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Inspection on 13/05/08 for Ryedale Court Nursing Home

Also see our care home review for Ryedale Court Nursing Home for more information

This is the latest available inspection report for this service, carried out on 13th May 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There was a very good response from surveys and generally all commented positively about the quality of care being provided in the home. Comments included: "Despite numerous staff changes, the friendly, caring staff attitudes remain, thanks to the present, experienced care home manager". "The nursing staff and carers treat my mother with respect and look after all her needs". As part of the inspection, contact was made by phone with two funding authorities. They both expressed no current concerns about the care being provided; and that issues raised were well received and acted on accordingly. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. Staff working in the home have received training in safeguarding adults to ensure that there is a proper response to any suspicion or allegation of abuse.

What has improved since the last inspection?

There have been marked and significant improvements in the service delivery and quality of care in the home, across all areas of the service. The manager is very resident focused and has worked hard, with the support of the staff team, to improve services and provide an increased quality of life for people living in the home. The decorating and refurbishment programme has been significantly progressed and the living environment now appears more attractive and homely. Together with the increased standard of cleanliness and comfort this has added considerably to the quality of everyday life for the residents It was evident that the skills and training deficits highlighted at the last inspection have been proactively addressed and training is being given a high profile by the organisation. Staff have received training in equality and diversity, wound care, moving and handling, health and safety, medication, safeguarding vulnerable adults, dementia, palliative care and dyingbereavement. Some staff have received training in the implications of the Mental Capacity Act 2005.

What the care home could do better:

Staff need to ensure that daily recordings are more in line with outcomes identified in the care plans, and also that the implications of the Mental Capacity Act are routinely taken into account in both care planning and daily recordings. There should be further development of specific `night` and end of life care plans. The registered persons must ensure that staffing levels are kept under review so that at all times there are sufficient staff and resources to meet residents assessed needs.

CARE HOMES FOR OLDER PEOPLE Ryedale Court Nursing Home Victoria Road Barking Essex IG11 8PE Lead Inspector Ms Gwen Lording Unannounced Inspection 13th May 2008 09:15 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 Ryedale Court Nursing Home DS0000015602.V362854.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. Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ryedale Court Nursing Home Address Victoria Road Barking Essex IG11 8PE 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 8514 2525 020 8514 2727 ryedalecourt@btconnect.com Avonpark Care Centre Limited Manager in post – application for registration currently being processed Care Home 70 Category(ies) of Dementia (70), Dementia - over 65 years of age registration, with number (70), Old age, not falling within any other of places category (70) Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include service users in the category Dementia (DE) aged 55 years and over. Date of last inspection 28th August 2007 Brief Description of the Service: Ryedale Court Nursing Home provides nursing care and accommodation for older people who have dementia or physical frailty due to the ageing process. The home is registered to accommodate seventy service users. The registered providers are Avonpark Care Centre Limited. The home has three separate units and the majority of the rooms are single and en suite. There is a passenger lift. The home employs an activities co-ordinator, catering, laundry, housekeeping, administrative and maintenance staff. The home is situated in a residential area of Redbridge on the borders of Barking and is well served by public transport. On the day of the inspection the fees for the home were between £550.00 and £750.00 per week. A copy of the Statement of Purpose and Service User Guide is made available to both the resident and the family. This information is also held at the main reception and on all three units. A copy of the most recent inspection report is available on request. Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use the service experience good quality outcomes. This was an unannounced inspection, which took place over six hours. The inspection was undertaken by two inspectors, namely the lead inspector Gwen Lording and Sandra Parnell-Hopkinson. One inspector focused on the care of residents on the dementia unit - Oaklands, and the other inspector focused on the care of residents requiring nursing and personal care due to frailty/ illness on Park and Garden suites. We also looked at the area of safeguarding in detail during this inspection. The home’s manager was available throughout the visit to aid the inspection process. This was a key inspection in the inspection programme for 2008/2009. We undertook an unannounced random visit to the home on 06/02/08. The reason for this inspection was to ensure that there were appropriate staffing levels in place to ensure the welfare and safety of residents, and also staff. This was following a concern raised by a placing authority. An Immediate Requirement was issued for the registered persons to ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The manager has reviewed staffing levels in line with individuals assessed nursing and care needs. Discussions took place with the manager; activity co-ordinator; kitchen and laundry staff, and the home’s administrator. We spoke to a number of residents and relatives on each unit; and where possible residents were asked to give their views on the service and their experience of living in the home. Nursing and care staff were asked about the care that residents receive and were also observed carrying out their duties. A tour of the premises, including laundry and main kitchen was undertaken. The files of several residents on each unit were case tracked, together with the examination of other staff and home records. This included medication administration, staff training and staff recruitment procedures and files, maintenance records and complaints. Information was taken from an Annual Quality Assurance Assessment (AQAA); which was completed by the manager and returned to us prior to the inspection. This is a self-assessment process, which all providers are required to complete once a year. Additional information relevant to this inspection was also obtained from Regulation 26 monitoring reports and Regulation 37, notification of events. Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 6 Surveys were sent out prior to the inspection for completion by staff, residents where possible, and relatives. As part of the inspection process the views of funding authorities that place residents in the home were sought and are commented on in this report. We asked the staff and several people living in the home how they wished to be referred to during the inspection. The majority expressed a wish for people living in the home to be referred to as ‘resident’. This is reflected accordingly in the report We would like to thank the residents, relatives and staff for their input during the inspection. What the service does well: What has improved since the last inspection? There have been marked and significant improvements in the service delivery and quality of care in the home, across all areas of the service. The manager is very resident focused and has worked hard, with the support of the staff team, to improve services and provide an increased quality of life for people living in the home. The decorating and refurbishment programme has been significantly progressed and the living environment now appears more attractive and homely. Together with the increased standard of cleanliness and comfort this has added considerably to the quality of everyday life for the residents Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 7 It was evident that the skills and training deficits highlighted at the last inspection have been proactively addressed and training is being given a high profile by the organisation. Staff have received training in equality and diversity, wound care, moving and handling, health and safety, medication, safeguarding vulnerable adults, dementia, palliative care and dyingbereavement. Some staff have received training in the implications of the Mental Capacity Act 2005. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ryedale Court Nursing Home DS0000015602.V362854.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 Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 & 5 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. A pre-admission assessment is undertaken for all prospective residents. Care plans are drawn up from the information in this assessment ensuring that the needs of the residents are identified, understood and met. The home does not offer intermediate care. EVIDENCE: Individual records are kept for each resident and a number of files were examined on each unit. All contained a comprehensive pre-admission assessment from which a care plan had been compiled with input from the resident where possible, family members where appropriate, and health and social care professionals. Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 10 Prospective residents and their families have the opportunity to visit the home, talk to staff and assess the home’s facilities. Relatives commented: “I chose this care home for my mother because of the friendly atmosphere and the welcome we received from all staff”. “We were given very good and clear information from the manager when selecting this care home”. Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 & 11 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Residents’ health and personal care needs are set out in individual care plans and provide staff with the information they need to satisfactorily identify and meet residents’ needs. There are clear medication policies and procedures for staff to follow, so as to ensure that residents are safeguarded with regard to medication. All residents could be assured that at the time of their death, staff would treat them and their family with care, sensitivity and respect. EVIDENCE: A significant improvement was noted in the standard of care plans and health related documentation since the last inspection. Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 12 Individual care plans were available for each resident and a total of fourteen files were case tracked, across the three units, and their care plans and related documentation inspected. It was not possible to talk to some residents in a meaningful way due to dementia however; it was evident from the care plans and from talking to the staff that the health care needs were being met. There was evidence that residents are able to access GP, dental care, chiropody services, optician and other specialist medical services as necessary. Care plans showed evidence that nutritional screening is being undertaken on admission and that a record is maintained of nutrition, including weight gain or loss. Where concerns are indicated there is evidence that appropriate action is taken, with an initial referral to the GP and then to a dietician or nutritionist. Where necessary advice and input is sought from the TVN (tissue viability nurse) and such a nurse was visiting the home on the day of the inspection. We spoke to the nurse who told us: “Staff are much better now and they refer to us sooner rather than later. The nurses are much more knowledgeable about residents and wound care. Because I visit the home regularly I have noticed that staff generally are more interactive with residents, and are really helpful to us.” The unit nurses told us that they had had training in wound management since the new manager had taken over. A resident who was diabetic, had a detailed care plan around the monitoring of the diabetes, and further records showed that regular blood monitoring was being undertaken in accordance with the care plan. However, another care plan indicated that the resident needed help with oral healthcare, but there was no detail around this. Where necessary risk assessment were in place, and in discussions with staff members they demonstrated a good understanding of the residents’ needs, and also of the identified risks associated with each individual, such as at risk of falling, or indicators which may lead to exhibiting behaviours which challenged. Accidents sustained by residents are being recorded on their files, together with any action, which has been taken, plus risk assessments are being updated when necessary. We observed that residents were from mixed ethnic groups as were the staff. Equality and diversity issues are addressed by the staff, and there was some evidence on the care plans around religion, dietary needs and language. For example one resident speaks only Urdu, and a member of staff who also speaks this language is designated as the residents key worker and this is included in the care plan. However, although there was a question on sexuality there was no meaningful information recorded. The questions were posed negatively, such as ‘displays no inappropriate behaviour’, ‘evidence of disinhibition’ and ‘exposing, and the assessor would just mark which they felt appropriate. However, all care plans examined did indicate preferred gender care. We did discuss with the manager the limitations of the current Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 13 assessment forms, and she acknowledged that they do require a review to ensure that all areas of equality and diversity are addressed in a more appropriate manner with more accurate and meaningful recordings. We were told that some of the staff have recently undertaken training around equality and diversity. Some files showed evidence of end of life care needs and wishes. However, these should be transferred into the actual care plan to ensure that such important information does not become lost. Some files contained a specific ‘night’ care plan, but there were some files which did not have such a plan. Whilst care plans were being reviewed on a monthly basis, but the manager must ensure that reviews are undertaken in a meaningful way and do not become a mechanical exercise with “no change” being automatically recorded. This, together with the need for night care plans and end of life care plans, was discussed at the time of the inspection. Staff also need to ensure that daily recordings are more in line with the outcomes identified in the care plans, and also that the implications of the Mental Capacity Act are taken into account in both the care planning and the daily recordings. We discussed with the manager the fact that some residents with dementia, and others because of physical fraility were unable to use the emergency call alarm system in their bedroom. With the increasing use of assistive technology in care homes some other systems may be of more benefit to some residents. Some assistive technology is in current use in the home, and this alerts staff when a particular resident turns over in bed. It is recommended that the service give consideration to the use of more assistive technology in the home. An audit was undertaken for the handling and recording of medicines within the home, and a sample of Medication Administration Record (MAR) charts were examined on each floor. We found these to be in good order. Controlled drugs were being store appropriately and the controlled drugs register was up to date. Room and refrigerator temperatures are taken and checked on a daily basis with a record being maintained. The home has recently changed the supplier of the monitored dosage system used in the home. Although not all residents have an end of life care plan, the home has been very proactive in ensuring that some nurses and staff have received training in palliative care. This was evidenced when a resident with a terminal illness chose to remain at the care home until the end of her life. Nurses had been trained in palliative care and the use of syringe drivers. Care workers had also undertaken training and were able to recognise signs and symptoms and so alert the nurses. Nurses and care workers worked as a team to provide consistent care to the resident, and when requiring support were able to contact the local Macmillan Nurses and also PELC (Partnership East London Corporation) where a locum GP could make changes to prescribed medication Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 14 for example, increase analgesia. Arrangements have been made with the home’s pharmacy who holds a stock of drugs and gave assurances that he would open up at any time for changes to medication, which had been prescribed by the GP. Staff used an end of life care tool, the Gold Standard Framework and the resident was allowed to end her life at the home, with family and staff around her and who knew her. There is now a designated room in the home for residents requiring such care and where family and friends can spend time. The relative of a resident admitted to the home for palliative care commented: “You will understand my high regard for Ryedale Court when I explain I was fortunate to get my wife admitted there for palliative care. She spent the last four weeks of her life in Ryedale Court, during which time she received the most loving care….second to none, for which I will always be grateful”. Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 15 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): Standards 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. There has been a review of the general activities programme, which now includes more trips outside the home and visits by professional entertainers. However, whilst only a small number of residents are able to participate in such trips the development of the sensory garden will benefit the majority of residents and their family/ friends. The routines of daily living are now more flexible to suit individual’s preferences and capabilities. The attitude and practice of the staff are now more proactive in promoting opportunities for residents to remain independent, exercise choice and express their wishes and needs. EVIDENCE: We were able to observe that some routines of daily living are flexible to suit the preferences and capacities of residents, especially around getting up in the morning and having breakfast. For example we observed that some residents were still enjoying breakfast at 10.30 a.m. However, we were concerned that Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 16 lunch was then being served at 12.30p.m. and did discuss the possibility of introducing a more flexible lunchtime into the daily routine, especially for those residents who enjoyed a later breakfast. We observed lunch being served and this was well presented on the plates, and residents with dementia were able to choose which meal as they were offered two choices at the time. They were able to make a choice through using other senses such as sight, smell and touch. Generally residents who required assistance were being given this in a positive and sensitive manner. However, this is still an area where some staff require more training, as some staff were still seen not to be talking to the resident while giving assistance and mixing the well presented meal into one unattractive plate of food. We observed that staff generally interacted well with residents, and demonstrated a good understanding of the differing needs of people living with dementia. Staff were seen sitting and talking, singing and watching a DVD with residents. We were able to speak to the activities co-ordinator who told us that “I think that activities have improved since the new manager came. There is more money for activities and I can now arrange trips out and also for entertainers to visit the home. We had an entertainer yesterday evening for the first time, and the residents really seemed to enjoy it.” We noticed that there were ‘rummage boxes’ in the lounges and saw some residents enjoying looking at the different items in these boxes. We were told that carers are now more involved in activities with the residents, and this was evidenced from observation. However, some comments from relatives in surveys returned to us included: “Activities should be increased – need additional staff to cover these duties”. “More entertainment” “For residents to be taken outside in the summer for walks or to get some fresh air” A visit was made to the main kitchen and we were able to discuss the storage and preparation of food, and menus with kitchen staff. The food is provided by an external catering company and is delivered to the home under cook/chill. with the exception of fresh vegetables and breakfast. The reviewing and amending of the menus and the quality of food provided is ongoing. Kitchen staff were aware of those residents requiring special therapeutic diets and other diets / foods to meet religious or cultural dietary needs. For example, Halal, vegetarian and Caribbean. There is a vegetarian option on the daily menu and fresh salad and prepared fresh fruits available at each meal. A cooked breakfast is provided each day and on the day of the visit ten residents had chosen one variety or other of this. The use of full cream milk, butter and cream is used wherever possible to supplement the diets of those residents with reduced food intake/ diminished appetite. Visiting times are flexible and relatives/ friends are encouraged to visit. Residents spoken to said that they always felt very welcomed by staff. One Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 17 relative commented: “It is reassuring for relatives that we are welcome to visit anytime, day or night…and I personally have done so”. Several spouses of residents visit every day and spend a good part of the day with them in the home. Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 18 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): Standards 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The home welcomes complaints, concerns and suggestions about all aspects of the service and uses these positively to improve service provision. The organisation and the staff team make every effort to sort out any problems and concerns. All staff working in the home have received training in safeguarding vulnerable adults to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: The complaints record was inspected, and it was evident that complaints are addressed in line with the home’s complaints procedure. The manager takes all complaints and concerns seriously, and uses the outcomes in a positive manner in order to improve services to residents. A fast track complaints/concerns system has been introduced and this does seem to be working well, with several relatives having used this. For example one relative had written “room and carpet could do with redecorating and replacement” and this had been responded to with a satisfactory outcome within 3 weeks. Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 19 All of the current staff have undertaken in safeguarding vulnerable adults, and this is included in induction training for all newly recruited staff. Some staff have also received training on the Mental Capacity Act, and its implications on the delivery of care to vulnerable people. We were able to evidence this on staff files and the training schedule. Those staff spoken to were able were able to demonstrate a good understanding of the organisation’s policy and procedures in this area and knew what action to take if they had concerns about the safety and welfare of residents, or if they witnessed any suspected abuse. Staff were also knowledgeable about the different types of abuse and the common indicators of abuse. Staff confirmed that safeguarding issues were always discussed at supervision and staff meetings. Since the last inspection there have been several safeguarding adult referrals to the local authority. However, these have been dealt with appropriately by the manager and the organisation, with any agreed actions fully implemented. The manager works co-operatively and openly with regard to safeguarding adult concerns. Information is provided in the home about how to contact independent external advocacy services. There is a policy on whistle blowing and challenging bad practice at work. A member of staff told us: “ I would report anything straight away, regardless of who it was”. Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 20 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): Standards 19, 20, 24 & 26 People using the service experience good quality outcomes area in this area. We have made this judgement using all available evidence including a visit to this service. There has been a notable improvement in the physical environment in many areas of the home. The living environment now appears more attractive and homely, with an increased standard of cleanliness and comfort, which adds considerable to the quality of life for residents. EVIDENCE: We toured the premises, accompanied by the manager, at the start of the visit and all areas were visited again later during the day. On Oaklands some of the bedrooms have been redecorated and are much brighter and there are plans for the corridor to be redecorated in the very near future. Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 21 We saw that there were some textured paintings on the walls of the corridor and this has made walking up and down more interactive for some residents as they were seen stopping, looking and touching these paintings. The decorating and refurbishment programme on both Park and Garden has been significantly progressed. This includes bedrooms, corridors and communal areas. Where there are no involved relatives staff had made good efforts to personalise individuals bedrooms and they were now more reflective of the occupant’s culture, religious and personal interests. Odour control and cleanliness throughout the home was very much improved. Relatives also commented on these improvements: “Home is now clean and welcoming”. Generally the communal areas were less cluttered and the layout of the furniture in the lounges more homely and appropriate to the specific needs and lifestyle of people living in the home. On the day of the visit a large number of portable air conditioners had just been delivered to improve residents comfort during the warmer weather. There are plans for the maintenance person to prepare a sensory garden with raised flowerbeds and seating areas, which would make this more accessible, and suitable for older people, some of who have sensory impairments. The home employs 1 full time and 1 part time maintenance person who are responsible for general maintenance duties around the home. There is now a more effective system in place for staff to report items requiring repair or attention. We visited the laundry and this was found to be clean, with soiled articles, clothing and foul linen being stored appropriately pending washing. Personal protective clothing and equipment were available and in use. Hand washing facilities are prominently sited and staff were observed to be practising an adequate standard of hand hygiene. Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 22 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): Standards 27, 28, 29 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Staffing levels are satisfactory and the effective deployment of staff ensures there are sufficient staff on duty to meet the assessed needs of the residents. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. EVIDENCE: We inspected staff rotas and the staffing levels and skill mix of qualified nurses and care staff, on all units was sufficient to meet the assessed nursing and personal care needs of the residents. The home was not up to full occupancy with approximately seventeen vacancies. We undertook an unannounced visit to the home on 06/02/08. The reason for this inspection was to ensure that there were appropriate staffing levels in place to ensure the welfare and safety of residents, and also staff. This was following a concern raised by a placing authority. An Immediate Requirement was issued for the registered persons to ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 23 The manager has reviewed staffing levels in line with individuals assessed nursing and care needs. The manager has developed and implemented a daily allocation sheet, which makes allowances for staff breaks. Staffing and resources are being more effectively deployed and utilised. However, in surveys returned staff and some relatives commented that staffing levels could be better. Comments from relatives included: “Main concern is staffing levels”. “Ryedale does a good job caring for my wife. The only improvement would be extra staff, especially during the busy periods”. Staff commented: “Increase the number of staff”. “We need more care staff in the mornings”. It is important that the registered persons keep staffing levels and resources under review and ensure that the home is staffed efficiently, with particular attention being given to the busy times of the day and in line with residents changing needs. We looked at the current training records and saw that staff have received training in food hygiene, equality and diversity, wound care, moving and handling, health and safety, medication, safeguarding vulnerable adults, dementia, palliative care, dying-bereavement and fire awareness. Some staff have received training in the implications of the Mental Capacity Act 2005. Equality and diversity is identified throughout the AQAA as an essential part of staff development, training and practice within the home. It was evident that the skills and training deficits highlighted at the last inspection have been proactively addressed and training is being given a high profile by the organisation. We were told that there are now lead nurses within the home for wound care, palliative care and continence. Ongoing training is available for all staff including National Vocational Qualifications. The AQAA stated that 100 of care staff are qualified to National Vocational Qualification (NVQ) level 2 or above. We inspected a sample of staff files and these were found to be in good order with necessary references, enhanced criminal records Bureau (CRB) disclosures, and application forms duly completed. All elements of recruitment are accurately recorded and all required documentation is obtained and verified prior to the commencement of employment Ryedale Court Nursing Home DS0000015602.V362854.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): Standards 31, 33, 35 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The manager is a very experienced and well-qualified person and residents benefit as the home is being run in their best interests. Monitoring visits are undertaken by the responsible person to monitor and report on the quality of service being provided in the home. EVIDENCE: The manager has been in post since August last year. She has submitted an application to the Commission to be registered as the manager and this is currently being processed. Ms McAweaney is very resident focused and has worked hard since she took up her post to improve services and provide an Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 25 increased quality of life for residents. She is building a strong and supportive staff team and working in partnership with the families of residents and professionals. Under her leadership there have been marked improvements in the service delivery and quality of care in the home, across all areas of the service. The manager has a clear understanding of what further improvements are needed and the key areas, which need further development. The AQAA clearly identifies the plans for improvement over the next year. Comments made by relatives in surveys also supported this noted improvement. Comments included: “The manager has made improvements since her arrival”. “The home is well run”. “The new manager has made so many changes” From viewing staff records and talking to staff we were able to evidence that staff are now receiving more regular supervision. This includes observational and peer supervision as well as 1:1 supervision sessions. A representative of the organisation undertakes monthly regulation 26 monitoring visits to monitor and report on the quality of the service being provided. A copy of the report is sent to the Commission. Currently the manager does not act as an appointed agent for any resident. Residents’ financial affairs are managed by the individual residents, or their relatives/ representatives. There is a computerised financial system, which is managed by the home’s finance administrator. Through discussion and records inspected, there was evidence to show that residents’ financial interests are safeguarded. Secure facilities are provided for the safekeeping of any valuables held on behalf of residents. The home employs 1 full time and 1 part time maintenance person who is responsible for general maintenance duties around the home, and ensures that routine checks are made on the water temperatures, emergency lighting, fire alarm testing, smoke alarm, PAT testing, pressure mattresses and chair cushions, and also to ensure that wheelchairs are kept in good order. Maintenance records were viewed and found to be in order on gas safety, electrical, lifts, hoists/baths, drug disposal, fire protection and a risk assessment, emergency call system and insurance. Ryedale Court Nursing Home DS0000015602.V362854.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 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Ryedale Court Nursing Home DS0000015602.V362854.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. 1. Standard OP27 Regulation 18 Requirement The registered persons must ensure that staffing levels are kept under review so that at all times there are sufficient staff and resources to meet residents assessed needs. Timescale for action 13/05/08 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 OP7 Good Practice Recommendations Staff need to ensure that daily recordings are more in line with outcomes identified in the care plans, and also that the implications of the Mental Capacity Act are routinely taken into account in both care planning and daily recordings. Ryedale Court Nursing Home DS0000015602.V362854.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Contact Team 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 Ryedale Court Nursing Home DS0000015602.V362854.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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