Inspection on 10/11/08 for Ranyard at Dowe House

This is the latest available inspection report for this service, carried out on 10th November 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

CARE HOMES FOR OLDER PEOPLE Ranyard at Dowe House The Glebe Blackheath London SE3 9TU Lead Inspector Keith Izzard Key Unannounced Inspection 10th November 2008 09:40 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 Ranyard at Dowe House DS0000070182.V373077.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. Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ranyard at Dowe House Address The Glebe Blackheath London SE3 9TU 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) 020 8488 2222 020 8488 2228 Ranyard Charitable Trust Manager post vacant Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP 2. Physical Disability - Code PD The maximum number of service users who can be accommodated is: 51 8th October 2008 Date of last inspection Brief Description of the Service: The Ranyard at Dowe House is a care home with nursing for older people, managed by the Ranyard Charitable Trust, a Company limited by Guarantee. Care and support is provided for up to 48 service users. The home is located approximately five minutes walk from Blackheath Village, in a residential street and has pleasant grounds to the rear. It is located on three floors. On the ground floor there is a large lounge and dining room with a conservatory and 14 bedrooms. There are 17 bedrooms on each of the first and second floors, providing solely nursing care, and there are lounges and dining areas on each of these floors. All bedrooms have en-suite shower or bath and toilet and all are single occupancy. The home’s stated aim is to provide the highest standard of care within a happy, loving and dignified environment, to adopt a sensitive and individual approach, to promote health and independence and to deliver appropriately individualised care. There is a dedicated team of staff for each floor, although staff members from other floors do interchange when there are shortages on any one floor. Information about the service provided is made available to current and potential service users in the homes Statement of Purpose and Service Users Guide. All residents are issued with their own personal copy of the Service User Guide. Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 5 The current range of fees for a placement at the home is between £463.00 and £799.00. The fees cover all of the homes charges including food. Residents have to pay extra for other personal expenses such as hairdressing, transport, personal shopping, private health services such as chiropody, and escort services when accompanying service users on hospital trips. Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 6 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. We spent four and a half hours at the home and talked with six people who use the service, three members of staff, a visiting relative and the registered manager/matron. Records and documents examined during the inspection included people who use the service’s care plans, activities, medication, staffing and training, quality assurance, and health and safety records. The home completed an Annual Quality Assurance Assessment (AQAA) to tell us about the service provided, how it makes sure of good outcomes for the people using it and any planned developments. What the service does well: People planning to use the service have good information about the home and they can be sure that the home can meet their needs because their needs are fully assessed before they move in. People can be sure that they are properly supported because care plans give good information about their health care and support needs and how the home can meet these needs. People are treated with respect and dignity and their right to privacy is upheld. People are offered a varied programme of activities that reflects their interests. People can have regular contact with their friends and families. The home has a clear complaints procedure that is accessible to people who live there. People told us that they would be confident that any concerns they had would be listened to and acted upon by the staff and the registered manager. There are policies in place for the protection of vulnerable adults and staff complete training in this important area. Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 7 People live in a safe and well-maintained and comfortable environment, which is clean pleasant and hygienic. Staff have good training opportunities. The management approach of the home creates an open, positive and inclusive atmosphere. People who use the service told us “we are very well supported with our health needs, the General Practitioner visits regular and we all get to see him if we need to, its excellent really”. A visiting relative told us “It is very friendly and homely, the General Practitioner is marvellous and the nurses are very patient with my husband, they are like angels without wings”. What has improved since the last inspection? What they could do better: Staff supervision sessions need to take place more often. The home could obtain proof of identification for a new member of staff and keep in this in their personnel file. The reason for the non-administration of medication could be recorded on the appropriate section of the medication administration record. We would like to thank the people who use the service, the person visiting their relative at the home, staff and the registered manager for their comments and support during the inspection process. Please contact the provider for advice of actions taken in response to this Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 8 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. Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 9 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 Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 10 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 and 6. 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 planning to use the service have good information about the home and they can be sure that the home can meet their needs because their needs are fully assessed before they move in. EVIDENCE: The home has a Statement of Purpose and Service Users Guide that include information about the home. The Service User Guide is given to new people when they move into the home. The home also has a brochure and information pack that gives good information about the service. The registered manager told us in the Annual Quality Assurance Assessment (AQAA) that multidisciplinary assessments and care management assessments are obtained for people prior to admission to the home. The home offers trial Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 11 periods, plus pre admission visits for example people can stay for a day and meet staff and other residents whenever possible. People are issued with written contracts that clearly set out the homes terms and conditions. The registered manager and one of the sisters in charge carry out detailed pre admission assessments in order to identify the care needs of potential new residents and if the home can meet these needs. These initial assessments form the basis of the care planning system within the home. People funded by a local authority also have care manager social services assessments of needs on their care file. One person was moving into the home on the day of the inspection. She told us that she had visited the home on two occasions before deciding to move in, she said that she could have stayed for a two week trial period but was so impressed with the environment, the atmosphere and the staff that after the first visit she decided to move in as soon as she could. The home does not provide an intermediate care service. Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. 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 who use the service can be sure that they are properly supported because care plans give good information about their health care and support needs and how the home can meet these needs. People who use the service are treated with respect and dignity and their right to privacy is upheld. EVIDENCE: We looked at a number of peoples care plans at random. Care plans are produced from care manager’s assessments provided by social services and the homes initial assessments. Care plans included details of peoples, General Practitioners, current medication needs, allergies, next of kin, needs around health care, mobility, communication, eating and drinking, washing and dressing, social care needs and activities. The care plans also included a Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 13 nursing assessment/evaluation that detailed what actions staff needs to take in order to meet the person’s needs. The registered manager told us in the AQAA, our General Practitioners service offers excellent support with symptom management allowing the majority of service users a comfortable death in their own home avoiding unnecessary hospital admissions. People can also access McMillan nurses, the mental health team, tissue viability nurses, speech and language specialists, dieticians and a challenging behaviours team. People have very detailed health care plans that address all areas of health care needs. There are very good health support plans on people’s files addressing areas such as oral hygiene, pressure sore management and a range of health care needs. We spoke to six people who use the service on the day of the inspection. One person told us “we are very well supported with our health needs, the General Practitioners visits regular and we all get to see him if we need to, its excellent really”. Another person told us “I am happy here and they look after my health, we get to see opticians and dentist if we need to”. Medication is stored in a locked cabinet in the lockable clinical room and quantities and dosage of medication tallied with the medication administration records examined and the amount remaining within the storage system. On one occasion medication had not been given, this had been recorded on the medication administration record as not administered but no reason was given for the medication not being administered. It is recommended that the reason for the non-administration of medication be recorded on the appropriate section of the medication administration record. The home had a policy and procedure for medication that was comprehensive. Nursing staff members administer all medication and good storage and administration records were being kept. A staff nurse told us that advice was readily available from the supplying pharmacist and had a homely remedies procedure in place signed by the General Practitioners for the home. Staff members were seen to respect residents privacy and dignity when assisting with personal care, ensuring that bedroom and toilet doors were closed and knocking before entering rooms. All the people spoken to commented positively on how staff treated them with dignity and respect. The home has achieved the Gold Standard Framework in End of Life Care. Ranyard at Dowe House DS0000070182.V373077.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use the service can be sure that their social and leisure needs are met because they are offered a varied programme of activities that reflects their interests. Appropriate arrangements are made so that people can have regular contact with their friends and families. EVIDENCE: The home employs an activities co-ordinator. She told us that she works at the home from Monday to Friday and arranges social activities at the home. The home has a weekly timetable of activities. Activities include board games, aromatherapy, coffee mornings, skittles, hairdressing, manicures, pampering sessions, arts and crafts, bingo, reminiscence, quizzes, musical mornings and film days. Some people attend a local Church on Sundays. The activities coordinator told us that the home often hires out a minibus so that people can go on day trips to the coast. Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 15 People are also supported by the Friends of Ranyard who play an active role in fund raising, provide generous donations and organise entertainment. Friends of Ranyard have a programme of activities including coffee mornings, tea afternoons, fetes, bazaars, quizzes and musical entertainment shows. They also run a hairdressing club where people can have their hair done once a week. The registered manager showed us a plan of activities for the Christmas period. These include Christmas floristry, fashion shows, pantomime, raffles, a local schools Christmas concert, hairdressing party, aerobics, Christmas carols, string quartet, presents and seeing in the New Year. People who use the service told us that there was a very good atmosphere at the home. One person told “the garden is wonderful, it’s so nice to sit in the garden on nice days” another person told us “we have such a laugh with the staff”. The registered manager told us in the AQAA that the home has open visiting arrangements and strong links with the local community. The home is located close to Blackheath Village and people who use the service have easy access to local amenities. The local community is actively involved in the life of the home. There are good levels of flexibility of routines for example waking and bedtimes, choice of meals and mode of dress etc. People are encouraged to personalise their rooms, bring their own furniture, pictures, photographs etc. Pet visitors are welcomed in the home. People can make private telephone calls in their room. Also use of private space (not bedroom) if required. A visiting relative told us “I have no complaints about this place, it is very friendly and homely, the General Practitioner is marvellous and the nurses are very patient with my husband, they are like angels without wings”. It was recommended at the last key inspection that the registered manager get a copy of signed agreements between three service users and the provider in respect of management responsibility for their financial accounts. It was also recommended that the registered manager request that regular financial statement be provided regarding their finances. The registered manager told us that most people look after their own finances or relatives have a power of attorney. She told us that the home tries to ensure wherever possible that people retain control over their finances. Only four people are supported with their finances. She produced copies of letters sent to those people indicating the current balance in their bank accounts and advising that if they had any queries then they should contact her. A letter is also sent to those people asking them if they are happy with the current financial arrangements. Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 16 The inspector joined three ladies for lunch. They told him that they enjoyed the food offered at the home but that this was not always the case. They had recently expressed their concerns about the food; they told the registered manager that they would prefer more traditional English fare. They felt that the registered manager had listened to what they had to say and made changes to the menu. One person told us “I was very pleased with the outcome, the manager has an open door and always listens to what we have to say”. Lunch was chicken chasseur, potatoes and green beans followed by a choice of rice pudding and jam, fruit or a yogurt and a cup of tea. The meal was well presented and very tasty. The home keeps records of food eaten by people who use the service and the chef retains records of peoples individual dietary needs Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 17 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a clear complaints procedure that is accessible to the people who use the service. Policies are in place for the protection of vulnerable adults and staff complete training in this important area. EVIDENCE: A requirement was set at the last key inspection that the home should ensure that all complaints including verbal are recorded with relevant information and the outcome and any action taken. All staff should be reminded of the value of the complaints procedure and the part this plays in the provision of a quality control mechanism. The registered manager produced a record of complaints made to the home. Eight complaints had been received at the home in 2008. All of the complaints had been resolved to the satisfaction of the complainant and within the timescales required. She told us that the complaints procedure had been discussed with staff following the last key inspection. The complaints procedure was clearly displayed in the entrance area of the home. The complaints procedure indicates whom the complaint should be Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 18 made to, how the service will deal with the complaint, timescales for action and details of the Commission For Social Care Inspection. The home has a policy and procedure in place with regard to the protection of vulnerable adults. Staff training records show that most staff has attended training on the protection of vulnerable adults. The registered manager told us in the AQAA that this was an area where the home could do better. The home could offer consistent staff training and regular updates on elder abuse and adult protection issues and training to raise awareness around managing complaints particularly in the absence of a manager. Over the last twelve months the home has reviewed and updated the policy on complaints. Arranged staff training on customer services and dealing with complaints. Arranged staff training on Elder Abuse and Protection of Vulnerable Adults. Regular surveys have been sent out from head office to monitor customer satisfaction. Over the next twelve months the home plans to continue to provide ongoing training to maintain skill levels among staff regarding complaints and adult protection issues. As the AQAA was completed in May 2008 much of this has already been achieved. People who use the service told us that they would be confident that any concerns they had would be listened to and acted upon by the staff team and the registered manager. Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use the service live in a safe and well-maintained and comfortable environment, which is clean pleasant and hygienic. EVIDENCE: The location and layout of the home is suitable for the needs of people who use the service. People who use the service have their own bedroom with en suite facilities. The home is well maintained and there is an internal system for reporting and carrying out maintenance. The home is of a modern design and is clean and kitted out with lifts, hoists and a well maintained fire alarm system. The grounds of the home are kept safe and tidy, and the home is completely wheelchair accessible. One person told us “the garden is wonderful, it’s so nice to sit in the garden on nice days”. Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 20 The registered manager told us in the AQAA that over the last twelve months that bedrooms were redecorated when they were vacated. Curtains and carpets cleaned or were replaced as required. Work commenced to convert double rooms with singles with en suite facilities on 1st and 2nd floors. Work commenced to enhance dining facilities on 1st and 2nd floors. Works have commenced on redecoration and refurbishment of the home. As the AQAA was completed in May 2008 much of this has already been achieved. The home employs three full time cleaners and a separate window cleaner. Clinical waste is collected under contract and this includes pharmaceutical waste such as sharps. There is sufficient laundry facilities that include sluice machines and a macerator for disposal of incontinence materials. The home is maintained to a very high standard of cleanliness and was so on the day of inspection. The registered manager told us in the AQAA that checks on the homes electrical, emergency call and fire equipment, gas appliances, hoists and lifts have been carried out. Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 21 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 and 30. 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. Staff have good training opportunities. The recruitment process is good with systems to make sure that appropriate checks are made. Staff supervision sessions need to take place more often. EVIDENCE: A requirement was set at the last key inspection that the registered provider must ensure that all new staff are registered on a recognised induction programme from the commencement of employment and that the manager is adequately supported to provide for this induction, including maintaining adequate records for each member of staff. The registered manager told us that two members of staff started employment at the home since the last key inspection. One of these staff has subsequently left. The remaining member of staff has completed the Mulberry House, Developing Competent Carers, Induction and Training record. The induction Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 22 record had been signed but had not been dated. It is recommended that the member of staffs Induction and Training record is dated. Some members of staff have moved to the home from Mulberry House another home run by the Ranyard Charitable Trust. The registered manager produced evidence that these members of staff had also completed an induction. A requirement was set at the last key inspection that the registered manager must ensure that all nursing and care staff are formally supervised at least six times a year and that written records are kept. The registered manager produced evidence that staff supervision has taken place on a more regular basis however not as required on a six times a year basis. All staff now has a supervision contract. A number of staff spoken to during the inspection told us that prior to the registered manager coming to the home in April 2008 that they had little or no supervision and that since the registered manager has arrived things have improved greatly. It is recommended that all members of staff receive formal recorded supervision at least six times a year. A number of staff personnel files were examined. All contained Criminal Record Checks, application forms, two written references, medical questionnaires, contracts, qualifications and proof of identification. The new member of staffs file did not include proof of identification. The registered manager told us that this was an oversight and not a usual occurrence. It is recommended that the registered manager obtain proof of identification for the new member of staff and keep in their personnel file. The registered manager produced a workforce development plan for 2008/9 this included staff training completed over the last twelve months and plans for staff training over the next twelve months. 73 of the staff team has completed an NVQ level 2 or 3 qualification in Care. The registered manager produced records of staff training. Records showed that most staff had attended training on fire safety, health and safety, adult protection, moving and handling, and food hygiene. Dates have been arranged in December 2008 for senior carers to attend training on moving and handling and first aid. Senior carers will become appointed persons in first aid and be able to monitor and support staff around moving and handling. A number of people who use the service told us that sometimes-staffing levels are low. They told us that this was because some staff doesn’t come into work because they are sick and they are not replaced. They had passed their concerns onto the registered manager. The registered manager told us that this was a concern for the home whilst trying to provide appropriate levels of staff cover. Some staff had in the past called in not fit for work at the last minute making it difficult for management to get staff in. The registered Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 23 manager told us that she is monitoring staff sickness and absence. Things had improved recently but there is room for improvement. Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed whilst maintaining an atmosphere of calm and conviviality. The management approach of the home creates an open, positive and inclusive atmosphere. EVIDENCE: The registered manager started working at the home in April 2008. She had previously managed the home and the Mulberry House another home run by the Ranyard Charitable Trust. She is a registered nurse with fourteen years management experience; she has completed the Management Faculty of Human Sciences at the University of Greenwich and recently completed the Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 25 Registered Managers Award NVQ level 4. She told us that the previous manager had left the home last year and the home had experienced some difficulties. She was brought in to raise standards in the home. People who use the service and staff spoken to on the day of the inspection told us that the registered manager had made great improvements at the home. She had an open door policy and always prepared to listen to what they had to say. Requirements were set at the last key inspection that the registered provider and manager must put in place an Annual Development Plan based on information gathered from audits, surveys and management observations, and make the published results available to service users and the registered manager must develop the current annual audit system to include such areas as care and support and should also include risk assessments conducted and also an audit of staff development. The registered manager produced an Annual Development Plan for the home. The plan included structural improvements to the home, service contracts, residents meetings, staff development, corporate risk assessments, audits and questionnaires to residents, relatives, health care professionals and staff for quality assurance feedback. Regulation 26 visit reports observed people who use the service and staff comments, staff sickness and absence, training, accidents and incidents and complaints. A requirement was set at the last key inspection that resident/relatives meetings must be held at least quarterly. Minutes of meetings must be produced showing actions to be taken by staff members and the outcomes reviewed at subsequent meetings. The registered manager told us that residents meetings are held quarterly and produced minutes from resident/relatives meetings. The registered manager told us in the AQAA that the home has a comprehensive policy document approved by the Trustees that is regularly reviewed and updated. Quality assurance surveys are sent out from head office to all of the people who use the service, their relatives and visiting healthcare professionals in order to understand better how the service is meeting expectations and how it can be improved. The quality assurance audit has been updated to include more information on care planning. An independent auditor conducts an audit on annual basis. Monthly financial reviews of budgets are carried out. Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 26 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 4 X X X X X X 4 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 X 3 X 3 X X 3 Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 27 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. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended that the reason for the nonadministration of medication be recorded on the appropriate section of the medication administration record. It is recommended that the registered manager obtain proof of identification for the new member of staff and keep in their personnel file. It is recommended that all members of staff receive formal recorded supervision at least six times a year. 2. 3. OP29 OP30 Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Ranyard at Dowe House DS0000070182.V373077.R01.S.doc Version 5.2 Page 29 - 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. 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