is an inspection that only looked at the specific area of medication and can take place at any time. A truly random inspection does not indicate that there have been any concerns about medication practices at the home in the past. The report relating to this truly random inspection is held at the Commission for Social Care Inspection office and can be made available to enquirers on request. We spoke with the registered manager; deputy manager and individual discussion took place with a member of the care staff team. Brief individual discussion also took place with two people living at the home and general discussion took place with a number of other residents during the course of the visit. A number of records were examined and a partial tour of the building took place that included communal areas of the home, kitchen and laundry areas and some bedroom accommodation. Information was also gained from the Annual Quality Assurance Assessment completed by the registered manager. Prior to the site visit taking place, ten Commission for Social Care Inspection (CSCI) surveys were completed and returned by people living at the home along with six staff surveys. This helped to form an opinion as to whether individual needs and requirements were being met to the satisfaction of people living at Redlands Care Home. Comments from residents were brief but complementary and staff comments were very positive. The current scale of charges ranges between £286.11 and £584.01 weekly. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: A letter should be sent to a prospective resident confirming the outcome of the pre admission assessment. There was no evidence that this had been happening. The registered manager will now confirm in writing, that the home can meet the assessed needs and requirements of each prospective new resident. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 7 All records required by regulation, including staff files must be kept in the home and available for inspection at all times. At this inspection, some information could not be evidenced because the written record had been taken out of the home. This is to be returned as soon as possible. The pharmacist inspector recommended that any hand written entries in the drug administration record should be signed and countersigned by a second member of staff to ensure accuracy of the recording. This is not always happening and could put residents at risk. There were still the occasional medication recording that had been completed incorrectly. Care must be taken to ensure medication records are always accurate. 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 Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 8 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 Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 9 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 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. A well-established and detailed pre admission assessment including relevant risk assessments and assessments undertaken by other professionals, is in place prior to a person being admitted into the home. This is to ensure that people are only admitted to the home if their particular needs and requirements could be met. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 10 EVIDENCE: As identified in previous inspection reports, Redlands Care Home has a structured and detailed pre admission assessment system in place. This is to make sure that as much information as possible is available prior to admission in order to make an informed decision as to whether the current needs, wants, wishes and requirements of each prospective resident could be met. As the vast majority of people accommodated are from out of the area, in most instances, the initially assessment of current strengths and needs is undertaken by a care manager of the prospective resident’s funding authority or through a Health and Social Services multi agency assessment process particularly if the person had recently been referred to a hospital. A representative of the home who lives nearer to where the majority of residents are admitted from, also routinely visits all prospective residents in their existing environment in order to complete an initial assessment to establish if Redlands Care Home could meet their current needs. This information gathering process is further developed by a comprehensive and detailed assessment of strengths and needs undertaken by the management team at the home that includes relevant risk assessments. In practice however, as the vast majority of people living at the home have lived a considerable distance away, in reality the home’s individual assessment and risk assessments are completed only after admission. One resident told us that the representative of the home asked him if he would like to live in St Annes. The representative of the home then drove the prospective resident to Redlands Care Home for two weeks stay at no charge, in order for him to make an informed choice about living at the home. The resident spoken with did decide to stay at Redlands however not all prospective resident’s that visit choose this option and transport is then arranged to take them back to the area they originated from. As observed at the time of inspection, the collated assessment information forms the basis of the initial care plan. Whilst it was clear that the needs of recently admitted people to the home were being met, there is a requirement that any person who has been assessed for possible admission to a care home must receive written information following the pre admission assessment. This should confirm the outcome of the pre admission assessment and that the prospective resident’s current needs and requirements could be met at the home. This should be provided prior to admission for permanent care. There was no evidence that this had occurred. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 11 Standard six was not assessed, as Redlands Care Home is not registered to provide an intermediate care service. Redlands Rest Home DS0000009765.V372749.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 excellent. This judgement has been made using available evidence including a visit to this service. There is a clear and consistent care planning and risk assessment system in place to provide staff with the information they need to maintain a high quality service. Personal and health care needs are well met and people are treated with dignity and respect, this helps to promote a feeling of security and self worth. EVIDENCE: All people living at Redlands Care Home have an individual plan of care based on current assessed strengths and needs that is developed from the initial assessment process. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 13 There is a consistent approach to the care planning and review system. Care plans observed were found to be comprehensive, detailed and clearly informed staff of how a task was to be achieved in order to ensure consistency of care and support for the individual. Care plans evidenced were very much person centred and individualised and as well as health, personal, social and religious care needs, also included issues such as laundry, finance/budgeting, alcohol intake, mental health and smoking. Care plans also incorporated elements of multi disciplinary decision-making and risk assessments particularly relating to mental health issues. The promotion of equality and diversity continues to be given high priority within the home. Individual diversity requirements are identified on the care plan and care is taken on how to manage the attitude of some other residents living at the home who may show less tolerance towards the needs of others. On one of the care plans observed there was a ‘plan of action’ for staff to follow if a particular circumstance arose. This gave clear and detailed direction to staff to make sure that the same consistent message was being given to the resident and that any associated risk was minimised. There was evidence of relevant risk assessments having been undertaken with significant outcomes incorporated in the care plan. All care plans are formally reviewed on at least a monthly basis. Incident reports were also available in respect of some residents. These again gave a clear description of the circumstances prior to the incident, detail of the incident and any action taken afterwards. Where necessary care plans and risk assessments were then reviewed and amended to take into account new or changed information. Comments from residents written on the Commission for Social Care Inspection (CSCI) survey forms, although brief, did confirm that residents felt that they received care and support and the medical support that they needed at the time that they needed it. The majority of residents are however very vocal in expressing their opinions and would have no hesitation in saying what they thought. A number of residents were spoken with during the course of the visit and nobody expressed any concerns what so ever about the care and support received. From observation of documentation, it was confirmed that resident’s health care needs, including mental health care needs are fully met. There is a good relationship with health and social care professionals in order to maintain health and social wellbeing. Visits by health professionals are fully documented and care plans amended as required to take into account any new information or direction. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 14 The home has good systems in place for the receipt, recording, storage, handling, administration and disposal of medicines in order to safeguard residents and generally medication is well managed. All residents that wish to and have capacity to do so are enabled to self medicate following the successful outcome of a formal risk assessment. This promotes independence. In August 2008 a ‘truly random’ pharmacist inspection took place. In consequence, at this inspection only the recommendations that the Pharmacist Inspector highlighted in the random report were re examined to see what progress had been made. Whilst there had been improvement to ensure that there was sufficient stock to ensure medication could be administered from each person’s own pharmacy labelled bottle, it was observed in the drug administration record that there were still occasional dose omissions without explanation and a hand written entry had not been signed or countersigned. This is important to help reduce the chance of error should a hand written entry be required. It was clear that where there was a dose omission without explanation, the medication had actually been administered to the resident although not recorded as such. It is clear that some staff are not following the home’s policy and procedures for the safe administration of medication. This could put residents at risk. Staff should be reminded of their responsibilities and possible consequences of their actions when administering medication to ensure that medication management is always handled safely. The manager is aware that this is an area that requires some improvement. As recommended in the recent Pharmacist random inspection report, a written format has been developed to undertake an audit of medication handling. Once introduced, this should provide clear detail of when certain staff are not recording medication administration correctly or following the home’s medication policy and procedures. Staff at Redlands work hard to ensure that the privacy and dignity of all residents is maintained. These values form part of the induction training programme for newly appointed staff and more advanced, National Vocational Qualification (NVQ) training. The maintenance of privacy and dignity is also incorporated in the staff handbook and staff were seen to be very respectful of each individual resident. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 15 To support privacy and dignity training, there is a question and answer sheet for staff to complete outlining different situations. Staff have to describe how they would respond to the given situation, that is then analysed and advice given when required to ensure an appropriate response from the staff team. Staff are also provided with a questionnaire with regard to challenging behaviour. A similar exercise takes place to ensure that staff have understanding of how to respond to behaviours that challenge while maintaining as much privacy and dignity for the resident as possible One member of staff had answered on a CSCI survey form to the question, ‘What does the service do well’, had written, “A good understanding of clients needs, each one being very different and treated as an individual”. Another member of staff said, “Listen to service users and quickly identify concerning issues/confrontation situations. Although residents may be of a challenging nature, they are offered respect, choice and dignity”. Staff were seen to show a great deal of respect even when a resident was challenging, this helped to maintain the dignity of the resident and helped to defuse a potential situation from developing. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 16 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. Residents experience the lifestyle that satisfies their wants, needs and interests. People who live at the home are encouraged to maintain contact with the local community and wherever possible their family and friends to ensure these relationships are sustained. Dietary needs of people who live at the home are well catered for with a balanced and varied selection of food available that meets individual taste and choice. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 17 EVIDENCE: Routines of daily living and social activities are kept flexible and varied in order to address individually assessed strengths and needs. Residents accommodated access community resources and facilities either independently or enjoy the one to one support of staff for outings and activities. The majority of people living at Redlands are not very interested in a structured in-house activities programme preferring instead to enjoy social activities of their choosing on a one to one basis with a member of staff. However recently a weekly film afternoon was introduced and has since been enjoyed by a number of residents. Some people living at the home do enjoy staff involvement particularly in the evening period, to complete crossword puzzles and playing card games with others preferring to individually undertake social activities of their choice. Some residents also enjoy the sessions of a physiotherapist who visits every two weeks. A member of staff explained that attending to resident’s nails is an important activity as it also provided time that is well spent talking individually to people Individual care plans clearly identify the diverse range of social activities that residents have chosen to enjoy. A great deal of effort is spent in developing one to one individualised activities that addressed the needs, wants and wishes of each resident. This can include visiting a pub with a member of staff, enjoying a skating show, attending a local football match, a weekly visit to a café with a member of staff and visits to places of interest specific to the individual, that recently included two members of staff and two residents visiting London for the day to enable the residents to visit their family and/or friends. Outings are also arranged to a local hotel that provides entertainment for people who may have difficulty in accessing community activity independently. One resident told us on a survey form, “I do not wish to take part in activities but I like the parties”. Another person said, “Don’t like in-house activities but I like to go out with a member of staff”. A third person told us that he, “Goes out with staff. Like to go in a chair for a walk”. As a result of the previous transient lifestyle of the majority of people living at the home, contact with relatives and friends is limited. However residents are encouraged and enabled to maintain or re-establish family or friendship links if they so wish. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 18 Visits by family and friends are encouraged and residents are enabled to access a range of social activities in the wider community including places of worship. Currently one resident independently attends a church service on a weekly basis. Two other residents of alternative faiths attend a religious service escorted by parishioners, and a church minister visits the home on a weekly basis to offer communion to those who wish to participate. All residents with capacity and who wish to do so are encouraged to remain independent in respect of their own financial affairs. However a number of residents currently accommodated have elected to receive their personal allowance on a daily basis in order to ensure there are sufficient funds available to last the week. Although it is infrequent that a newly admitted resident will have personal possessions, people living at the home can personalise their bedroom accommodation to reflect their individual wishes. Meals and mealtimes at Redlands are given high priority with a varied and balanced menu provided that is designed round the known likes and dislikes of people living at the home. There is a four weekly rotating menu however this is kept flexible and is determined by what residents enjoy eating. There is a varied range of foods offered including several roast dinners throughout the week. Although there is a set menu for the main meal of the day, an alternative of the resident’s is always made available. Specialist diets in respect of medical needs are provided and as observed, hot and cold drinks and snacks are made available throughout the day. It is understood that consideration is to be given to changing the teatime menu as many residents do not want to have two hot meals a day preferring instead to have a lighter teatime meal such as cheese on toast, teacakes or salad. As always, residents spoke very positively about the variety and quality of the meals served. One resident told us on a survey form that, “I can eat at various times and I am quite happy with this. Sometimes I have my tea at supper”. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 19 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. The home has a comprehensive complaints system with evidence that residents feel their views are listened to and acted upon. Staff received training in respect of adult abuse issues that helps protect people living at the home from potential abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection only one complaint was made to the home. The registered manager thoroughly investigated the complaint using the home’s complaint procedure. The complaint was not upheld. The Commission for Social Care Inspection (CSCI) received no complaints. There has been no allegation of adult protection issues. The home’s complaint procedure is compliant with requirements and incorporated in the written information provided to people who are admitted to Redlands Care Home. Redlands Care Home provides an open and inclusive atmosphere. People living at the home are encouraged to voice any concerns immediately so that issues can be discussed and addressed. Individuals that completed a CSCI survey were aware of the complaint information and confirmed that their views and concerns are listened to and acted upon. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 20 The home also has a robust policy and procedures in place for protecting people using the service from possible abuse. Discussion with a member of staff confirmed a good understanding of issues of vulnerability for this client group. Staff supervision arrangements provide opportunity for any work performance issues to be addressed. Redlands Care Home also has a variety of further policies and procedures for the protection of people living at the home. These include a whistle blowing policy to help protect residents from abuse or discrimination and policies in respect of service users monies, gifts, wills, hospitality and aggression. All staff receive adult protection training at induction that consists of reading relevant information, followed by a question and answer paper that is reviewed by the registered manager, any gaps in knowledge are addressed. Annual refresher adult protection training is also provided for all staff. A recent development has been the introduction of challenging behaviour training. The reading material provided is in-depth and comprehensive and includes, causes of challenging behaviours, build up of challenging situations, defusing situations and protecting staff. Again there is a question and answer workbook to complete that is reviewed by the registered manager. In addition, there is now a challenging behaviour book for staff to complete to record what had happened before an incident, how the incident was managed and the outcome. This will help to prevent challenging situations from developing and provided staff with clear information of how similar situations were managed and how successful the particular intervention(s) had been. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 21 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. The standard of the internal environment within this home is adequate in providing residents with a comfortable place to live. EVIDENCE: Redlands Care Home is maintained and decorated to an acceptable standard. As identified in previous reports, staff try hard to maintain the physical environmental standards, however this can sometimes be impeded by the personal behaviours, habits and life style of some of the residents accommodated. The home offers alternative lounges, a large dining room and there is a passenger lift available for ease of access to first and second floor bedroom accommodation. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 22 Since the last inspection the on-going redecoration and refurbishment programme has continued. This has included the hall and stairs carpet being replaced and the area redecorated. One of the lounges has also been redecorated and provided with new curtains, the smoking lounge is to receive a similar refurbishment. The two downstairs toilets have been redecorated and provided with new flooring, a new boiler has been fitted and some bedrooms have been provided with new furniture, curtains and equipment. All front and some back bedroom windows have been replaced with new double-glazing units and a new grab rail has been fitted in one of the bathrooms. The garden areas to the front and back of the property have been redesigned with seating provided to the front and decking and new paving stones flags to the side and rear area of the home. As recommended at the last inspection, a risk assessment has now been completed in respect of the lock fitted to the front door. Although this was provided as a safety feature, it did not allow for independent access or exit to or from the building. This caused no problems what so ever for residents who clearly knew exactly what to do, but it could have posed a safety risk. The Lancashire Fire and Rescue Service were contacted for advice, no concerns were expressed about the particular lock provided. Redlands Care Home has a variety of policies and procedures in place for the control of infection and safe handling of waste products including clinical waste and dealing with spillages. Laundry facilities are situated away from kitchen and dining areas and do not intrude on residents accommodated. A new cleaning system has recently been introduced whereby all cleaning materials and cleaning cloths are colour coded. This clearly identified cleaning products/cleaning cloths for different tasks and helps to protect residents and staff from cross infection. Each cleaning product is also provided with COSHH information to advise staff and to clarify what the produce should be used for. Staff training in respect of infection control was ongoing at the time of the site visit. Soap dispensers and paper towels have now been provided in all toilets and bathrooms this also helps eliminate cross infection. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 23 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. Morale in the long standing, core staff team remains high resulting in an enthusiastic staff team that works positively with residents to improve their quality of life. Recruitment processes are robust that helps to protect people who live at the home from harm. There is a good programme of staff training to ensure staff have the skills to provide a consistently high service. EVIDENCE: The relationship observed between staff and residents was friendly and good. As the majority of people living at the home have no family contact or friends that visit, the staff group provide a vital role in supporting people and in providing a real friendship. Residents are often heavily dependent on the staff for emotional and psychological support as well as support in every day living. Residents appeared very comfortable living at Redlands and generally get on well with each other and very well with the staff group. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 24 Staffing levels at Redlands are determined by the assessed needs of people accommodated. Additional staff are on duty at peak times of activity during the day time period and at night a ‘waking watch’ member of staff is on duty along with a person who is ‘sleeping in’ on the premises. This staffing arrangement allows for individual social activity to take place with a member of staff. Recently a number of recently appointed people have left their employment at the home. Although the registered manager tries hard to equip newly appointed staff with the skills and the understanding of resident’s particular needs, some staff find working at the home hard and leave. Currently there are some staff vacancies. This is being managed by existing staff covering additional hours to make sure that residents needs, especially social care needs are not compromised. One member of staff stated on a survey that there was, “Good team workgood relationships with all staff. Although residents have their grumbles, I feel they are happy with living here as the length of time they have lived here indicates they feel settled”. Another member of staff said, “There is a lot of communication especially between manager/staff. Sometimes we have to work with new staff to support them and instil the need/importance of good communication”. There continues to be a clear commitment to the training and development of all staff that work at the home. The majority of staff are proactive and enjoy attending specific short course training such as the ongoing infection control training, however a number of staff are less keen to undertake nationally recognised National Vocational Qualifications (NVQ) training in care. The registered manager had previously explained that staff feel the short course training is relevant and useful in their job, where as there is less confidence in the usefulness in undertaking NVQ training. Currently there is 15 care staff employed. Of these four members of staff have successfully completed a National Vocational Qualification (NVQ) level 2 qualification and another member of staff has almost completed this course of study. Another member of staff has also completed Level 3 of this award and a further member of staff is currently undertaking a Level 4 NVQ qualification. Whilst it is acknowledged that the majority of the staff group have worked with the residents for a considerable period of time and are aware of, and able to address their current wants, strengths and needs of each resident, it is never the less recommended that care staff are encouraged to undertake formal, nationally recognised NVQ training in care to develop and reinforce their existing skills and to ensure residents are cared for by a well qualified staff group. It is understood that a number of staff have been disillusioned by the NVQ trainer. One person told us, “I started NVQ Level 3 after much encouragement but feel totally let down by the trainer. It was a while before I heard anything after starting but by that time I felt I did not want to continue. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 25 The manager has asked me if I would like to continue with another trainer. I am thinking about this, hoping what I have already done would count and transfer over”. Since the last inspection, some new members of staff have been appointed. However only one recently appointed person, remains in employment at Redlands Care Home. Although the registered manager and the member of staff in question confirmed that the full recruitment process had taken place, this could not be evidenced because the staff member’s personal file had been taken out of the building. It is required that all records and clearances required by regulation be kept at the home and available for inspection at any time. It is essential that the personal file of this member of staff be returned to the home as soon as possible. Previous observation of staff files confirmed that the recruitment practices followed were robust in order to protect people living at the home. Appropriate references and clearances had been obtained and deemed to be satisfactory before the new member of staff commenced employment at the home. Each new member of staff attends an induction-training day before actually working with residents at the home. This is predominately to provide ‘in-house’ induction training and to read some policies and procedures and learn about the needs and requirements of people accommodated. A contract of employment is issued at this time and the newly appointed member of staff is paid for the time spent on ‘in-house’ induction training. One fairly recently appointed member of staff spoken with confirmed that although she had received in-house’ induction training she had not been allowed to work at the home until the POVA First clearance had been received. She was then closely supervised until the full Criminal Records Bureau (CRB) clearance had been obtained. All newly appointed members of staff are provided with an individual copy of the General Social Care Council’s, code of conduct. This provides explicit information about the code of conduct expected of employees and employers working in social care. Formal ‘Skills for Care’ induction training standards for newly appointed staff that are new to care work is provided over a three- day period by an external training organisation. Staff also undertake a variety of other ‘short course’ training, that has recently included health & safety training, dementia care training, medication part 1 & 2 training, continence training, advocacy and infection control training. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 26 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 excellent. This judgement has been made using available evidence including a visit to this service. The registered manager is enthusiastic and well supported by a core staff team who demonstrated a good awareness of their role and responsibilities. The home regularly reviews aspects of its performance through a programme of self-review and consultation with users of the service and staff. Systems are in place to ensure as far as possible the health and safety of residents, staff and visitors. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 27 EVIDENCE: The registered manager is very competent and experienced and has now obtained the Registered Managers Award. This is a qualification that managers of care services are expected to achieve to ensure they have the skills and abilities to successfully run a care home. Comments from staff were very positive about the registered manager one person said, “A good manager in all areas, always willing to listen to problems/new ideas”. A member of staff spoken with also said that the “Manager and deputy are very supportive and there is good communication between staff” Residents at Redlands generally prefer not to complete questionnaires, preferring instead to verbally state their views and opinions about living at the home. However, formal resident surveys are provided periodically with outcomes of the survey explained to residents and incorporated in the Service User Guide. There is a suggestion board in the dining room that residents can write suggestions on and residents meeting have been re-introduced that take place about every three months. Surveys for professional staff involved with residents were provided in September 2008 and surveys were sent out to any relatives. The outcome of these surveys has yet to be analysed. There is very good formal and informal communication within the staff team and staff also have opportunity to air their views at regular formal staff meetings. This also helps to influence change and bring about improvements for the benefit of residents. In addition, Redlands Care Home has achieved the ‘Investors in People’ award that is nationally recognised and only awarded when a specific standard has been achieved. It was evidenced that policies and procedures are regularly reviewed and updated as required. Formal supervision arrangements are in place. All staff receive formal supervision on a regular basis. It was observed that a wide range of topics is discussed and staff are provided with an opportunity to say what they think and feel about the home. Future training needs are discussed, and incorporated into the training plan. There is also an annual appraisal system in place. All residents with capacity and who wish to do so are encouraged to control their own money. However there are a number of formal agreements with individual residents in place to enable the home to assist with daily budgeting of benefit entitlement and/or limit the amount of alcohol or cigarettes consumed in any one day. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 28 Secure facilities are available for the safe keeping of monies or valuables held on behalf of residents with clear, well-documented and relevant records and receipts kept. In order to ensure residents monies held at the home are kept to a minimum, people living at the home have been encouraged to open a saving account and to deposit monies appropriately in these accounts. Redlands Care Home ensures safe working practices are maintained through implementation of the home’s policies and procedures and staff training in respect of health and training issues. All members of staff receive mandatory health and safety training covering a variety of topics including manual handling, fire safety, food hygiene, medication safe handling, infection control and first aid training that is updated on a regular basis. Observation of documentation including maintenance records confirmed that various routine health and safety checks are maintained and environmental risk assessments are in place. There is a system in place for recording health and safety issues and it was evident that equipment is regularly serviced and a number of up to date certificates were evidenced that included fire safety equipment gas certificate and a small appliance testing certificate Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 29 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 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 2 X X X X X X 3 STAFFING Standard No Score 27 4 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 3 X 4 Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? N/A 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 OP3 Regulation 14(1)(d) Timescale for action Prospective residents must 30/11/08 receive confirmation in writing, that their current needs and requirements could be met at the home. The staff records of all persons 30/11/08 working at the care home must be kept in the care home. Requirement 2 OP29 Schedule 4(6) 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. Refer to Standard OP9 Good Practice Recommendations Care needs to be taken to ensure medication administration records are clearly completed to show why doses are ‘missed’. Handwritten entries should be signed and countersigned to reduce the risk of errors. A written audit (check) of medicines handling should be regularly completed to help ensure medicines are safely handled. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 31 2 OP9 A minimum ratio of 50 trained care staff (NVQ Level 2 or equivalent) should be achieved. Redlands Rest Home DS0000009765.V372749.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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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