Inspection on 10/10/05 for Ramping Cat House Nursing Home

This inspection was carried out on 10th October 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ramping Cat House Nursing Home 14/10/08

Ramping Cat House Nursing Home 09/08/07

Ramping Cat House Nursing Home 04/07/06

Ramping Cat House Nursing Home 19/01/06

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

CARE HOMES FOR OLDER PEOPLE Ramping Cat House Nursing Home White Hill Burford Oxfordshire OX18 4EX Lead Inspector Kate Harrison Announced Inspection 10th October 2005 13.00 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 Ramping Cat House Nursing Home DS0000064639.V256102.R01.S.doc Version 5.0 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. Ramping Cat House Nursing Home DS0000064639.V256102.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ramping Cat House Nursing Home Address White Hill Burford Oxfordshire OX18 4EX 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 8440 4666 Atlantis Healthcare Ltd Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Ramping Cat House Nursing Home DS0000064639.V256102.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. On admission persons should be aged 60 years and over Date of last inspection 10/09/04 Brief Description of the Service: The Ramping Cat House is a care home with nursing, registered with CSCI to provide accommodation and services to 15 individuals. The home is situated in open countryside on the edge of the Cotswolds, near to Burford. Accommodation is provided in a mix of single and double rooms over two floors, with a stair lift providing access to the first floor. The manager and a team of nursing, care and household staff provide care. Since July 2005 the home has had a new owner, who has plans to improve and extend the accommodation. Ramping Cat House Nursing Home DS0000064639.V256102.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection against the National Minimum Standards took place over one afternoon and early evening in October 2005. The inspector met with residents and visitors, and discussed the management of the home with the home’s manager. The manager had previously completed and returned the pre-inspection questionnaire, giving information on all aspects of the home. The inspector had also received completed comment cards from relatives and health care professionals about their experience of life in the home. The new owner has applied for planning permission for the home to be developed, and visits the home regularly. What the service does well: What has improved since the last inspection? What they could do better: A computer is needed at the home so that the manager can efficiently manage her work by having access to email and Internet services. Pre admission assessments should be current, and the home’s pre-admission forms should be amended, to allow a full assessment of need to take place. When relatives cannot help with clothing repairs, the manager needs to make arrangements for residents’ clothing to be appropriately cared for. The inspector recommends that life stories be developed for each resident, so that appropriate interests be identified and offered at the home. A member of staff should be responsible for developing a care plan for each resident to combat boredom, with reference to life stories and available resources. Ramping Cat House Nursing Home DS0000064639.V256102.R01.S.doc Version 5.0 Page 6 The activities provided should be a mix of group and individual activities, and should reflect the views of residents. Appropriate resources should be made available to meet the leisure needs of the residents. The home’s complaints procedure needs to be amended to include timescale for replying to complaints, and should reflect the Commission’s change of name to CSCI, and the change of management. The home’s protection of vulnerable adults policy needs to be amended to include reference to the Oxfordshire multi-agency Protection of Vulnerable Adults codes of practice. The inspector recommends supplying a copy of the ‘Guidance for Staff’ to all staff, so that they know what to do in the event of any allegation of abuse. A risk assessment needs to be carried out regarding the home’s ‘open door’ policy to determine if any further action is needed to protect residents and staff. Quality assurance audits should be conducted on the cleanliness of the home, and action should be taken to address any shortcomings. Appropriate members of staff should attend supervision training, and formal supervision needs to be started for all staff as soon as possible. All the necessary information needs to be available about staff working at the home. The home’s job application form should contain information about the individual’s employment history. When requesting references, care should be taken to ensure that the form complies with the Data Protection Act. More staff need to be trained in First Aid to meet the National Minimum Standard. 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. Ramping Cat House Nursing Home DS0000064639.V256102.R01.S.doc Version 5.0 Page 7 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 Ramping Cat House Nursing Home DS0000064639.V256102.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Prospective residents have their needs assessed, but improvements need to be made to the home’s forms to allow a full assessment to take place. EVIDENCE: The inspector saw the assessment records for two recently admitted residents. One resident had been assessed by a member of staff four months before admission due to delays at the hospital, and had been admitted without an updated assessment of need from the care manager, though a discharge summary had been provided by the hospital. The other resident had been assessed by one of the home’s nurses shortly before admission. Pre admission assessments should be current, and the home’s pre-admission forms should be amended, to allow a full assessment to take place. Ramping Cat House Nursing Home DS0000064639.V256102.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 10. Residents are treated with respect, but staff need to pay attention to detail so that residents’ dignity is preserved. EVIDENCE: New staff are given practical training on how to address issues of privacy and respect, especially regarding personal care. Residents can use the home’s cordless phone to talk with relatives. The resident’s preferred term of address is appropriately recorded so that all staff are aware of the preference. All residents can use their private rooms for GP or other consultations. The inspector saw one resident wearing a garment secured by a large safety pin, and she told the inspector that she needed help with sewing in buttons to her blouse. The inspector recommends that where relatives cannot help with clothing repairs the manager make arrangements for residents’ clothing to be appropriately cared for. Ramping Cat House Nursing Home DS0000064639.V256102.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 14 Residents are offered few opportunities to engage in leisure activities, and resources regarding activities are limited. Residents are able to maintain contact with friends and relatives, supported by the home’s policies. Residents’ financial affairs are appropriately managed. EVIDENCE: The inspector saw that the social interests of the two residents assessed are recorded, and efforts are made to engage residents in the pastimes available. It was clear from records that one resident was bored, and one resident told the inspector that she wanted to walk outside regularly to follow her pastime of bird watching, but staff were not always available to help her when she wanted to go. One relative said that more activities need to be provided, and the inspector noted that no member of staff is responsible for activities at the home. No evidence was seen that information about activities is circulated to residents, though the manager said that visits from the mobile library are regular, and that entertainment from local schools is occasionally arranged. Families often take residents out, and this appears to be the only time when able residents are able to leave the home. The inspector recommends that life stories be developed for each resident, so that residents’ interests are identified and are appropriately offered at or outside the home. Ramping Cat House Nursing Home DS0000064639.V256102.R01.S.doc Version 5.0 Page 11 A member of staff should be responsible for developing a care plan for each resident to combat boredom, with reference to life stories and available resources. The activities provided should be a mix of group and individual activities, and should reflect the views of residents. Appropriate resources should be made available to meet the needs of the residents. Visitors are able to come at reasonable times and residents can choose whom to see and not to see. None of the residents are able to manage their financial affairs and the family or Care Management has responsibility. The manager is able to contact advocates when necessary to protect residents’ interests. Ramping Cat House Nursing Home DS0000064639.V256102.R01.S.doc Version 5.0 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The home’s complaints procedure is easy to implement but needs amending. The home’s policy and procedure regarding vulnerable adults needs to be developed to ensure that residents are protected from abuse. EVIDENCE: The home’s complaints procedure must be amended to include timescale for replying to complaints, should reflect the current arrangements and should reflect the Commission’s change of name to CSCI. No complaints have been received recently. The home has a protection of vulnerable adults policy, which needs to be developed to include reference to the Oxfordshire multi-agency Protection of Vulnerable Adults codes of practice. The inspector recommends supplying a copy of the ‘Guidance for Staff’ to all staff, so that they know what to do in the event of any incident. Some relatives expressed concern about the safety of residents, as the front door is unlocked during the daytime, and staff may not always be in the hall area. The inspector recommends that a risk assessment be carried out to determine if any further action is needed to protect residents and staff. Ramping Cat House Nursing Home DS0000064639.V256102.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26. The home has infection control procedures in place, but regular quality assurance checks need to be conducted. EVIDENCE: The home has infection control procedures and protective clothing is available for staff. The home’s laundry is managed on site, and the laundry room is located in the basement. Appropriate facilities are provided, including hand washing and drying facilities. One relative commented that the level of cleanliness is poor, especially in the bathrooms. The inspector discussed the cleaning arrangements with the manager, and recommends that quality assurance audits be conducted, and action be taken to address any shortcomings in cleanliness. Ramping Cat House Nursing Home DS0000064639.V256102.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Residents’ needs, especially regarding activities, are not always met. The home is working towards meeting the minimum ratio of 50 of the care staff with NVQs. The home’s recruitment procedures do not comply with legislation and must be improved. Not enough staff are first aid trained. EVIDENCE: At present the home is advertising for another nurse, and agency staff are used when necessary. One part-time cleaner is employed, and care staff also manage the cleaning, especially at night. Two cooks manage the preparation of meals and a bank cook is available when necessary. The home has no member of staff responsible for the provision of activities, and this needs to be addressed. Three members of staff have achieved National Vocational Qualifications (NVQ) and two more are taking NVQ courses. When five members of the care staff have achieved the NVQ Level 2 or above then the home will be meeting the standard of having 50 of the care staff with an NVQ. One member of staff is an NVQ assessor, and the manager is expecting to meet the standard by the end of the year. The inspector checked two staff recruitment files, and noted that one file did not contain an appropriate CRB, neither had proof of identity information or photographs of the individuals. Only one reference was available for one Ramping Cat House Nursing Home DS0000064639.V256102.R01.S.doc Version 5.0 Page 15 individual. The home’s staff application form should contain information about the individual’s employment history. When requesting references care should be taken to ensure that the form complies with the Data Protection Act. The proprietor must ensure that all the necessary information as detailed in Schedule 2 is available before individuals start work at the home. There is no formal induction or foundation training programme at the home, though the manager said that new staff have a practical induction and shadow experienced staff in a supernumerary capacity for the first week. The proprietor must ensure that all new staff are appropriately inducted into the policies and procedures of the home. Only one member of staff is first aid trained, and more staff must be trained in first aid to meet the national minimum standard. Staff receive mandatory training, including moving and handling residents and food hygiene training updates. Ramping Cat House Nursing Home DS0000064639.V256102.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 36. Supervision of staff needs to be formalised. EVIDENCE: Informal supervision of staff takes place regularly, but no recorded 2 monthly one to one sessions are taking place. The inspector recommends that appropriate members of staff should attend supervision training, and that formal supervision be implemented for all staff as soon as possible. Ramping Cat House Nursing Home DS0000064639.V256102.R01.S.doc Version 5.0 Page 17 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 X X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 2 X X Ramping Cat House Nursing Home DS0000064639.V256102.R01.S.doc Version 5.0 Page 18 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 OP16 Regulation 22 Requirement The home’s complaints procedure must be amended to include timescale for replying to complaints, to reflect the Commission’s change of name to CSCI and to reflect the new management arrangements. The proprietor must ensure that all the necessary information as detailed in Schedule 2 is available for all staff working at the home. The proprietor must ensure that more staff be trained in first aid. The proprietor must ensure that all new staff are appropriately inducted into the policies and procedures governing work at the home. Timescale for action 30/11/05 2 OP29 19 30/11/05 3 4 OP30 OP30 13 18 31/12/05 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Ramping Cat House Nursing Home DS0000064639.V256102.R01.S.doc Version 5.0 Page 19 No. Refer to Standard OP3 OP10 Good Practice Recommendations 1 2 Pre admission assessments should be current, and the home’s pre-admission assessment forms should be amended, to allow a full assessment to take place. The inspector recommends that where relatives cannot help with clothing repairs that the manager make arrangements for residents clothing to be appropriately cared for. The inspector recommends that life stories be developed for each resident, so that appropriate interests be identified and offered at the home. A care plan should be developed for each resident to combat boredom, with reference to life stories and available resources. Activities provided should be a mix of group and individual activities, and should reflect the views of residents. Appropriate resources should be made available to meet the needs of the residents. The home’s protection of vulnerable adults policy needs to be amended to include reference to the Oxfordshire multiagency Protection of Vulnerable Adults codes of practice. The inspector recommends supplying a copy of the ‘Guidance for Staff’ to all staff, so that they know what to do in the event of any allegation of abuse. The inspector recommends that a risk assessment be carried out regarding the home’s ‘open door’ policy to determine if any further action is needed to protect residents and staff. 3 OP12 4 OP18 5 OP26 Quality assurance audits should be conducted on the cleanliness of the home, and action should be taken to address any shortcomings. The home’s staff application form should contain information about the individual’s employment history. When requesting references care should be taken to ensure that the form complies with the Data Protection Act. The inspector recommends that appropriate members of DS0000064639.V256102.R01.S.doc Version 5.0 Page 20 6 OP29 7 OP36 Ramping Cat House Nursing Home 8 9 OP36 OP27 staff should attend supervision training. Formal supervision should be implemented for all staff as soon as possible. Designated staff should be responsible for the provision of activities at the home. Ramping Cat House Nursing Home DS0000064639.V256102.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 Ramping Cat House Nursing Home DS0000064639.V256102.R01.S.doc Version 5.0 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. 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!