Care Home: The Red House

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What the care home does well What has improved since the last inspection? The issues regarding the environment identified at the last inspection have all been addressed. Staff recruitment procedures have improved since the last inspection with all the necessary checks being made prior to new staff commencing employment. What the care home could do better: Medication received by the home and that returned to the pharmacy must be accurately and consistently recorded. The entrance to the home should be clearly identified to ensure that all visitors enter the home in the same way and therefore staff are aware of who is on the premises. CARE HOMES FOR OLDER PEOPLE The Red House Clonway Yelverton Devon PL20 6EF Lead Inspector Susan Samways Unannounced Inspection 18th August 2008 10:00 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 The Red House DS0000046280.V367707.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. The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Red House Address Clonway Yelverton Devon PL20 6EF 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) 01822 854376 01822 853331 Crocus Care Limited Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 28 people 65 or over can be accommodated at one time. 23rd August 2007 Date of last inspection Brief Description of the Service: The Red House is owned by Crocus Care Limited. Ms Clare Hunter is the Responsible Individual for the company. The Red House is registered to provide accommodation and care for a maximum of twenty-eight people in the registration category of Old Age. The Red House is a large detached house with a landscaped garden. It is situated on the outskirts of the village of Yelverton, which has a number of shops, churches and public houses and a frequent bus service to and from Plymouth and Tavistock. Most of the bedrooms are single rooms with en-suite toilet facilities. The Service Users Guide and Statement of Purpose are available in the office. The Service Users Guide makes up part of the homes welcome pack and is given to each Service User. The Red House DS0000046280.V367707.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 stars. This means the people who use this service experience good quality outcomes. This was an unannounced inspection which lasted for eight hours. Since the last inspection the registered manager has left and a new manager appointed. At the time of the inspection the manager had only been in post for a couple of months and although off duty came in to the home for the inspection. Time was spent in discussion with the manager and the senior carer on duty. Various documents including care plans and staff records were examined and staff and people living in the home were spoken to. Before the inspection took place surveys had been sent to some of the staff and residents. Three surveys were completed by staff and six by residents. Prior to the inspection the Annual Quality Assurance Assessment, completed by the new manager, had been received. This provided information about how the national minimum standards had been met, what had improved since the last inspection and future plans for The Red House. What the service does well: The people living in the home were complimentary about the staff and said that they were treated with respect and were very well cared for. They said that there were a lot of activities that they could participate in if they wished. Their family and friends were made welcome and they could invite them for a meal when they wanted. They said that the meals were very good and one person described the chef as first class. The home is clean and comfortable and the people living there are consulted about the décor and furnishings. There are good links with community groups which welcome people from the Red House to participate in their activities and who also visit the home. The home also has a strong volunteer group who provide activities for everyone living in the home, if they wish to join in, several times a week. The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 6 Peoples’ preferences with regard to their daily routines, how they spend their time, the food they wish to eat and any other choices which are important to them are respected and recorded in their care plans. Staff said that they had good training which was relevant to the care they were providing. They also said that they felt well supported in their role. The home is run with an open style of management which welcomes comments and any complaints and uses them to improve the standard of care provided. What has improved since the last inspection? What they could do better: Medication received by the home and that returned to the pharmacy must be accurately and consistently recorded. The entrance to the home should be clearly identified to ensure that all visitors enter the home in the same way and therefore staff are aware of who is on the premises. The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 7 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. The Red House DS0000046280.V367707.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 The Red House DS0000046280.V367707.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): 1,3,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering moving to The Red House can be confident that that their needs will be assessed to ensure that they can be met by the home. EVIDENCE: The home provides prospective residents with a comprehensive pack of information to help them decide whether the Red House could be a suitable home for them. In addition they are encouraged to visit the home as many times as they wish to meet the staff and other people living there and join them for a meal if they wish. This was confirmed by those who completed surveys and those spoken to during the inspection. The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 10 Before anyone is admitted to the home they have a thorough assessment carried out by the manager or a senior member of staff. This ensures that the person’s needs are identified and it is established whether the home can meet them. The assessment includes information from health care professionals, relatives and others involved as well as the person themselves. The assessment also ascertains the person’s likes and dislikes, information about how they like to spend their time and any dietary requirements. All this information is then used to devise an appropriate care plan. The files for three people living in the home were examined. Those for the most recent admissions had assessments in place. The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 11 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. The health and social care needs of those living in the home are clearly identified and regularly reviewed. People living in the home are treated with respect and their dignity is maintained at all times. EVIDENCE: The care plans for three people living in the home were examined. These were detailed and had been reviewed. The manager said that when reviews are due the person concerned is encouraged to invite relatives and others involved in their care to participate in the review. She said that some people welcome this The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 12 while others decline. The care each person requires is clearly identified. The manager stated that staff have received training in completing the daily records and these were seen to be in good order. The records also included details of all visits by health professionals and any appointments the person had attended. Risk assessments had been completed in particular with regard to pressure care and manual handling. Evidence was also seen of nutritional screening, the monitoring of peoples’ weights and attention being paid to their emotional and psychological well-being. During the inspection people were seen to be treated with respect by the staff and this was confirmed by those spoken to. They said that staff listen to what they say and act upon it and that they are usually available when they need assistance. One person said that they felt very well cared for, others named specific staff who they thought were particularly good. Records of medication given were checked and found to have been completed correctly however, records of medication received from and returned to the pharmacy were inconsistent and this needs to be addressed. In addition the assessment for people wishing to manage their own medication needs to be revised to ensure the safety of all concerned. Medication is stored in a trolley which is kept in a locked walk in cupboard. A refrigerator for the storage of certain medicines had been ordered from the pharmacy and should have arrived the week before the inspection. The manager was making enquiries about the expected delivery date. The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 13 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 excellent. This judgement has been made using available evidence including a visit to this service. People living in the home have opportunities to participate in a wide range of activities in the home and in the local community. The meals provided are varied, well balanced and nicely presented. EVIDENCE: People living in the home who had completed surveys said that there were usually activities available for them to participate in. Part of the assessment process for each resident is identifying the sort of activities they enjoy and their preferred way of spending their time. The home then aims to ensure that there is something for everyone. This is supported by a team of volunteers who visit the home several times a week to do different social and craft activities with people in groups or on an individual basis. A session took place during the inspection and volunteers were observed encouraging some of the The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 14 residents with more limited abilities to take part in a quiz. Some people were obviously enjoying the individual attention they were receiving. A member of staff is also allocated each morning and afternoon with responsibility for activities. During the inspection several people living in the home were spoken to. Some said that they preferred their own company and followed their own pastimes such as reading, knitting or sewing and doing crosswords. Others said that they enjoyed many of the activities available to them but would like more trips out and possibly go to a show. This was shared with the manager who said she would see what was available. Positive comments were also made about the local vicar who visits once a month to hold a communion service but who also talks to everyone regardless of their religious beliefs. This was clearly appreciated. Friends and relatives are welcome to visit at any reasonable time and residents are encouraged to invite them for meals as they did when living in their own homes. The home also has good links with local community groups who welcome residents to participate in their activities and who attend events at the home. The manager stated that the daily routines of the home are as flexible as possible and this was confirmed by those spoken to. People living in the home are encouraged to live their lives how they wish and those choices are recorded in the care plans. Everyone who made comment praised the standard of the meals provided. They said that their preferences are taken into consideration e.g. one person said that they do not like chips and asked for mashed potato instead. They said that the cakes are particularly good, there is always fresh fruit available and that they can have drinks whenever they want. The manager stated that the chef endeavours to provide a wide range of meals and will cook something different for just one person if they do not like what is on the menu. The chef also asks residents in person for feedback about the meals. During the inspection the meal served was seen to be nicely presented and taken in a pleasant dining room which encouraged people to talk to each other. The manager also stated that staff are trained to provide assistance at meal times in a discreet and sensitive way. The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 15 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 the home can be confident that any concerns or complaints they might have will be taken seriously and acted upon. People living in the home are safeguarded by staff training in the protection of vulnerable adults. EVIDENCE: The home has a clear complaints procedure and all those who completed a survey said that they knew how to make a complaint should the need arise. A copy of the procedure is included in the Service Users’ Guide and is on display in the entrance hall. Any complaints received by the home are dealt with appropriately and in a timely fashion. The manager stated that complaints are used to make improvements in the service provided. The manager stated that all the staff have had training regarding the protection of vulnerable adults to enable them to recognise what constitutes abuse and to inform them of the action they should take if they become aware of abuse having taken place. Staff contacted confirmed that they knew what The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 16 to do should a situation affecting the safety of someone living in the home arise. The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 17 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): 19,24,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Red House provides a clean, comfortable and homely environment in which to live. EVIDENCE: The inspection included a tour of the building. The home was found to be clean and comfortable and furnished in a homely way. The manager stated that when a bedroom is redecorated the person concerned is consulted about the colour scheme and everyone has the opportunity to express an opinion about the décor of communal areas. Bedrooms were seen to have been The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 18 personalised with some of the person’s own furniture and other items being used to furnish the rooms if they wish. The home employs a handyman who was seen during the inspection dealing with maintenance issues. Since the last inspection a new, ramped access to the garden has been created which now enables everyone to go out in the garden if they would like to. An issue discussed with the manager was the entrance to the home. On arrival at the home it is not immediately clear where the main entrance is and on the day of the inspection it was possible to walk into the home through the conservatory with the staff unaware that a visitor was on the premises. This potentially could compromise the safety of those living in the home and the manager agreed to address this as a matter of urgency. The home was found to be clean, hygienic and free from unpleasant odours. Staff have training in infection control and they stated that there are sufficient supplies of gloves, aprons and cleaning materials for them to use in order to reduce the risk of cross infection. The manager stated that all rooms are regularly deep cleaned. The issues regarding the environment identified at the last inspection have all been addressed. The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 19 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. People living in the home are safeguarded by the improvements made in the staff recruitment procedures and by the staff training programme. EVIDENCE: On the day of the inspection there appeared to be sufficient staff on duty. The senior carer in charge clearly knew the people living in the home and the staff well and was able to answer questions until the manager arrived. The manager stated that she had reviewed staffing levels to ensure that there were sufficient staff available during peak times. This was done in consultation with those living in the home. The reorganisation is being monitored to check that there are no unforeseen detriments to the well being of residents. Of the twelve care staff four have NVQ Level 2 in care and another three are working towards it. In addition three staff have NVQ level 3 and one person is undertaking it. Staff who completed surveys and those spoken to said that the training they had received, including induction training, was good and relevant to the care they provide. The manager said that the company that owns The The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 20 Red House has employed an in-house trainer to ensure that all staff receive mandatory training with refresher sessions at the required intervals. Other training will be tailored to the needs of each staff member and the people they are caring for. Those who have attended training sessions are encouraged to feedback about what they have learnt to their colleagues. The files for four staff members were examined to check that correct recruitment procedures had been followed. A requirement was made at the last inspection regarding the necessary checks being made prior to a new member of staff commencing employment. These included police checks and references. Of the files checked on this occasion all had two written references and all but one had had satisfactory police checks before starting work. The one that didn’t had been employed prior to the last inspection. The correct procedures had been followed for the people recently employed. In discussion with the manager she was very clear about the recruitment procedure and the need to carry out all the checks necessary in order to safeguard the people living in the home. The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 21 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): 31,32,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management style is open and receptive to the views of the residents and others involved with the home. The policies, procedures and safe working practices provide protection for both residents and staff. EVIDENCE: The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 22 Since the last inspection the registered manager has left and a new manager appointed. At the time of the inspection the new manager had only been in post for a couple of months. However, she demonstrated a good level of knowledge of the running of the home, the people living there and the staff. She said that she has an ‘open door’ policy so that anyone involved with the home can feel confident in approaching her about any issue. This was seen to be the case during the inspection when residents, staff and visitors asked her questions or shared information. Most of the residents spoken to said that they found her approachable and easy to talk to. Staff said that they often met with her and felt well supported. A volunteer said that they felt welcome and that their contribution to the life of the home was viewed positively by the manager. The manager has many years experience of working in care homes on both the care and administrative sides and in senior positions. She is supported in her role by a newly appointed administrative assistant. She is undertaking the Registered Managers Award and is applying to the Commission for Social Care Inspection to become the registered manager. The manager stated that she actively seeks the views of all those involved with the home especially the people living in the home. Questionnaires are distributed every six months, once a year these are returned directly to the company’s head office and the other time to the manager. The results of these are fed back at the monthly residents’ meetings. The manager stated that the findings are acted upon. The views of those living in the home are also sought through the residents’ meetings, an ideas book and at care plan reviews. People spoken to during the inspection said that it was worth putting forward ideas and suggestions as they would be taken seriously. The financial affairs for most of the people living in the home are managed either by themselves or their relatives. At the time of the inspection general spending money was being held by the home for four people living there. This money is provided by the relatives and the home keeps detailed records, including receipts, of all money spent. These records are available for relatives to inspect at any time. Since the manager started she has had supervision sessions with all but two of the staff and has held a staff meeting. She is aiming at present to have supervision with each member of staff every three months moving to every two months when she is more established in her role. She plans to hold monthly staff meetings to ensure that staff are kept informed and have an opportunity to ask questions, raise issues and share ideas. Staff have been trained in safe working practices but with the appointment of an in-house trainer refresher sessions should be established to ensure that staff are kept up to date and are confident in the correct practices and procedures. The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 23 Records show that policies and procedures have recently been reviewed and that equipment, including fire equipment and gas appliances have been regularly serviced. The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 24 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 3 x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x 3 x 3 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 3 3 x 3 3 x 3 The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13 Requirement Records of the receipt of medication into the home and the disposal of medication no longer required must be accurate and consistent to ensure the safe management of medication at all times. Timescale for action 30/06/09 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 OP19 Good Practice Recommendations The entrance to the home should be clearly identified to ensure that all visitors enter the home in the same way and therefore staff are aware of who is on the premises. The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 26 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. Extracts may not be used or reproduced without the express permission of CSCI The Red House DS0000046280.V367707.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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