Random inspection report
Care homes for older people
Name: Address: Mavesyn Ridware House Church Lane Mavesyn Ridware Near Rugeley Staffordshire WS15 3RB zero star poor service 18/01/2010 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jane Capron Date: 3 0 0 3 2 0 1 0 Information about the care home
Name of care home: Address: Mavesyn Ridware House Church Lane Mavesyn Ridware Near Rugeley Staffordshire WS15 3RB 01543490585 01543490585 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Sandra Margaret Black Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mavesyn Ridware Residential Home Ltd care home 21 Number of places (if applicable): Under 65 Over 65 0 21 0 dementia old age, not falling within any other category physical disability Conditions of registration: 6 0 8 The maximum number of service users who can be accommodated is: 21 The registered person may provide the following category of service only: Care Home Only (Code PC) 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 (OP) 21 Physical disability (PD) 8 Dementia (DE) 6 Date of last inspection
Care Homes for Older People 1 8 0 1 2 0 1 0 Page 2 of 9 Brief description of the care home Mavesyn Ridware is located off a public transport route near to Armitage and Handsacre. It provides care and accommodation to 21 older people. The service stands in its own grounds with stunning views, the gardens are well maintained and offer appropriate seating areas for the people who use the service. The service has a large lounge, conservatory and separate dining room. Bedrooms are single occupancy and some have an en-suite facility. The current range of fees are not included in the Service User Guide. People are advised to contact the home directly for this information. The most recent inspection report is available from the home upon request. Care Homes for Older People Page 3 of 9 What we found:
We undertook a random inspection to check the services progress in meeting the requirements we made at the last key inspection. Following the last key inspection the service sent us with an improvement plan to show how they would address the issues we had raised. This random lasted approximately five hours hours. During that time we looked at a range of documents, spoke to staff and the manager and spent time observing the care and support people receive. We saw that the service had responded t the requirements relating to health and safety issues. Staff had received training in fire safety and fire drills had taken place. The service does still need to ensure night staff have a fire drill. The manager is to write and confirm to us that this has been completed. The fire alarm was now being tested as required. The service had also completed a assessment relating to potential hazards at the service. We saw evidence that issues raised had either been addressed or had been referred for attention. On our previous inspection the service did not have proper records evidencing the involvement the staff had in supporting one person with their money. We saw that a system is now in place to address this. This will safeguard both the person concerned and the staff. We therefore feel that the requirement in respect of this has been met. The service had made progress in providing people with support to have their dental needs met. The service has arranged for a dental practice to visit the service. We therefore feel that adequate progress had been made to meet this requirement. We have however asked the service to confirm to us by letter when this is fully in place. Gaps were found in the staff records in respect of identity checks and references when we visited last. The service has started to reorganise the files ensuring that all the necessary documentation is in place. The service is to provide us with written confirmation that all files are completed. In the light of this we feel that sufficient progress has been made for this requirement to be met. We identified at the last inspection that the service had no evidence to support that it was auditing and reviewing its fall risk assessments. On this inspection the service had addressed this issue and we saw evidence that audits of falls are taking place and actions taken to address any falls. We feel therefore that this requirement is met. At previous inspections we found that the service did not know the safeguarding procedures and that this had led to an incident not being referred properly. We spoke to three staff and the manager and they confirmed that they had received training and that further training was arranged. All of the people we spoke to knew that the correct procedure was to refer potential safeguarding incidents to the local authority. This should ensure that incidents will be correctly responded to in the future. We therefore feel that the service has met this requirement. When we visited last time we felt that the staff did not have the skill and knowledge to
Care Homes for Older People Page 4 of 9 meet the needs of people with dementia and mental health issues. The service has informed us that it will now only be admitting people with dementia care needs rather than other mental health conditions. We noticed that some changes had been made. We saw one staff member going through a photo album with one person and the manager informed us that albums of photographs have been developed for some of the people with dementia. We also saw that the service had introduced some pictorial signage to help people to orientate themselves to the building. As part of this inspection we spent dome time observing people in the lounge looking at their state of wellbeing and their interactions and relationships with staff. We found that there was limited interaction between staff and the people with dementia although several staff tried to engage with them. People were also encouraged to take part in a quiz although we felt this was not suitable for people with dementia. One staff member we spoke to had some understanding of the needs of people with dementia and was able to tell us of how two people living at the home could be stimulated through for example stroking a dog and looking at pictures. However we feel that although staff are caring and motivated to provide a good service to people with dementia but do not as yet have all the skills and knowledge to do this appropriately. The manager did tell us that the service is in the process of arranging in depth training for the staff. Although improvements have been made and there is the staff motivation to develop their skills we feel that this requirement is not met. We have asked the service to confirm in writing to us the dates of the training. We will look at this area again on our next key inspection. On this visit we did not look at whether the service had addressed the recommendations we had made at the last key inspection. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 5 of 9 Are there any outstanding requirements from the last inspection? Yes R 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 30 18 Staff must have the knowledge and skills to be able to support people with needs relating to mental health issues including dementia care and mental disorder. This will ensure that people with these needs are provided with the support they need. 20/03/2010 Care Homes for Older People Page 6 of 9 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 Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 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 7 Person centred plans should contain all the relevant information to support staff to provide people with the support they need, particularly in respect of people with more complex needs. The service should review it current nutritional assessment document to ensure that it is the most relevant tool for the people it cares for. The service should look at ways of meeting peoples spiritual needs. People should have more opportunity to take part in activities of their choice both in and out of the service. The provision of activities should take account of peoples individual and diverse needs including those people with needs relating to dementia care and mental disorder. The complaints procedure should provide the correct address of the Commission to enable people to make contact if they wish. The manager must keep up to date with current practices including being competent in such areas as person centred
Page 7 of 9 2 8 3 4 12 12 5 16 6 31 Care Homes for Older People 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 planning, risk management and quality audits. 7 8 31 33 The service should ensure that the manager has sufficient time to undertake the management tasks required. The service should put in place a robust method for reviewing and monitoring the service. Care Homes for Older People Page 8 of 9 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 9 of 9 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
