Care Home: The Redhouse

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Redhouse 49 Wharncliffe Road Ilkeston Derbyshire DE7 5GF two star good service The quality rating for this care home is: 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: Janet Morrow Date: 1 5 1 0 2 0 0 8 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. They reflect the things that people have said are important to them: 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 Adults (18-65 years) 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: The Redhouse 49 Wharncliffe Road Ilkeston Derbyshire DE7 5GF 01159447869 01159308160 Notgiven Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Voyage Ltd Name of registered manager (if applicable) Miss Janet Brown Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 8 0 care home 8 learning disability Additional conditions: Date of last inspection A bit about the care home The Redhouse is a listed building, which used to be a hotel prior to becoming operational as a Care Home. The Redhouse was registered on the 18th September 2003 by National Care Standards Commission, and is owned by Voyage Ltd. The home has been refurbished and is managed as a smaller family type unit. The home was first registered for seven people, but following an application to vary the registration the home is now registered for 8 individuals with a learning disability between the ages of 18 - 65 years old. The home is situated close to the centre of Ilkeston and the shops and facilities are within walking distance. Information about the service is provided in the Statement of Purpose and Service User Guide; both of these documents are made available to individuals and their families/representatives. The current fees for this service commence from #1,110.43 a week to #1680 a week. Items not covered in the fees include toiletries, transport and holidays. Service users give a contribution to trips out. 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home We visited the home for one day for 5.5 hours and looked at the records of the help people needed. We talked to 4 people who lived at the home. We also met some of the staff working at the home. We looked at some of the policies and procedures in the office. Policies are rules about how to do things. Procedures tell people how to follow the rules. We looked round the building. The home had sent some written information and we looked at this before the visit. We received 7 surveys from people living in the home after the inspection visit. What the care home does well Everyone liked living at the home. They said they were happy there and it was friendly. One person said I love all the staff and a survey said I am really enjoying myself at the Redhouse. Another person put on a survey that they were more independent and that I trust myself more. Staff are helpful and sort things out for people who live in the home. People who live at the home can choose to go to different activities. The home is clean and comfortable. People said the meals were good. Staff were recruited properly. This meant that they were checked to see if they were suitable to work at the home. People living in the home helped to choose which staff came to work there and had a say in how the home was run. Staff kept people safe. What has got better from the last inspection The manager had told the inspectors how she was going to make things better at the home. All the written information about peoples needs was now checked regularly to make sure it was right. What the care home could do better Peoples medicine records need to be better to make sure they are given out properly. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Janet Morrow Edgeley House Tottle Road Riverside Business Park Nottingham NG2 1RT 011 5934 0900 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 . There was sufficient admission information available to ensure people could make an informed choice about moving to live in the home. Evidence: Two peoples care and support files were examined and both had a detailed assessment in place. Information from external professionals was available. Detailed information about individual needs was available in both files examined. Good use had also been made of information obtained from health care professionals, previous placements and families in the assessment of needs of each individual. The records showed that regular reviews were taking place and the information was updated as required. Risk assessments for each individual were also included in the information, for example one person had a risk assessment in relation their health condition. The manager stated that the the admission process included visits to the home prior to making a decision to move in. Six of the seven surveys received said that they were asked if they wanted to move in to the home and that they had enough information to make a decision about moving in. One persons survey said they had not been asked if they wanted to move in and had not received enough information. Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 . Detailed care and support planning and risk assessments ensured that peoples needs were met in the way that they chose. Evidence: Two peoples care and support files were examined and showed that comprehensive support plans were in place that demonstrated how individual needs would be met. The files and the details provided contained sufficient information to enable staff to deliver care and support in a consistent way. For example, there were clear instructions about assisting one person with their diet and likes and dislikes were recorded. The support plans also emphasized peoples abilities and promoted independence. There was evidence to demonstrate within the person centred plans seen that staff were involving people and their representatives such as family in developing the support required. For example, one person had signed their care record. Both files contained a variety of risk assessments that indicated key areas of concern and ways in which staff could minimise or eliminate any problems arising from these risks. There was a general risk assessment in place on both files and also assessments related to the individual concerned. For example, one person had an assessment regarding overeating and there were instructions for staff on how to minimise this risk. The support plans and risk assessments had been reviewed in 2008 and one file showed that there had been a multi-disciplinary review in April 2008. Evidence: The written information supplied by the home stated that more pictorial information for support plans was being developed. People spoken with confirmed that they were encouraged to be independent in their lives and that staff consulted them about their care and about the running of the home. Six of the seven surveys received from people in the home responded that they always made decisions about what they did each day and one responded that they sometimes did. A friendly and positive rapport was observed between people living at the home and staff. Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 . Well-managed meals, contacts with the community and activities ensured people had a good quality of life. Evidence: There was a range of activities available that included college courses, using local facilities such as shops and libraries in the Ilkeston area, gardening and having holidays. Some people had their own hobbies such as painting and walking, which they pursued in their own time. The home was making efforts to include additional areas of interest and had built a hen house and were hoping to have hens at the home in the near future. A vegetable garden had been established and the produce grown had been used in meals. Composting and a wormery had also been established for those people who were keen on gardening. The written information supplied by the home also stated that trips to stage shows, cinema and theatre had also been arranged at peoples request. A visit was made to the local fair during the inspection visit. Individuals were supported by their designated key worker to complete a weekly planner of their preferred activities. All seven surveys received from people in the home stated that they could do what they wanted in the daytime, evening and at weekends. One person commented on the survey that I can play my music. Evidence: Staff were able to demonstrate through discussions, and observations confirmed, that they were supportive of each persons needs and actively encouraged and promoted personal development and independence. For example, one person with mobility problems was being encouraged to walk during the inspection visit and another assisted with preparing the evening meal. People living at the Redhouse were encouraged to maintain links with their families as appropriate. Families were made welcome and the written information supplied by the home stated that families were invited to parties and meals. The serving of the evening meal was observed and showed that it was plentiful and nutritious and was adapted to take account of individual likes and dislikes. People living at the home confirmed that they all discussed their preferred meal choices and then meals were planned to ensure everyones choices were included throughout the week and the written information supplied by the home stated that menus were reviewed regularly. Food stocks in the kitchen were good. Everyone stated that they enjoyed the meal and that they thought the food was good. Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 . Access to health professionals and clear systems for monitoring health ensured that peoples health and personal care needs were met. Evidence: Two peoples care and support records were examined and showed that there were details about the type of assistance and guidance needed to meet health care needs. One person was having specialist input from a speech and language therapist and the records showed that appointments with other health professionals such as dentists, chiropodists and opticians took place.There were regular reviews of care and support held with other health professionals that ensured changing needs were addressed. It was observed that personal support was offered sensitively and warm relationships existed between staff and people in the home. Six of the seven surveys received responded that the staff always treated them well and one responded that they sometimes did. Five surveys responded that staff always listened and acted on what the person said and two responded that they sometimes did. One survey commented that I can speak to all the staff and team leaders. A random sample of three medication administration record charts was examined for accuracy of recording. These showed that they were signed accurately and the amount of medicine received was recorded. There was detailed information on a front sheet about allergies, how the person preferred to take their medication and what the medicine was used for. The charts were hand written by the home. Two peoples records were then examined in more detail. There was an error on one chart about the dosage of one medicine; this was recorded as 2mg but the tablet was actually 1mg. Medicines that were given as required had the reason for the Evidence: administration recorded. Both charts were signed accurately and corresponded with the dispensing system. There were no controlled drugs in the home at the time of the visit but there were secure storage facilities for them should they be required. There were no homely remedies in stock although the policy stated that five items were able to be dispensed as homely remedies. There was a refrigerator for the storage of medicines, if needed. This was working but the temperature recorded on a regular basis was fourteen degrees, which was high for cold storage. The deputy manager stated that weekly audits of medication records took place and an inspection by the supplying pharmacist had taken place in July 2008. Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 . The views of people living in the home were taken seriously and acted upon and the systems in place ensured people were protected from abuse. Evidence: The complaints procedure was clear and was included in the service user guide. There was a complaints book that showed one complaint had been received since the last inspection in November 2007 and the action taken was recorded. There had been no complaints received at the office of the Commission for Social Care Inspection since the last inspection in November 2007. Six of the seven surveys received from people living in the home stated that they knew how to make a complaint. One survey did not give a response. The company had corporate procedures on dealing with safeguarding issues and allegations of abuse and these included information from the Local Authority and whistle blowing procedures. Those staff spoken with were aware of their responsibility to report any suspicions of abuse and training records showed that safeguarding training had been provided in September 2008. The written information supplied by the home stated that there were posters in pictorial format for people living in the home about safeguarding people and these were seen in prominent positions throughout the building. No safeguarding referrals or investigations have been made in relation to the service. People spoken with were confident that if they had any worries these would be dealt with by the staff team and confirmed that they would speak to staff if they had any concerns. Two peoples financial records were examined. This showed that people were signing for transactions and there were receipts available. The monies held corresponded with the records seen. Monies were checked and signed for at each staff handover, which Evidence: demonstrated that safe working practices were in place to safeguard peoples financial interests. 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 was well maintained, which ensured people living at the home had safe and comfortable accommodation. Evidence: The Redhouse is a grade 2 listed building and had access only by stairs to the three floors and basement. Therefore the individuals that lived there needed to be independent in their mobility. A tour of the communal areas of the building was undertaken. A maintenance person was employed at The Redhouse and the companys maintenance department was used for any maintenance work that could not be undertaken by the maintenance person employed in-house. The written information supplied by the home stated that communal areas had been re-decorated, new garden furniture had been supplied and peoples bedrooms had been decorated to their specifications. It also stated that one way the home could improve was by providing a ramp for easier access at the main entrance. This was under consideration at the previous inspection in November 2007 but had yet to be addressed. The laundry was viewed and had equipment suitable for the needs of the people living at the home. Staff spoken with were knowledgeable on how to control infection and stated that there were plentiful supplies of protective equipment such as gloves and aprons. Three peoples bedrooms were viewed and all had en-suite facilities. All people spoken with stated that they were pleased with their rooms. Each reflected their own individual interests. Evidence: The home was clean and tidy and there were no offensive odours. Six of the seven surveys received from people living in the home responded that the home was always fresh and clean and one responded that it sometimes was. One survey commented that the staff cleaned on a daily basis. 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 in the home were supported by sufficient, competent and trained staff and the recruitment practices in place empowered them and enhanced their protection. Evidence: The staff rota for 13th - 19th October 2008 was examined and showed that there were four staff to cover the morning shift, three for the afternoon shift and one waking and one sleep-in staff at night. The written information supplied by the home identified staff shortages over the past year as a barrier to improvement but also stated that the staff team at the Red House have worked hard to cover the shifts as a collective group to deliver continuity of care. The manager stated that new staff had been recruited and were awaiting Criminal Record Bureau checks before commencing employment. This would then mean the home was fully staffed. Nine of seventeen staff had achieved a National Vocational Qualification at level 2 or above. This meant the home had achieved the target of having 50 of staff with an NVQ at level 2 or above. Staff confirmed in discussion that they had undertaken mandatory health and safety training as well as training applicable to the job, such as diabetes and the Mental Capacity Act 2005. The manager stated that courses in autism, epilepsy, bi-polar disorder and person centred planning had been requested. Staff spoken with stated that the access to training was good. Two staff files were examined and showed that recruitment procedures were comprehensive and it was documented that all the information required by the Care Homes Regulations 2001 had been received prior to staff commencing employment. Evidence: This helped to ensure that people living in the home were safeguarded. Although original documentation was not available in the home, there was a signed checklist for both files saying that the relevant information had been received. The original information was stored at the companys head offices. The home retained copies of identity information such as birth certificates and driving licences. People living in the home were actively involved in the recruitment of staff and were part of the interview panel. One person spoken with was able to say what questions they asked at the interview and was obviously pleased that they were able to have a say in the outcome.The written information supplied by the home stated that they hoped to encourage more of the service users to participate in the recruitment and selection process and to access training for them around recruitment and selection. Evidence was in place within the staff records seen of supervision that had taken place and staff spoken with confirmed that it was undertaken every 6 to 8 weeks. One member of staff praised the support received and said the home was better due to the manager. Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 was well managed, which ensured it was run in peoples best interests. Evidence: The manager had had many years experience within the learning disability field and had achieved a National Vocational Qualification (NVQ) at level 4 and had completed the Registered Managers Award. She had been registered as manager with the Commission for Social Care Inspection in 2008. Staff were complimentary about her abilities and one described the home as stable since the manager took over. Observations of the manager with both staff and people living in the home was noted throughout the day and demonstrated an open and positive relationship was in place. The company had clear processes for quality assurance and completed an annual service review when they tried to obtain views and comments from a range of different people including visiting professionals and relatives. Monthly audits were undertaken in addition to the usual monthly visits undertaken in response to Regulation 26 of Care Homes Regulations 2001. The review covered areas such as the environment, personal care, catering and management and most areas were scored as excellent. Feedback on relatives surveys in 2008 was positive with comments such as amazing, delighted friendly atmosphere and really patient and good. One survey from a person living in the home said I love all the team leaders and staff. Staff spoken with confirmed that health and safety training was undertaken in food hygiene, moving and handling, infection control, first aid and fire safety. The training records confirmed that these had occurred over the last twelve months. Evidence: The written information also confirmed that maintenance checks were undertaken regularly; for example, fire equipment and alarms had been tested in July 2008, emergency lighting had been checked in July 2008, gas safety in August 2008 and portable electrical appliances in March 2008. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description Timescale for action 1 20 13 Handwritten medication administration record (MAR) charts must be checked and signed for accuracy by two people. 01/12/2008 This is to minimise the risk of errors and to ensure medicines are administered safely. 2 20 13 The medication refrigerator 01/12/2008 must be checked or replaced to ensure it operates at a safe temperature for the storage of medicines. This is to ensure medicines are stored correctly and that they are safe to use. 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 29 The home should install a ramp at the entrance to ensure anyone with mobility problems can access the building. Helpline: 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 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 © (2008) 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. 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