Care Home: The Red House

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What the care home does well The home is a combination of a large purpose built building and a converted house. It is situated in its own grounds. There are lounge areas in each building, plus other quiet areas for people to use if they wish. Staff members are polite and talk to people with respect. We talked to people during this inspection and they said the staff are nice, respect their privacy. One visitor said, “In my opinion everything is done to an extremely high standard. The focus is on the resident and their wellbeing. From the management, to the nurses and to the carers, each and every one always listens carefully to every anything you have to say. The home is always clean, the grounds are beautiful and well maintained. It is also a very happy environment”. Assessments are completed before people move into the home, they have contracts with the home and they say they have enough information before they move in. One person who returned a survey said the manager brought a brochure about the home with her when she visited her mother in hospital and said, "this instantly brought her will to live back". People are referred to health care professionals, like dentists, opticians and dieticians. These visits are recorded in their care records and people who returned surveys told us they get the medical support they need.The Red HouseDS0000024304.V376665.R01.S.docVersion 5.2People can have visitors when they want and there are places where they can meet in private. They are able to choose where to spend their time in the home, when to get up and go to bed, and what they do during the day. There have been 14 complaints made to the home in the last year. These are looked at properly and information to show why the home has taken action, if it needed to, is also kept. People who make complaints have a response in the correct timeframe. People said they know who to talk to and how to make complaints. Staff members have training in how to keep people safe and what to do if they think abuse has happened. There have been no safeguarding referrals in the last year. Staff members are given induction training when they first start working at the home and more than 50% (half) of the non-nursing care staff have a National Vocational Qualification. A quality assurance survey is carried out every year at the home, where people are asked what they think of the care and the environment in which they live. A report is written and the manager has to produce an action plan to show how an issues are going to change and improve. Money that is kept and transactions that are made on behalf of people at the home is documented on a central computer. Interest is paid on this money and this is also recorded. The whole system is audited every year. Records are also kept of the health and safety checks that are carried out, which means the home can show if things are in good working order and what they have done to repair problems. What has improved since the last inspection? The amount of personal information written in care plans has improved. They give staff members` details about how people like to be looked after and what they should do in particular circumstances. For example, when someone has a visual impairment the plan tells staff how that person knows where things are. This helps people to keep their independence and skills for longer than if staff were doing things for them. Medication records are completed properly and medicines are stored correctly. Medication administration is carried out in a safe way that gives people time to take their medication at their own pace. There is an activities co-ordinator at the home who organises trips, activities and events for people in the home. Visitors who returned surveys told us, "Always some kind of activity or entertainment each afternoon and some evenings" and "She`s always doing some thing, playing cards, painting and much more".The Red HouseDS0000024304.V376665.R01.S.docVersion 5.2There is a choice of main meals each day and staff members stay with people who need help to eat. Everyone we spoke to said they like the meals and the food is good. One person said, "Meals always cooked lovely and piping hot". All staff at the home have been given training in safeguarding adults (adult protection). There have been no referrals or investigations in the last 12 months, but staff member know what to do if they think abuse may have happened. Recruitment checks are completed properly before people start working at the home, so that new staff members are safe to work there. What the care home could do better: People told they don`t usually have to wait very long for staff to help them, although they still have to wait at times when it is busy. None of the people we spoke to said they have to ask again and again for help, although comments from visitors and a staff member told us that there are not always enough staff at weekends. There are updates of mandatory training, but not all staff have this as often as it is needed. Training in moving and handling, and fire safety are required for all staff every year to make sure people are safe. Half of the visitors who returned surveys said the home helps people keep in touch with them, if they`re able to do this. Most of them said they are kept up to date with issues about their relatives, but that they have to ask for this information and staff don`t offer it to them. One comment was, "Staff do not pro-actively engage with relatives. They do so reactively when chased up". Key inspection report CARE HOMES FOR OLDER PEOPLE The Red House Bury Road Ramsey Cambridgeshire PE26 1NA Lead Inspector Lesley Richardson Key Unannounced Inspection 22nd June 2009 11:40 DS0000024304.V376665.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Red House DS0000024304.V376665.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Red House DS0000024304.V376665.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Red House Address Bury Road Ramsey Cambridgeshire PE26 1NA 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) 01487 813936 01487 711504 www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd Lorna Jean Smith Care Home 60 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (60), of places Physical disability (3), Physical disability over 65 years of age (60) The Red House DS0000024304.V376665.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age range of the three residents in the Physical Disability (PD) category is 60 - 65 years only 23rd June 2008 Date of last inspection Brief Description of the Service: The Red House is a large converted house and a second purpose built building to the rear, situated on the main road into the market town of Ramsey. It is owned by BUPA Care Homes and provides care and support, including nursing care for up to 60 residents over the age of 65 years. Fees for the home range between £680 and £798 per week and a more accurate quote is available from the home. The most recent inspection report is available in the foyer of the home for people living at the home and visitors who wish to read it. The home has 58 single rooms and one double room, all with en suite facilities. Service user accommodation is on two floors in both buildings, the upper floors being accessible by stairs or lift. Forty-six rooms are located in the purpose built premises that were opened in May 1996 and 12 beds are in the older, original house, which was refurbished in 2000. There are a variety of communal areas available to service users, the smaller areas being on the upper floor. The home is set in its own grounds and is a ten-minute walk from Ramsey town centre. The Red House DS0000024304.V376665.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. This was a key inspection of this service and it took place over 7 hours and 5 minutes as an unannounced visit to the premises. It was spent talking to the manager and staff working in the home, talking to people who live there and observing the interaction between them and the staff, and examining records and documents. The requirements from the last inspection have been met. There have been no further requirements or recommendations made as a result of this inspection. Information obtained from the Annual Quality Assurance Assessment (AQAA) and from returned surveys was used in this report. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. We received ten surveys from people living at the home, 9 surveys from visitors and 3 surveys from staff at the home. What the service does well: The home is a combination of a large purpose built building and a converted house. It is situated in its own grounds. There are lounge areas in each building, plus other quiet areas for people to use if they wish. Staff members are polite and talk to people with respect. We talked to people during this inspection and they said the staff are nice, respect their privacy. One visitor said, “In my opinion everything is done to an extremely high standard. The focus is on the resident and their wellbeing. From the management, to the nurses and to the carers, each and every one always listens carefully to every anything you have to say. The home is always clean, the grounds are beautiful and well maintained. It is also a very happy environment”. Assessments are completed before people move into the home, they have contracts with the home and they say they have enough information before they move in. One person who returned a survey said the manager brought a brochure about the home with her when she visited her mother in hospital and said, this instantly brought her will to live back. People are referred to health care professionals, like dentists, opticians and dieticians. These visits are recorded in their care records and people who returned surveys told us they get the medical support they need. The Red House DS0000024304.V376665.R01.S.doc Version 5.2 Page 6 People can have visitors when they want and there are places where they can meet in private. They are able to choose where to spend their time in the home, when to get up and go to bed, and what they do during the day. There have been 14 complaints made to the home in the last year. These are looked at properly and information to show why the home has taken action, if it needed to, is also kept. People who make complaints have a response in the correct timeframe. People said they know who to talk to and how to make complaints. Staff members have training in how to keep people safe and what to do if they think abuse has happened. There have been no safeguarding referrals in the last year. Staff members are given induction training when they first start working at the home and more than 50 (half) of the non-nursing care staff have a National Vocational Qualification. A quality assurance survey is carried out every year at the home, where people are asked what they think of the care and the environment in which they live. A report is written and the manager has to produce an action plan to show how an issues are going to change and improve. Money that is kept and transactions that are made on behalf of people at the home is documented on a central computer. Interest is paid on this money and this is also recorded. The whole system is audited every year. Records are also kept of the health and safety checks that are carried out, which means the home can show if things are in good working order and what they have done to repair problems. What has improved since the last inspection? The amount of personal information written in care plans has improved. They give staff members details about how people like to be looked after and what they should do in particular circumstances. For example, when someone has a visual impairment the plan tells staff how that person knows where things are. This helps people to keep their independence and skills for longer than if staff were doing things for them. Medication records are completed properly and medicines are stored correctly. Medication administration is carried out in a safe way that gives people time to take their medication at their own pace. There is an activities co-ordinator at the home who organises trips, activities and events for people in the home. Visitors who returned surveys told us, Always some kind of activity or entertainment each afternoon and some evenings and Shes always doing some thing, playing cards, painting and much more. The Red House DS0000024304.V376665.R01.S.doc Version 5.2 Page 7 There is a choice of main meals each day and staff members stay with people who need help to eat. Everyone we spoke to said they like the meals and the food is good. One person said, Meals always cooked lovely and piping hot. All staff at the home have been given training in safeguarding adults (adult protection). There have been no referrals or investigations in the last 12 months, but staff member know what to do if they think abuse may have happened. Recruitment checks are completed properly before people start working at the home, so that new staff members are safe to work there. 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 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. The Red House DS0000024304.V376665.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 DS0000024304.V376665.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have enough information before moving into the home, which means they are able to decide if they would like to live there. EVIDENCE: Almost 3/4 (7 out of 10) of the people who we received surveys from said they had enough information before moving to the home and 6 people said they had received a contract. Seven of the nine visitors who returned surveys also said they or their relatives had enough information about the home before moving there. One persons relatives said that the manager brought a brochure about the home with her when she visited her mother in hospital and said, this instantly brought her will to live back. The Red House DS0000024304.V376665.R01.S.doc Version 5.2 Page 10 Assessments are completed before people move into the home and assessments by health and social care teams are also obtained to provide more information. We looked at the care records of 2 people who had moved into the home since the last inspection. There was a written assessment completed by another BUPA home in one persons file, as that person lived too far for the home manager to visit, that included information about the persons needs, and likes and dislikes. An assessment was completed as soon as the other person moved into the home as they went to live there in an emergency. A social care assessment had been obtained before this person went to live at the home. The home does not provide accommodation specifically for intermediate care or for rehabilitation purposes. The Red House DS0000024304.V376665.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care and medication records are not completed accurately or in enough detail to ensure the health and welfare of people living at the home. EVIDENCE: Most people who commented in surveys said they get the care and support they need from staff members and during the inspection people told us care staff are nice, are polite and treat them with dignity and respect. We saw this during the inspection and that staff knock on doors before entering rooms. Comments from visitors who returned surveys were, Majority of carers know the guests, are polite, pleasant and caring, Mum is very happy living at the Red House. She is well cared for, always clean and My sons and myself are completely happy with all the staff at the Red House. We feel fortunate that my husband is so well cared for. However, one visitor told us that they had often seen their relative wearing other peoples clothing, even though they The Red House DS0000024304.V376665.R01.S.doc Version 5.2 Page 12 have enough of their own clothes. Clothing is personal and should not be used communally as it does not treat people as individuals. Care plans for 5 people were looked at as part of this inspection. They show that each person has a plan that gives staff members information about what they need to do to meet most of the identified needs. Risk assessments, for things like falls and moving and handling, are completed and reviewed regularly. We found the care plans gave staff members advice about how to meet most of peoples needs, and that there is a good level of detail about people. Care plans for care needs generally told staff how each person likes to be cared for and what their preferences are, and there were some plans that gave staff a lot of information about people. For example, one person has a sensory impairment and the care plan tells staff how that person can tell where things are when they are close by. Another persons plan tells staff what they prefer to be dressed in and what they dont like wearing and what they are able to do for themselves. Plans for more task orientated things, such as specialised medication and tube feeding are also written clearly and in enough detail for staff to easily know what to do and what to look for. Most plans are reviewed monthly and we saw that most information and changes are recorded, and the plans are rewritten to give staff updated guidance. Not all reviews are evaluations of the care that has been given and do not show whether the care plan is effective or needs changing. We talked to the care staff responsible for this and explained about showing what they have looked at to make the decision that the care plan doesnt need to change. However, this wasnt the case for most plans. Care plans for one person hadnt been reviewed since December 2008, although this was the only person we found this for. We spoke to the manager about this. Risk assessments are completed and show staff members what actions should be taken to reduce the risk. Most of the people (9 out of 10) who returned surveys said they receive medical attention when they need it. There is information in care records to show health care professionals, such as specialist nurses, opticians and chiropodists, are contacted for advice and treatment. Information about changes to medical needs and discussions around care that may or may not be given is also recording in care records. We saw information in one persons care records that showed details of a meeting between a visiting doctor, specialist nurse, the persons family (as the person was not able to be there) and staff at the home. The discussion was well recorded and shows that significant decisions about peoples lives and wellbeing are not taken without involving everyone involved with the person. Medication administration records (MAR) were looked at for 3 of the people whose care records we looked at and another twelve people. The MAR sheets are completed and there are few records with entries missing. Entries for The Red House DS0000024304.V376665.R01.S.doc Version 5.2 Page 13 medications that have not been given show the reason for this. Amounts of medication remaining in blister packs of medication tally with the amount the MAR indicates are remaining. The controlled drug register is recorded in a satisfactory way and the register contains the name and address of the supplying pharmacy. Medication fridge and storage room temperatures are taken and recorded as being at an acceptable level for the safe storage of medication. We watched part of one medication round and saw that the medication trolley was locked when the nurse was giving medication to people, which means medication is kept securely. However, one persons relatives told us in a survey that medication is not always given out safely. On one occasion a child visiting the home put medication that was on the floor of the persons room in their mouth. We talked to the manager about this, and she said staff had not reported being told about the incident. The Red House DS0000024304.V376665.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities and a choice of meal are available, which means most people can choose what they do and where they eat. EVIDENCE: The home has an activities co-ordinator who arranges for entertainers to visit the home, activities and events in the home. Visitors who returned surveys told us, Always some kind of activity or entertainment each afternoon and some evenings, Lots of activities and encouraging participation, Shes always doing some thing, playing cards, painting and much more and Good trips for more mobile residences. One person who returned a survey said that help is given with mobility on days out. The activities’ programme is displayed on notice boards around the home. Nine of the ten people who returned surveys to us said there are activities that they can take part in, although 1 person said that activities are never available to them. One person we spoke to at the home said there are limited things to do during the day. This person used to listen to classical music but doesnt now as its not to everyones taste. We noticed that during lunch in another part of the home there was classical The Red House DS0000024304.V376665.R01.S.doc Version 5.2 Page 15 music playing in the background, although the person does not have lunch in this area. It may be something that staff could talk to the person about or introduce in to the other part of the home if other people are in agreement. People are able to make everyday choices about when to get up and go to bed, how to spend their days, whether that is in their own room, in the main lounge/dining area. We saw and listened to how staff members interact with people and found they ask what people would like and how they would like it rather than telling people or giving limited options. Staff members we spoke to know the people they care for and were able to tell us their preferences and how they like to be cared for. Seven of the nine visitors who returned surveys said that the home supports their relative to live as they choose. The home has an open visiting policy and people can have visitors at any time of the day. Seven out of nine visitors who returned a survey said they are kept up to date with issues concerning that person. However, comments about this show that some visitors would like to be told more often how their relative is. Two comments were, Staff do not pro-actively engage with relatives. They do so reactively when chased up and Improve communication with named relatives who all live along way away and only visit occasionally. Four visitors said the home helped people keep in touch with them, although 3 other visitors said this was not applicable. The main meal is served at lunchtime and there is a choice of two hot meals every day. We saw lunch being served in one of the main dining rooms. Food was served appropriately in a relaxed and unhurried way and drinks were offered throughout the meal. Everyone we spoke to said they like the meals and the food is good. Staff help people if they need this and we saw them being attentive and concentrating on what they were doing without being distracted. Comments were received in surveys and during the inspection and include, Good cooking and catering, Meals always cooked lovely and piping hot and The food prepared is suitable for my mother i.e. mashed and soft. The carers help my mother feed herself when necessary. The kitchen staff are cheerful and friendly and chat to the occupants in the dining room. The Red House DS0000024304.V376665.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 know how to make complaints and concerns known and can be confident that these will be listened to. EVIDENCE: Eight of the ten people returning surveys said they know who to speak to, although only half (5) said they know how to make a complaint. Seven people said that staff listen to what they say and act on it, and 3 people said this happens only sometimes. Everyone we spoke to during the inspection also said they know what to do if theyre not happy about something. Seven of the nine visitors who returned surveys said they know how to make a complaint and they are appropriately dealt with. Everyone we spoke to during this inspection said they are happy with the service given to them. We only received 2 specific comments about complaints and keeping people safe, both of these were positive; They look after my mother pretty well. I have no fear that she is abused or ignored in any way. This is a good care home and From the management, to the nurses and to the carers, each and every one always listens carefully to anything you have to say. The home has a complaints procedure and keeps a complaint log to show how they have looked at and the outcome of complaints that have been made. We The Red House DS0000024304.V376665.R01.S.doc Version 5.2 Page 17 were told before the inspection there have been 14 complaints made to the home in the last 12 months. All complaints have been investigated and all responded to within the correct timeframe. We have been contacted in the last 12 months by 2 people who had concerns about staffing levels at the home and 1 person who let us know of a complaint they had made to the home. Neither of the people who were concerned about staffing levels contacted the home about the concerns. We asked the home for information about one complaint at the time and were satisfied that staffing numbers were at an acceptable level. We asked both people to give us more details about their concerns but heard nothing from them. The other complaint was dealt with by senior management at Bupa. The staff training matrix shows that all staff members, care staff and support (housekeeping, kitchen, admin, etc) staff, have received training in safeguarding (adult protection) within the last year. We talked to care staff, who said they had received training in safeguarding people. Two staff we spoke to told us what should be done if abuse was suspected. Information provided to the Care Quality Commission before the inspection shows there have been no safeguarding referrals or investigations in the last 12 months. The Red House DS0000024304.V376665.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 generally clean and provides a safe environment, giving most people a pleasant place to live. EVIDENCE: The home comprises of two parts; a large purpose built property situated at the back of the property and a large converted house at the front. People living at the home have access to a number of communal areas inside both buildings. There are gardens surrounding the house at the front and an enclosed garden in the centre of the building at the back. The general décor within the home is satisfactory, and it was clean and tidy. One person told us, The home is always clean, the grounds are beautiful and well maintained. There were no obvious areas that needed immediate attention. The Red House DS0000024304.V376665.R01.S.doc Version 5.2 Page 19 We noticed one part of a corridor that had a strong offensive smell, but otherwise there were no unpleasant odours. The smell lessened as the day went on. Eight of the ten people returning surveys said the home is always or usually clean and tidy and people at the home said the home is clean. Comments from visitors show there are some problems with laundry and having peoples own clothes returned to them, that rooms can be dusty and that call bells are not always left within reach. The Red House DS0000024304.V376665.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are not always enough staff members and not all staff members have required training to care for people safely. EVIDENCE: The training matrix shows new staff members are given induction training, which includes mandatory health and safety training. Mandatory training is updated regularly; most staff members have received moving and handling, and fire training within the last year. Although 6 staff members last received fire training and 7 staff members last received moving and handling training in early 2008. Three other staff members have not received moving and handling training since 2007. The training matrix only shows the possible reason for one of these staff members not having received the training. If staff are currently employed at the home, they must received fire and moving and handling training every 12 months. Staff members who returned surveys said they are given training that is relevant to their role and helps them understand how to meet different needs. Although 2 of the 3 staff members said they are not given training that gives them enough knowledge about medications and health care needs. We spoke with staff in one part of the home who said they would like more training on The Red House DS0000024304.V376665.R01.S.doc Version 5.2 Page 21 how to record blood pressure. Other training, such as infection control training, is also given to staff although the training matrix shows that 2 nurses and 8 care staff have not received this. Information in the Annual Quality Assurance Assessment tells us that 56 of non nursing qualified care staff have a National Vocational Qualification at level 2 or above. The recommended number of staff with a NVQ is 50 . Six people who returned surveys said staff members are available when they are needed, 4 people said staff are only available sometimes. However, 9 out of 10 people said that they get the care and support they need. People we spoke to during the inspection said there is usually enough staff on duty, one person said they sometimes have to wait when they first get up, another person said they rarely have to wait for long. Comments from visitors surveys gave a different view and 3 people said there are not enough staff at weekends. Three staff members also returned surveys and 2 staff members said there is only sometimes or never enough staff to meet peoples needs. One staff member said, Have more staff - care assistants because there is not always enough off us on, which can make things very tight in the mornings and not able to meet all the resident needs. Two people have contacted us since the last inspection about low staffing levels and the home has let us know once when they were low staffed and unable to get bank or agency staff to cover. Staffing levels were found at the last inspection to be low and we made a requirement then for there to be adequate staffing numbers so that people don’t have to wait. Although other people have commented about the lack of staff, people living at the home said they don’t have to wait as long to get the care they need. This means that the requirement has been met, but we will continue to look at staffing at the home. We looked at recruitment records for three staff members employed since the last inspection and they all contained the appropriate recruitment documents including references, application forms, and PoVA/CRB checks. The Red House DS0000024304.V376665.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 a safe place to live and people are asked their opinion so that things they are not happy with are changed. EVIDENCE: The manager has been working at the home for a number of years and is registered with the Care Quality Commission as manager. She is a nurse registered with the Nursing and Midwifery Council and completed an NVQ level 4 qualification in management in March 2007. She also has qualifications in the care of older people. One visitor commented, (the manager) is very approachable and knows the guests very well. The Red House DS0000024304.V376665.R01.S.doc Version 5.2 Page 23 An annual quality assurance survey was carried out by the home in July 2008, a report has been written and shows the issues that were found. There was an overall improvement in satisfaction with the service given by home. Although there were drops in overall satisfaction for food and activities. This is in contrast to what we found during this inspection and shows there have been improvements since the satisfaction survey was last completed. We asked the home to complete and return an Annual Quality Assurance Assessment (AQAA) before the inspection. They did this within the time we asked for it and they gave us the information we asked for. People going to live at the home are given written information about how their money is taken care of and the procedures involved in debiting an account. Statements are sent on a monthly basis, which shows the incoming and outgoing transactions, and any interest earned. Although individuals money is all placed into the same account, each person using the system has a separate written account and record on computer. Information provided before this inspection shows equipment, like hoists, lifts and fire-fighting equipment has been serviced or tested as recommended by the manufacturer. We looked at fire equipment around the home; this has been tested within the last 12 months. The Red House DS0000024304.V376665.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 X X 3 X X 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 3 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Red House DS0000024304.V376665.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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Red House DS0000024304.V376665.R01.S.doc Version 5.2 Page 26 Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 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. 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