Inspection on 01/02/06 for Rakelands Nursing Home

This inspection was carried out on 1st February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rakelands Nursing Home 14/11/06

Rakelands Nursing Home 05/09/05

Rakelands Nursing Home 20/01/05

Rakelands Nursing Home 13/07/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Rakelands Nursing Home London Road Rake Liss Hampshire GU33 7PH Lead Inspector Tracey Box Unannounced Inspection 1st February 2006 10:00 Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 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 Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 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 Adults 18-65. 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. Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Rakelands Nursing Home Address London Road Rake Liss Hampshire GU33 7PH 01730 894621 01730 890036 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) Robinia Care Limited Mrs Yasmin West Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th September 2005 Brief Description of the Service: Rakelands is a care home providing accommodation and nursing care for up to sixteen younger adults with learning and physical disabilities. Rakelands is a large detached home set back off the main road on the outskirts of a village called Rake. Rake has a village shop, post office and garden centre. The home is owned by Robinia Care Limited, a national company who own a number of care homes within Hampshire. The home also provides day service facilities which include physiotherapy, horticulture, music therapy a sensory room, cookery, and a craft room. The home has a hydrotherapy pool and a large trampoline which service users use on a regular basis. Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over three and a half hours. The people living at Rakelands prefer to be referred to as service users, therefore will be referred to as this throughout the report. The inspector witnessed good interacting between the majority of service users and staff who were participating in activities that service users seemed to enjoy, which included physiotherapy and exercises. The inspector looked at records and asked staff for their views of working in the home. The manager showed the inspector the layout within and surrounding the home, which appeared clean, comfortable and warm, providing a pleasant environment for the service users. What the service does well: What has improved since the last inspection? Additional expenses payable by the service are clearly stated in the individual s statement of terms and conditions. A record of staff who have attended fire drill practices is in place. Service user files have been set up which include all information regarding the individual being held in one file. Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 6 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. Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 5. Practices need to be improved to ensure service user’s contracts with social services are available at the home. EVIDENCE: The home did not have any records of the social services contract for each service user they provide funding for. Each Service users contract with Social Services is held at the Robinia head office, this is common practice within Robinia homes. The home must ensure copies of service users contracts with social services are held within the home to enable the manager to monitor contractual obligations to provide additional staffing in order to support service users appropriately. THIS REMAINS A REPEAT REQUIREMENT FROM 05/10/05. Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9. Practices within the home demonstrate that service users are encouraged to make decisions about their lives and to take risks as part of an independent lifestyle. EVIDENCE: The inspector spoke with the manager and staff, who confirmed the way they ensure service users views are listened to is to communicate in the style and pace appropriate to the individual, spend one to one time with service users, arrange regular review meetings, form positive relationships with families, friends and outside agencies. One member of staff confirmed staff use a variety of ways to enable service users to make choices, for example, when choosing which clothes to wear, the staff member will arranging the options in front of the service user and prompt the service user to look and point to their choice. The same system is used when choosing to redecorate/ refurbish of areas within the home and where to go on holiday. One member of staff said the care plans are reviewed almost daily, any changes are discussed with the service user and agreed before any action is taken, signed documentation showed this practice occurred. Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 10 Service users see a speech therapist if required to help their communication. Care plans and risk assessments are also reviewed at the service users six month review, where relatives/representatives, day placement representative and social workers are invited if the service user wishes, the inspector saw four service users files which included detailed minutes from the reviews which included names of people who attended and what was discussed. Each service user has a timetable of daily activities, which is devised and agreed with them at their review. The home operates a keyworker system, which means each service user has a named member of staff who has specific responsibilities for the service user. The inspector saw staff communicate with service users in their preferred manner, as stated in their care plan. One service user used pictures to communicate with the inspector. Staff confirmed this has helped the service user to communicate more effectively. The manager explained “service users communicate in many different ways, usually a facial expression or body language informs us of whether or not the individual is happy or agrees with the outcome!” Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17. Service users participate in activities appropriate to their age, peer group and cultural beliefs as part of the local community. The home actively promotes appropriate personal, family and sexual relationships. Practices within the home demonstrate that individual rights and responsibilities are respected and recognised. Dietary needs of service users are well catered for with a balance and varied selection of food available that meets individual’s dietary requirements and choices. EVIDENCE: Staff explained that Service users are encouraged, in line with their care plan and risk assessments, to participate in social activities, both within the home and the community. Records of activities are recorded in the individuals care plan and daily records, these include daily activities such as art, games, awareness of the world by looking at stories in newspapers/magazines, listening to stories on audio tape, cooking and nutrition, as well as visits to the Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 12 cinema, theatre and shopping in Portsmounth and Basingstoke. Staff confirmed they often support service users in going to the pub, or to local areas of interest. Staff record on a daily basis what each service user has participated in and whether or not the service user enjoyed or benefited from it, this information then feeds into the service users review where a timetable of activities is discussed and devised. Care plans reflect the individuals cultural beliefs and individuals sexual preferences, the staff explained at present service users do not wish to partake in relationships, other than friendships outside the home. Should the need arise, service users would be fully supported and staff would follow the homes policy on personal and sexual relationships. Staff confirmed they would obtain support from outside agencies (an advocate) should it be required for any service user. The inspector witnessed the visitors book that detailed family and friends visits to the home. Staff reported there are no restrictions on visiting, unless stated in an individuals care plan. A copy of Service users rights and responsibilities are held in the service users guide, the home’s statement of purpose, and in each individual service users contract. The inspector saw the home’s menus displaying a variety of nutritious meals, which included an alternative. Food storage areas and fridges were well stocked with fresh and tinned produce, the menu displayed a variety of nutritious meals. The inspector saw a record of individual’s food intake, staff said this helps them to ensure service users are receiving a balanced diet that they enjoy. Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. Service users receive personal support in the way they prefer and require. Comprehensive procedures ensure service user’s physical and emotional health needs are met. Service users are protected by appropriately trained staff, who follow the homes policies and procedures for dealing with medicines. EVIDENCE: The care plans and risk assessments states how the individual wishes to receive their personal support and are reviewed on a monthly basis or as needs change with the service users agreement. Daily records comment on individuals daily activities, physical and emotional health and behaviour, records of visits to outside agencies, such as doctor, dentist, optician are kept on the individuals file, this enables the home to monitor and track the information recorded. The inspector sampled two care plans, both included guidance of how to meet the individual’s physical and emotional health needs, and most recent visits to healthcare professionals. One member of staff said “I find the information in the care plans very useful and detailed, it includes trigger factors to be aware of for behaviour and seizures, and what to do about an incident when it occurs.” Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 14 Staff confirmed they receive a variety of training to support service users, including, communication, awareness of disabilities, diabetes, epilepsy and care planning. At the time of the inspection, staff administer all service users medication. Staff told the inspector that residents prefer them to store and administer residents medication for them. The inspector saw medication being correctly administered, staff followed the homes medication policy and procedure, the home administers from single blister pack system provided by a local pharmacist and correctly stores the medication in a lockable cabinet which is on wheels, which enables staff to take the medication to the area that the service user is in. The home use ‘Medicine Administration Record Sheets (MARS) system for recording the administration of medication. The records kept in conjunction with medication received and returned to the pharmacist were sampled and were found to be correct. Records of all staff trained to administer medication were found to be in order. The inspector saw a risk assessment completed by the manager for drug administration errors. Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23. The home has satisfactory procedures for protecting service users’ form abuse EVIDENCE: Staff follow comprehensive care plans and risk assessments for a service users who may harm others, the inspector found the records to be eligible and complete, staff confirmed the details in the care plan and risk assessments enable them to carry our their role effectively. The inspector saw the homes adult protection procedure, which includes the Department of Health “No Secrets” guidelines. The home has a copy of Hampshire’s guidelines for the Protection Of Vulnerable Adults. Staff confirmed they have attended abuse awareness training, and that abuse was covered during their comprehensive induction, the inspector sampled staff’s files include records of training and certificates. Staff said they discuss issues surrounding abuse policy and procedures at their monthly staff meetings with their line manager supervisions, and confirmed their awareness of the procedure and where to find it should it be required. Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30. The home is safe, clean and hygienic, however, some areas within it require attention to ensure it is a comfortable and pleasant environment for service users to live in. EVIDENCE: The manager showed the inspector around the home, all appeared well maintained, however the sofas and dining room chairs in lounge/diners one and three need replacing to provide more appropriate comfortable seating to meet the needs of the service users. The manager confirmed new chairs have been ordered and are being delivered in the next few days. All bedrooms were brightly decorated and had personal effects in, such as posters and photographs on the walls. The manager explained service users are encouraged to furnish the room with personal belongings, furniture and pictures to make it feel like home. The rest of the home appeared clean, warm and no offensive odours were detected. The home’s radiators and pipe work are safe ensuring that all potential hot surfaces are kept to low temperature. Some bedrooms had special adaptations to ensure the safety of the service user, risk assessments and care plans confirmed this. Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 17 The garden is well maintained and is accessible to service users. The inspector witnessed the homes procedures to ensure hygiene is maintained, staff were seen to use protective clothing whilst completing their cleaning and food preparation and serving duties. The inspector saw certificates of staff who have attended Infection control and food hygiene training, staff confirmed they found the training useful. The home have developed an ‘infection control committee’ which consists of domestic and care staff and registered nurses. The committee will meet monthly to discuss issues and practices. Results of this will be feedback to the remaining staff and service users at their monthly staff meeting. Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34. Service users needs are met by staff who are well trained, supportive and in sufficient numbers. The home operates robust recruitment, induction, training and development procedures to ensure that ensure service user’s are not put at risk. EVIDENCE: The manager confirmed staffing levels are adequate, the rotas showed that there were ample staff on duty to meet the service users joint and individual needs. The manager said the home uses agency staff if required to cover shifts, and that the home requests the same agency staff to provide continuity. Staff were seen to be spending one to one time with service users who require additional support, this was reflected in the individuals care plan and on the staff rota. One member of staff said “I feel we have adequate staff on duty to meet the needs of the service user.” The manager is positive and supportive of staff development and training, the inspector saw records which show staff receive regular supervisions, annual appraisals and various staff meetings that are minuted. Certificates showed staff had received all mandatory training, the manager explained there is always someone on duty who has attended Strategy for Crisis Intervention and Prevention (S.C.I.P.) training. Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 19 One staff member said “ I feel I have adequate training in order for me to carry out my job, I can just ask if I want training, I don’t have to wait until a meeting or my supervision.” Staff explained “we work well together as a team, during staff meetings we talk openly and share ideas and support one another, this helps us meet the needs of all service users.” 80 of the staff team have either achieved or are working towards their National Vocational qualification (NVQ) level 2 and 3 and the Certificate In Working with People with Learning Disabilities The inspector was able to sample three different staff records and found that they were detailed with the necessary checks taken to ensure staff are fit to work at the home. The manager confirmed that the home’s induction programme has been assessed against the Skills for Care Council induction standards. One member of staff said she had completed induction training and Learning Disability Award Framework, which included training on, policies and procedures of the home, learning disability, epilepsy, visual impairment, Autism, syndromes relevant to the needs of the service users and communication-“I feel that the induction training I have done so far has given me the base training to enable me to start a career in this field.” “I attended a course about ‘Makaton’ this helps me to communicate with the service users very well.” Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39. The systems for service users consultation are good, with some evidence that indicates service users views underpin all self monitoring, review and development by the home. EVIDENCE: Robinia have a service users forum, two service users from Rakelands attend a meeting as representatives of the home to discuss various issues with other service users who live in homes owned by Robinia South. The home arranges an annual open day for families, social workers and anyone else service users want to invite, giving people the opportunity to visit the home and see how it is run. The inspector receives monthly reports from the homes responsible individual when they visit the home, in which service users are consulted on their views of the home, to meet regulation 26 of the Care Standards Act (CSA). The manager said the provider sent a satisfaction survey to service users, their families/representatives, social workers and staff on an annual basis. The results of this survey were not available for the inspector to read. Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 21 Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 X 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X X X 3 X X X X Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 23 YES Are there any outstanding requirements from the last inspection? 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 YA5 Regulation 5 (3) Requirement The home must ensure copies of service users contracts with social services are held within the home. THIS IS A REPEAT REQUIREMENT FROM 05/10/05 Timescale for action 02/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 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 Rakelands Nursing Home DS0000011536.V280890.R01.S.doc Version 5.1 Page 25 - 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. 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