Inspection on 05/09/05 for Rakelands Nursing Home

This inspection was carried out on 5th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 but made no statutory requirements on the home.

Other inspections for this house

Rakelands Nursing Home 14/11/06

Rakelands Nursing Home 01/02/06

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 London Road Rake Liss GU33 7PH Lead Inspector Tracey Box Unannounced 05.09.05 9:30am 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 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 Stationary 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 H54 S11536 Rakelands V244820 050905.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Rakelands Address London Road, Rake Liss, GU33 7PH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01730 894621 01730 890036 Robinia Care Limited Mrs Y West CRH 16 Category(ies) of LD - 16 registration, with number of places Rakelands H54 S11536 Rakelands V244820 050905.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: N/A Date of last inspection 20.01.05 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, horticulure, music therapy a sensory room, cookery, and a craft room. The home has a hydrothapy pool and a large trampoline which service users use on a regular basis. Rakelands H54 S11536 Rakelands V244820 050905.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over five and a half hours by Tracey Box and Marilyn Lewis. Yasmin West, the manager, assisted the inspector. The people living at Rakelands prefer to be referred to as service users, therefore will be referred to as this throughout the report. The inspectors witnessed good interacting between service users and staff who were participating in activities that service users seemed to enjoy, including listening to dance music and staff spending one to one time sitting close by. The inspectors looked at records and asked staff for their views of working in the home. The manager showed the inspectors the layout within and surrounding the home, which appeared clean and comfortable, providing a pleasant environment for the service users. What the service does well: What has improved since the last inspection? Comprehensive care plans have been devised, and include all aspects of the individuals care and support needs, as well as risk assessments for pressure areas where necessary. Additional lighting has been installed in the stairwell between the ground and first floor to aid the escape route in case of a fire at night. The manager stated Staff moral has improved, resulting in an enthusiastic workforce that works positively with service users. The home have developed an ‘infection control committee’ which consists of domestic and care staff and registered nurses. The committee meet monthly to discuss issues and practices. Results of this are then feedback to the remaining staff at their monthly staff meeting. The inspector received verbal confirmation from the company’s client finance officer that Robinia Care Ltd have stopped claiming each Service users’ Disability Living Allowance (D.L.A.) to cover the cost of transport, this came into effect at the end of July 2005, and that one service user that had paid for two staff to support them during days out had been fully reimbursed to the sum of £100.00. Rakelands H54 S11536 Rakelands V244820 050905.doc Version 1.40 Page 6 Each service user can obtain up to £1.50 and towards the cost of lunch whilst away from the home. Staff can obtain up to £2.50 towards lunch expenses whilst on duty supporting a service user on an activity whilst working away from the home. 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 H54 S11536 Rakelands V244820 050905.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Rakelands H54 S11536 Rakelands V244820 050905.doc Version 1.40 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 standard(s) 2, 5 A comprehensive procedure for assessing the needs and aspirations of potential new service users is in place to ensure the service users and the homes needs are met prior to admission. Each service user has a statement of terms and conditions, however their content was limited regarding additional payments and fees. EVIDENCE: The inspector looked at four service users file which included two pre placement assessment forms which were completed by the service users social worker and Yasmin West. The information included educational and recreational wishes, likes and dislikes. Family/representatives are invited to participate in the completion of the assessment to obtain as much information as possible. The manager explained that prospective service users are invited to spend a day at the home with their own cars staff, if that is successful, the service user is invited to spend a night at Rakelands. The next stage of the assessment process involves the service user, their relatives and social worker meet with the manager of Rakelands where they all discuss the assessment, and whether or not the service user wishes to live at Rakelands, if the home is able to meet their needs. Four service users statement of terms and conditions were looked at, they included a list of extras the service user would be expected to pay for or contribute to, the following had a fixed fee: hairdressing, chiropody, Rakelands H54 S11536 Rakelands V244820 050905.doc Version 1.40 Page 9 physiotherapy with a physiotherapy assistant, one to one staffing, attendance at the resource centre. The following fee was stated as variable: homeopathic remedies, annual holiday, direct damage to furnishings, fittings, property, entry fees to leisure and recreational activities. The inspectors saw records which showed an amount of £80.00 being deducted from each individuals bank accounts to cover the cost of transport. No records were available to show who had accessed transport and when. The inspector received verbal confirmation from the company’s client finance officer that Robinia Care Ltd have stopped claiming each Service users’ Disability Living Allowance (D.L.A.) to cover the cost of transport, this came into effect at the end of July 2005. The inspectors saw bank statements to show this deduction had not occurred since July 2005. The manager confirmed the providers Robinia Care Ltd were producing a policy/ guideline on transport fees to service users. The statement of terms and conditions did not state that service users would be expected to contribute paying for entertainers who come to the home. Receipts were seen by the inspector which showed service users had been charged £3.66 for an entertainer, with one person being charged £3.67. The home is required to investigate this and reimburse, if necessary. Statement of terms and conditions need to reflect additional cost to service users. The home did not have any records of the social services contract for each service user they provide funding for, the manager explained these contracts are held at the Robinia head office. The home must ensure copies of service users contracts with social services are held within the home. Rakelands H54 S11536 Rakelands V244820 050905.doc Version 1.40 Page 10 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 standard(s) 6 Service users know their assessed and changing needs and personal goals are reflected in their individual plan. EVIDENCE: The inspector saw four individuals personal care plans, they included in their care plan, risk assessments, strengths, needs and wishes list which includes educational and recreational activities, the support the individual requires to achieve this, and by whom is also identified. These plans are reviewed each month (unless their needs change sooner) and form the base for the individuals six monthly review of their care, minutes for these meetings were held on the individuals file and 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 at their review. This timetable is included in the individuals their care plan, evidence of the activities taking place were found in the individuals daily notes, which included details of alternative activities which took place when the day centre was closed. Individual’s records are very good, however the information is held in several different files. To enable staff to obtain the information efficiently, the home is Rakelands H54 S11536 Rakelands V244820 050905.doc Version 1.40 Page 11 recommended to store individual’s information in one file, specific to the individual service user. Rakelands H54 S11536 Rakelands V244820 050905.doc Version 1.40 Page 12 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 standard(s) These standards were not assessed on this occasion. EVIDENCE: These standards were not assessed on this occasion. Rakelands H54 S11536 Rakelands V244820 050905.doc Version 1.40 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 standard(s) These standards were not assessed on this occasion. EVIDENCE: These standards were not assessed on this occasion. Rakelands H54 S11536 Rakelands V244820 050905.doc Version 1.40 Page 14 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 standard(s) 22 Service users views are listened to and acted on. 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. The manager 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. The home has a clear complaints procedure, which is held in each service users guide and statement of purpose. Throughout the inspection, staff listened to the service user, and responded appropriately to meet the individuals needs. Rakelands H54 S11536 Rakelands V244820 050905.doc Version 1.40 Page 15 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 standard(s) These standards were not assessed on this occasion. EVIDENCE: These standards were not assessed on this occasion. Rakelands H54 S11536 Rakelands V244820 050905.doc Version 1.40 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Appropriately trained staff ensure individual and joint needs of service users are met. EVIDENCE: The inspector witnessed the homes training and development record, which showed all staff had received mandatory training. Staff confirmed learning disability training was included in the “principles of care” induction training. Staff are working towards their National Vocational qualification level 2 and 3 and the Certificate In Working with People with Learning Disabilities 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 as a team work well together, during staff meetings we talk openly and share ideas and support one another, this helps us meet the needs of all service users.” “we operate a keyworker system, this ensures we spend one to one time with the service user.” One member of staff said “I feel we have adequate staff on duty to meet the needs of the service users.” The manager confirmed staffing levels are adequate. Rakelands H54 S11536 Rakelands V244820 050905.doc Version 1.40 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The health, safety and welfare of service users are not fully protected. EVIDENCE: The manager has devised a system for recording staff attendance to fire drill practices, however, at the time of the inspection the records had not been completed, therefore the home is required to keep a record detailing when staff have attended fire drill practices. Staff receive adequate training on other health and safety issues, as evident from the staff training plan, the inspector saw certificates for staff attending moving and handling training, first aid, food hygiene and Control Of Substances Harmful to Health. The home has risk assessments in place for the building and safe working practices for staff, manual handling risk assessments are in place. Certificates showed the maintenance of services within the home were up to date. The inspector saw thermometers in the bathrooms, one member of staff Rakelands H54 S11536 Rakelands V244820 050905.doc Version 1.40 Page 18 confirmed they were used to check the temperature of the water prior to bathing a service user. Rakelands H54 S11536 Rakelands V244820 050905.doc Version 1.40 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x 1 Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Rakelands Score x x x x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x H54 S11536 Rakelands V244820 050905.doc Version 1.40 Page 20 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. 2. Standard Regulation Requirement Timescale for action 5/10/05 YA 5.2 (iv) Schedule 4.8 3. YA 5 5 (3) 4. YA 42 17(2) Schedule 4 (14) Additional expenses payable by the service user must be clearly stated in the individual’ s statement of terms and conditions. The home must ensure copies of service users contracts with social services are held within the home. A record must be kept detailing when staff have attended fire drill practices. THIS IS A REPEAT REQUIREMENT FROM 28/02/05 5/10/05 5/10/05 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 6 Good Practice Recommendations To enable staff to obtain the information efficiently, the home is recommended to store individual’s information in one file, specific to the individual service user. Rakelands H54 S11536 Rakelands V244820 050905.doc Version 1.40 Page 21 Commission for Social Care Inspection 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 H54 S11536 Rakelands V244820 050905.doc Version 1.40 Page 22 - 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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