Care Home: Redstones Care Home

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What the care home does well The home has a good assessment process, people are well informed, and are able to visit before moving in. Care plans, which guide staff to support people in an individual manner, are up to date and reviewed with the people they are about. People`s health care needs are well met, and medication is generally well managed. People decide how they are going to spend the day and are happy with the activities available to them. People feel listened to by staff and are supported to make choices about their lives. People praised the quality of the meals and the cleanliness of the home and its high standard of maintenance and decoration. The home is well run with a caring and committed staff group. One of the people living at the home told us that it is `well organised and a home from home` and a relative told us that Redstones provides `homely, personal and holistic care`. What has improved since the last inspection? People`s care needs have changed since the last inspection, and people are more able but the manager is clear about who to ask for help if people`s needs increase i.e. advice to manage people`s skin care needs. Currently the home does not manage people`s personal finances. New staff to the home complete an induction and we saw that their training needs were planned for. All staff have now attended moving and handling training to help ensure they support people in a safe manner. There have been some improvements to the home`s recruitment procedure. What the care home could do better: We made two requirements, which have timescales attached to them. Staff recruitment practices still need further improvement to help ensure that new staff are suitable to work with the people living at the home. Controlled drugs are currently kept in a secure manner but the arrangements do not meet with the legal requirements for this type of medication. Recommendations have been made to increase the number of staff with an NVQ 2 in care, and further work is needed to provide local guidance for staff on making a safeguarding alert. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Redstones Care Home Redstones 8 Surbiton Crescent St. Thomas Exeter Devon EX4 1PB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Louise Delacroix     Date: 1 1 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Redstones Care Home 8 Surbiton Crescent Redstones St. Thomas Exeter Devon EX4 1PB 01392421385 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : srew@blueyonder.co.uk Redstones Care Home Limited care home 7 Number of places (if applicable): Under 65 Over 65 7 old age, not falling within any other category Additional conditions: 0 The maximum number of service users that can be accommodated is 7 The registered person may provide the following category of service only: Care Home only - Code PC to service users of either gender whose primary needs on admission to the home are within the following category: Old age, not falling within any other category - (Code OP) Date of last inspection Brief description of the care home Redstones is a large modern detached bungalow, which is situated in a quiet area of St Thomas. It is within walking distance of St Thomas shopping centre, the local health centre, post office, churches and other local amenities. The home has been extended to provide accommodation for up to seven people, with five single bedrooms and one double bedroom, which is currently used as a single room. The Provider and their family live upstairs and have a private lounge downstairs. The home is clean, bright and furnished and decorated to a very high standard throughout. There is a good-sized garden that is well laid out and well used during the warmer weather. The Home does Care Homes for Older People Page 4 of 27 Brief description of the care home not provide intermediate care. The average cost of care 400 - 465 pounds per week at the time of inspection. Additional costs, not covered in the fees, include chiropody, hairdressing and personal newspapers. Previous inspection reports are available at the home in the hallway. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was unannounced and lasted approximately three and half hours. During the inspection, we looked at key areas of care by observing care and looking at records kept in the home e.g. medication records and care plans. We also spent time talking to individual people living at the home, which included visiting people in their individual rooms and in communal areas. Prior to the inspection, the home completed an Annual Quality Assurance Assessment (AQAA), which provides information about the service, details improvements that have been made and further work that would benefit people using the service. We have incorporated information from this document into this report. We had an excellent response to the surveys that we sent out and again we have included peoples Care Homes for Older People Page 6 of 27 comments and views into the main body of the report. Everybody living at the home responded, as did their relatives, and the staff working at the home. Three health and social care professionals also shared their views on the service with us. Throughout all of the surveys there has been repeated praise for the caring and homely ethos of Redstones and the friendly atmosphere. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a good admission process, which helps ensure that they can meet peoples care needs. Evidence: We saw from the homes records that people are assessed before they move in to help ensure that their health and social needs can be met. There is a set format with additional information added by the home to help promote individualised care. This approach was confirmed in discussion with the manager, and in the homes AQAA the manager explained how potential residents are visited in their own home or in hospital. Depending on the outcome of this assessment, the person is then invited to spend time at the home, including having lunch and meeting other people living and working there. We saw that health and social assessments were also in place for individuals. People told us how they had visited several times before they moved in to help them make a decision that it was the right place for them. Relatives told us that Care Homes for Older People Page 10 of 27 Evidence: the home either always or usually provides enough information to help them make decisions. The home does not provide intermediate care. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and social needs are well met by caring and well informed staff. Evidence: Care planning is comprehensive and promotes consistent and individualised care. All aspects of daily life are recorded, such as communication needs. Daily records relate to the care plans and concerns are followed up with a recorded outcome. Plans are discussed with the individual involved, and they sign their agreement to the content. The care plans are reviewed and risk assessments are updated. Staff told us that the way information is shared is managed well at the home, which helps them keep up to date. Discussion with the manager demonstrated an understanding of peoples social needs and how to support people with their mental well-being. For example, the importance of friendships, building a sense of belonging for new people moving to the home and supporting people with bereavement. We saw this style of approach in the managers conversations with people living at the home. Care plans detail health problems and the steps that have been taken to manage Care Homes for Older People Page 12 of 27 Evidence: them, and what equipment is used by an individual. The manager confirmed that at present there is nobody at risk of pressure sores, and that a previous recommendation on the last inspection related to someone who was no longer living at the home. The manager also told us that there was nobody with moving and handling needs. We were told that the home has a sliding sheet if people need help with transfers but that they have never needed to buy a hoist, although there is a hoist in the bath. The manager was clear in her discussion about recognising what the home can offer and when to seek further advice and support. We saw that all staff have attended external moving and handling training to ensure people are supported in a safe manner. Three health and social care professionals told us in their surveys that the home always meets peoples health and social care needs, which are monitored and reviewed. Two felt the service always sought advice and acted upon it to meet peoples social and health care needs, and one felt this was usually the case. One commented that Redstones provides a very homely and caring environment. It provides good individual care for its residents and makes them feel like a small family and a second respondent said appears to be a very caring and supportive home. Six of the people living at the home told us in their surveys that they always received the care and support they needed and that the home always ensured they received the medical care they need. This was confirmed in our discussions with people on the day of the inspection. A visitor said that their relative is encouraged to exercise regularly and if there is any concerns about her health, then she is immediately taken to see the doctor, and another relative said that the home is quick to respond to any need. We had seven surveys from relatives and they were all positive about the quality of the care provided at Redstones. We looked at medication practice in the home, and saw that records are well kept and up to date. The manager confirmed which staff are trained in this area of care and told us that some staff are awaiting training. We saw how medication that is prescribed as required is managed appropriately. We looked at the storage arrangements for medication, and saw that the storage of controlled drugs does not meet the current storage requirements. During our inspection, we saw that staff practice that maintained peoples privacy and dignity, which was confirmed in the surveys from people living at the home, and visiting the home. Six people living at the home told us that staff always listened to them, and we heard staff seeking peoples opinions and acting on peoples requests. A number of relatives told us that they could not see how the service could be better. Care Homes for Older People Page 13 of 27 Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from good quality meals and are supported with their interests in a welcoming atmosphere. Evidence: Redstones has a homely and family feel, which people told us about during the inspection and in their surveys. We saw people being supported to go out for a walk, which is a regular occurrence, and being encouraged with specific interests. We saw people making decisions about where and how they spent their time. One person told us they enjoyed sitting in the communal areas reading the newspaper, while somebody else said they enjoyed time in their room reading. We also saw that the home has links with the local community and that people enjoy spending times with their families. Playing cards is a popular past time for a number of people living at the home. Plans also include daily activity records for each person, which include meeting peoples spiritual needs. A couple of staff members told us in their surveys that they would like there to be more variety of activities but then one said but at present residents do not seem to want to do many different activities. They are happy to play cards or bingo and look Care Homes for Older People Page 15 of 27 Evidence: forward to the various religious groups/entertainers who call and always enjoy singing hymns and songs. The second person said we often try out new things because we only have 6 residents its quite difficult to find activities that they all enjoy and can take part in. Staffing levels should ensure that people are not restricted in their social interests i.e. pursuing an interest outside of the home. All care plans have individualised life stories, and this individualised approach came through when we spoke with the manager who provides hands on care. Important details are recorded, such as significant relationships. Families told us that they felt welcomed, and one said Redstones is a caring care home. I would recommend it to anybody in need of a homely happy life. A second relative said that the home creates a friendly, family atmosphere. People living at the home, and their relatives praised the quality of the food. We saw peoples likes and dislikes being catered for and people being offered choice. The atmosphere at lunchtime was calm and unrushed. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home can be confident that they can raise concerns, which will be acted upon appropriately . However, improvements to the homes safeguarding policy would provide further protection to people. Evidence: People living and visiting the home told us in their surveys that they knew how to make a complaint and that they felt confident concerns would be addressed. Staff members told us they knew what to do if someone has concerns about the home. We saw a detailed record of concerns that had been raised and how these had been addressed and resolved. This shows that the manager and their staff group take peoples concerns seriously. We saw that most staff have attended safeguarding training but the homes relevant policy does not currently provide enough detail to support staff in making an alert. For example, providing clear guidance on local reporting procedures of abuse to help ensure a consistent approach. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Redstones is maintained to an excellent standard, whilst remaining homely for people living there. Evidence: We looked around the building, which is homely and well maintained. Both externally and internally, it looks like a family home, which many people told us they appreciated. A visitor said the care home is excellent. It is clean inside and out lovely garden. Family run as a family . People take a pride in their own rooms, which they had personalised with their own belongings, including pictures and small pieces of furniture. People looked relaxed in their surroundings. Communal areas are open plan, and there is a light conservatory with comfortable chairs, which provides access into a well cared for garden. People told us they enjoyed spending time in the garden or just looking out onto it. The manager told us that rooms are re-decorated on a regular basis and we could see this to be the case. People confirmed they were asked about the colour and style of their room before they moved in. The homes AQAA states that there is an action plan to deliver best practice in the prevention and control of infection.We talked about infection control arrangements with the manager, and saw that training has taken place for the majority of staff in this area of care. Throughout the home, the rooms are clean, odour free and people Care Homes for Older People Page 18 of 27 Evidence: told us this was always the case. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from friendly and trained staff but are not adequately protected by the homes current recruitment process. Evidence: On the day of the inspection, there were two carers on duty. At night there are two sleep-in staff. The Home is also the owners home and the family have separate accommodation upstairs. People living at the home appeared relaxed with staff, who were friendly and had a good rapport with individuals. Staff told us in their surveys how much they enjoyed working at the home. Six people living at the home told us that there were enough staff on duty and this was confirmed by nine staff in their surveys. People who visit the home told us about the positive qualities of the staff group, who they described as caring. One person said there is a very high quality of service and all the residents are superbly cared for and another person said that the home shows that caring for the elderly can be done well and happily. A third person said the owners and helpers are to be commended. A person living at the home made the comment that staff have a friendly manner and will do over and above therefore making life here a pleasure. The homes AQAA states that three out of the ten permanent staff have an NVQ in care, which is below the national minimum standard of fifty percent of the care staff Care Homes for Older People Page 20 of 27 Evidence: group. On the last inspection, we found that the homes recruitment process was not robust and this is still the case. However, the requirement from the last inspection has been met as it relates to police checks which are in place. We looked at three recruitment files for staff that have been recruited since the last inspection. We saw interview notes and terms and conditions but we saw that some key information was not in place for some staff before they started working at the home. This is not safe practice. For example, there was a gap in one persons employment history which had not been accounted for, and for another person a reference stated To Whom It May Concern, which is not best practice. We looked at the training records for staff to see how they are supported to carry out their job. Recording of induction for new staff needs further improvement i.e. signing off completed work, but we saw that mandatory training was generally in place for most of the staff group, such as first aid, infection control, moving and handling. The manager was clear about the different skills of the staff group and explained how people had been encouraged and supported with their learning needs. We saw evidence of staff appraisals and personal development plans, which reflected this supportive approach. Staff told us that they felt they had the skills and training to carry out their duties. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed, which promotes the well-being and safety of the people living there. Evidence: The manager, who is also the owner, was registered with the Commission in 2006 and as described in the homes AQAA has completed their NVQ 4 in care. Comments from staff highlight the managers clear leadership and support, which is reflected in comments from people visiting the home. People living at the home told us that it was well run. The home recognises the importance of gathering peoples views on the service,and regularly gathers peoples opinions about the quality of care, and we saw evidence of this during the inspection. All the survey responses praised the service and we saw no areas that people were requesting to change. We were told that peoples views are also sought informally on a day to day basis. Care Homes for Older People Page 22 of 27 Evidence: We were told that currently people living at the home manage their own finances. During the tour of the building, we saw that the majority of radiators are covered and we were told that nobody living at the home is currently falling regularly, which otherwise could make them more susceptible to risk of burns. Mandatory training for the staff group covers health and safety areas for care and the building is well maintained making it a safe place to live. The home notifies the Commission appropriately about adverse events. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Arrangements must be 31/08/2009 made for the safe custody of controlled drugs in the home. This is to prevent the risk of diversion of these occurring. 2 19 13 Schedule 2 Prior to staff 31/08/2009 starting work, references must be robust and gaps in peoples employment history must be explored and the outcome recorded. This is to help ensure that people are suitable to work at the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 18 19 The homes safeguarding policy should contain local reporting procedures to help ensure a consistent approach. Fifty percent of the workforce should have an NVQ 2 in Care Homes for Older People Page 25 of 27 care. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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