Inspection on 04/07/06 for Ramping Cat House Nursing Home

This inspection was carried out on 4th July 2006.

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

Ramping Cat House Nursing Home 14/10/08

Ramping Cat House Nursing Home 09/08/07

Ramping Cat House Nursing Home 19/01/06

Ramping Cat House Nursing Home 10/10/05

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 Delia Styles Unannounced Inspection 4th July 2006 11:00 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.V301055.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 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 chetan@atlantishealthcare.co.uk Atlantis Healthcare Ltd Jane Pocock 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.V301055.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. On admission persons should be aged 60 years and over Date of last inspection 19th January 2006 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. The present owner acquired the home in July 2005, visits regularly, and has plans to improve and extend the accommodation. The current range of fees is from £518 to £675 per week. Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, changed the way in which it undertakes its inspection of care services. This inspection of Ramping Cat House was an unannounced ‘Key Inspection’. A ‘key inspection’ focusses on the National Minimum Standards for the service that the Commission considers should be inspected at least once a year. The inspector arrived at the home at 11 am and was in there for 4.5 hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s owner or manager, and any information that CSCI has received about the home since the last inspection. The inspector asked the views of the people who use the services, and other people seen during the inspection or who responded to questionnaires (‘comment cards’) that the Commission had sent out. The inspector looked at how well the service was meeting the standards set by the government, and has in this report made judgements about the standard of the service. The inspector received a total of 6 comment cards from residents, 3 from relatives or visitors and 3 from GPs who provide medical care to the residents. During the visit the inspector had conversations with the home’s registered manager, a visiting professional, and three staff on duty, as well as most of the residents in the lounge or dining areas of the home. The inspector also met the home owner, Mr Chetan Borkhatria, who arrived at the home unannounced to undertake his own ‘spot check’ inspection as required by the Commission. What the service does well: The home has a homely and welcoming atmosphere. Residents praised the staff and said how kind and caring they are. They enjoy the individual attention and care they receive – residents’ comments included: ‘I am very happy here and enjoy the staff who care for me’; ‘I enjoy living here very much’. Residents said that the meals are good and are home cooked. The home overlooks the open Cotswold countryside and Windrush valley to the rear. Many residents enjoy the country setting of the home and bird and wildlife that they can see around them. Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The homes ‘Aims and Objectives’ (Statement of Purpose) document still needs updating to include the complaints procedure and the timescale for replying to complaints. This is an outstanding recommendation from the last inspection. The home’s Policies and Procedures have not been reviewed and updated and are, in many cases, inaccurate and signed by the previous owner/managers. This work should be completed as soon as possible. The requirement made at the last inspection, that all new staff must be inducted into the policies and procedures governing the home, is therefore difficult to monitor and there is a risk that residents may be harmed if staff do not work to safe agreed policies and standards. The home still does not have copies of the Oxfordshire multi-agency Protection of Vulnerable Adults Codes of Practice as recommended at the last inspection. All staff working in the home should have training about how to recognise suspected abuse, how to report it and to take appropriate actions to maintain the safety of residents living here. Residents’ care plans need further development so that they have enough detail and are based on individual assessed care needs. There should be a better evaluation of care – that is, the records should show whether the care met the resident’s individual needs and wishes, and if not, what changes have been made to their care plans. The décor and furniture in some rooms looks shabby and worn. Whilst the Commission accepts that the provider intends to build a new, purpose built extension and then refurbish and upgrade the original home, regular audits Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 7 and replacement of old furniture and beds and soft furnishings, should take place to make sure that the current residents live in well maintained and furnished rooms. Some areas of the home showed lack of attention to detail in cleaning. As recommended at the last inspection, quality audits should be conducted on the cleanliness of the home and prompt action taken to improve where there are shortcomings. All staff employed in the home should attend training in infection control. Use of shared bar soaps in shared bath and shower rooms, and barrier creams or lotions can be a source of cross infection between residents and should stop. Thorough cleaning of the outside environment and storage bins from bird droppings should be undertaken. Particular care should be taken that clinical waste bins used inside the home are kept clean, as they are source of infection and contamination for staff and residents. The home should consider keeping full waste bins in a covered area and/or with temporary plastic sheeting whilst awaiting bin collection by the waste disposal company, to protect the bins from birds, or vermin access. When the birds have fledged and left the nests, nest materials should be removed from the eaves of the home and the external windows thoroughly cleaned. There was an unpleasant and strong smell of urine in the front entrance and ground floor corridor of the home. The home managers are aware of this and plan to replace the floor covering in one room. The home must obtain all the necessary information about new staff before they are employed in the home so that the home can show that it has taken all reasonable steps to protect residents from unsuitable people being employed. This is an outstanding requirement also made at the last inspection. All staff should be aware of, and be given copies of the General Social Care Council (GSCC) Codes of Conduct for Employers and Employees. A computer and printer is needed at the home so that the manager can have access to e-mail and internet services to assist her to manage her workload more easily and efficiently. This recommendation was made at the last inspection. Training about staff supervision (the arranged date had been postponed by the training organisation) should be attended as soon as possible, and the programme of formal supervision of all care staff started. It is important that staff have the opportunity to discuss their work, progress and training needs with managers on a regular basis, which will in turn improve the care of residents. This recommendation was made at the last inspection. Please contact the provider for advice of actions taken in response to this Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 8 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.V301055.R01.S.doc Version 5.2 Page 9 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.V301055.R01.S.doc Version 5.2 Page 10 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. Standard 6 does not apply: the home does not provide intermediate care. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their families have sufficient information about the home to make a decision about whether the service is right for them. The assessment process provides a basis for staff to plan for new residents care needs before they move in. EVIDENCE: The inspector looked at the pre-admission assessment for two recently admitted residents. The information included assessments by care managers and nursing and health care professionals. The manager visits prospective residents in their own home, or in hospital, to carry out assessments and discuss care needs with the person and their relatives and carers. The three residents’ care plans showed that there was enough information from which staff could plan the residents’ initial care. Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The written care plans and records of care should be improved to make sure that residents health and personal care needs are documented and will be fully met by the staff. EVIDENCE: The inspector looked at a sample of three residents’ care plans and care records. There was little evidence that the resident and/or their representative had been involved in the process of drawing up the care plans. The information was brief with insufficient detail in the instructions for care staff who are to carry out the care. For example, the plans did not state the type of hoist and sling to be used when transferring a dependent resident, or the signs of possible low or high blood sugar of a resident with diabetes. The care plans are still largely focussed on the physical care of residents, although the member of staff responsible for activities has started to develop ‘life stories’ from which staff plan to develop care plans for residents’ preferred social and recreational time. It is evident that the manager and individual care staff know the care needs of the residents well in practice. However, this needs to be documented in the Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 12 care records, so that staff do not rely largely on verbal handover of information, which can lead to mistakes or omissions in care for residents. From the recorded evidence seen, the inspector cannot be confident that this home would be able to provide a service to meet the needs of individuals of a wider range of religious, racial or cultural needs. The care records were not up to date in some cases – for example, the condition of one resident’s skin and the frequency and type of wound care they needed, and the medical instructions in relation to the monitoring of another resident’s diabetes. The manager explained the most recent care instructions but these were not as written in the care plans. The care records should also include evaluation comments, that is – has the prescribed care been effective? and if not, what changes have been made to the planned care of the resident? Risk assessments for residents’ nutritional needs or where bed rails or other equipment is in use, were not fully written or regularly reviewed. Where a resident may be ‘at risk’ from poor appetite and dietary intake, or where equipment is in use to reduce the risk of injury of falls from bed or a wheelchair, the home should record the involvement of residents and their representatives in agreed plans of action to reduce these risks. The storage area for medicines and medicine records were looked at. Overall, the arrangements for the storage and administration of medicines in the home are satisfactory and the recommendations following the last inspection have been met. The temperature of the storage room is close to the maximum recommended because this is an inner room with no windows. The ventilation fan should be repaired to reduce the temperature to below 25°C. Some Medicine Administration Record (MAR) sheets contained lists of the resident’s medication and instructions written by a nurse. It is recommended that, where possible the doctor checks and signs the MAR sheet (the usual practice in this home), but if the doctor is not available, then the nurse should have a second nurse to check the entries and countersign them to reduce the risk of mistakes being made. The inspector noted that there were items of out of date prescribed skin lotion in the shower and prescribed barrier creams in some rooms that were marked with another resident’s name, not that of the room occupant. Residents are able to use their own rooms for GP or other consultations. Shared rooms have curtain dividers. At the time of this inspection only one of the 4 double rooms was in use for two residents. There is a cordless phone that residents can use to receive calls from relatives in private. The inspector noted that a resident’s catheter drainage bag was on view to others and Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 13 recommends that a cover is provided, or better positioning under clothing, to maintain the person’s dignity. Residents’ are referred to by their preferred name. The comment cards indicate that residents feel comfortable and well cared for by staff. Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 14 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, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The range of activities in the home has improved since the last inspection, giving residents more opportunities to participate in stimulating activities and there is a good capacity for continued improvement in this area. Meals and mealtimes are an enjoyable aspect of life in this home. EVIDENCE: Since the last inspection the home now has a staff member who organises activities for residents. She works for 4-5 hours on weekdays. Four residents had completed ‘life story’ booklets with staff and relatives assistance. The activities worker said that this had been very interesting and informative for all involved. The life story booklets will be used as the basis for care plans for residents, so that the activities will be developed and matched more to the residents’ personal abilities and interests. After lunch on the day of the inspection several residents enjoyed a game of carpet skittles and chat with each other and the staff member. The home has visits from the mobile library and occasional entertainment from local school children. Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 15 Visitors are able to come at reasonable times and residents can choose whom to see and not to see. Relatives/visitors comment cards confirmed that they are welcomed in the home and can visit their relative/friend in private. All the residents spoken with said they enjoy the food in the home. The inspector had sandwiches, and sampled the homemade quiche on the menu for residents, served with a salad garnish: these were very well presented and tasty. Most residents gather in the small dining room for lunch, but those who wish to eat in their own rooms or the sitting room area can do so. The home has a bottled water dispenser in the dining room, and there was chilled water or fruit squash served to residents to drink. Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents feel safe and listened to. Howver, formal processes need to be further developed so that the homes procedures are available, understood and consistently applied. EVIDENCE: The inspector was given a copy of the current Statement of Purpose information about this home. It is insufficiently detailed in that it does not contain all the information required under the Care Standards Act. The arrangements for making complaints are non-specific and do not refer to, or include a separate Complaints procedure, telling residents or their representatives who complaints should be made to and the timescales within which the home will respond and investigate complaints. A requirement was made in relation to this at the last inspection. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. There were no formal complaints listed in the home’s own complaints file. The home has still not obtained copies of the Oxfordshire Multi-agency Protection of all Vulnerable Adults Codes of Practice, as recommended at the last inspection. It is important that all staff know how to report any suspected abuse and follow the agreed local guidance in order to safeguard residents promptly and effectively. The inspector advised the manager on how to obtain copies of the Oxfordshire guidance and that reference should be made to this in the home’s own policy and procedure documents. Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 17 The home’s policy and procedure in relation to staff ‘Whistle-blowing’ is out of date and non specific: it was written by the previous home owner/managers and together with all the policies and procedures should be reviewed, updated and re-written. The inspector was informed that this work is to be undertaken by an operational manager, employed by Atlantis Healthcare Ltd that owns this home. There was no evidence of routine training for care staff in adult protection issues. The manager confirmed that the registered nurses have attended training and assumes that they share information with the care staff. New staff have not been given the General Social Care Council (GSCC) Codes of Conduct for Employees and Employers: this sets out the general standards and safeguarding conduct expected of staff so that vulnerable adults in their care are protected, and the responsibilities of employers towards staff employed in social care settings. All staff should receive training in protection of vulnerable adults. The manager said that risk assessment had been undertaken in relation to the front door as recommended at the last inspection, and said that when the laundry lady is working in the laundry at the front of the house, she is aware of any visitors arriving. The manager or nurse in charge is often working at the front desk in the hall area. At other times, the front door is kept closed and it is felt there is satisfactory security to protect residents and staff from unauthorised callers at the home. From conversations with residents and their written comments, the inspector concluded that residents feel safe and secure in the home and able to raise any concerns or complaints with the manager and staff. Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 18 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): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The routine checks on standards of cleanliness recommended at the last inspection, are still not done, so that in some areas of the home the fixtures and fittings mean that residents live in an inadequate environment. The manager and proprietor recognise shortfalls in the service and are taking action to improve these. EVIDENCE: The inspector toured the home. Overall, the home is clean and homely, and residents’ rooms are personalised with their own ornaments, plants and pictures. By contrast some (first floor) rooms look shabby, with old and worn carpeting and mismatched furniture. There were some shortfalls in the standard of cleanliness – for example, a shaving light cover that had an accumulation of dead crane flies; the facemask on the emergency oxygen cylinder was uncovered and dusty and there were dead flowers in vases in the entrance hall and some bedrooms. Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 19 As recommended at the last inspection, the manager should ensure there is a regular audit of cleaning standards and prompt action taken to improve any shortfalls. The manager said that a second cleaner had been employed so that this should improve the standards. The home has a seasonal problem, in that swallows nest under the eaves of the house and their droppings accumulate on the windows and window cills and clinical storage bins stored outside. A clinical bin in a first floor bathroom was overfull and had bird droppings on the lid. This is a potential risk of infection for staff and residents and all waste bins must be kept clean. The inspector noted that a divan bed base was noted to be badly stained, in an unoccupied first floor room that was being considered for a prospective new resident. This was pointed out to the manager and proprietor and a new bed was promptly ordered to replace it. Several new beds have already been purchased to replace old items. A wall-mounted fire extinguisher at the base of the stairs was insecurely mounted: if it fell, it could cause serious injury to staff or residents. This was pointed out to the manager who said she would make sure the fixings were promptly repaired. There was a very strong and unpleasant odour of urine evident in the area of the front entrance lobby and ground floor room corridor, despite the open front door. A relative had commented on this as a long-standing and increasing problem in a comment card. The manager confirmed that the source of the odour was one room and there are plans to replace the floor covering. Some items of clean laundry in the linen cupboards were old and had torn hems and a pillow in use in a resident’s room was torn. Old and worn items should be removed and replaced with new stock so that all residents’ rooms have a good standard of bed linen. There were tablets of soap left in the bathroom and shower that indicated to the inspector that these are shared between residents. Staff should not leave bar soaps in communal bathrooms and toilets because it is a source of infection for residents. Staff have protective clothing, and disposable soap and paper towels available for hand washing. The inspector recommended that all staff have training in infection control to ensure that they are up to date with current policies and procedures for the protection of residents and staff. Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 20 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 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is showing improvement in the plans to improve staff training and supervision. However, the process for recruiting and inducting new staff has not improved since the last inspection despite the requirements made by the CSCI and may put residents at risk. EVIDENCE: The inspector looked at the current staffing rota and discussed the staffing of the home with the manager. There are sufficient numbers of staff to meet the care needs of the residents. However, the manager does not have sufficient supernumerary time for the additional administrative and supernumerary part of her role. She said that an additional registered nurse was needed. The home does not use agency staff, and has its own ‘bank’ staff who can cover vacant shifts if needed. The number of care staff who are enrolled on National Vocational Qualification courses has increased, so that the proportion of staff who have, or are working towards NVQ Level 2 or above, is nearing the recommended 50 target expected by the Commission. All staff have attended fire safety lectures and moving and handling training and all trained staff have attended a First Aid course. Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 21 Examination of a sample of three staff files most recently recruited to the home showed that the records are unsatisfactory and do not contain the information and confirmation of police checks required to safeguard residents. Two staff had only one reference and no proof of identity or photographs of the individuals. The manager explained that these new staff members had been employed by the provider through a London employment agency. The provider told the manager that he had received the confirmation of satisfactory police checks. There was no written record of the two newest staff members induction and supervision, though the manager confirmed that both had worked under the supervision of a registered nurse during the first week of their employment in the home, but she had not completed the written records of their induction yet. The third member of staff whose file was examined, also works in another registered care home. There had been a delay in the Ramping Cat home having applied for a new Criminal Records Bureau (CRB) check through their own ‘umbrella body’ for this employee: this is a required safeguard to ensure that the person’s CRB is still current. The inspector was very concerned that the requirement made at the last inspection in relation to recruitment practices has not been met. The manager must have all the necessary information required under the Care Standards Act and Regulations available before employing new staff in the home. Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 22 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): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are indications that the manager is endeavouring to address the work needed to update the policies and procedures for the home, and to develop the systems for quality assurance to improve the outcomes for residents and staff in the home. EVIDENCE: Mrs Pocock successfully completed the process with the CSCI to become the registered manager of this home in November 2005. She has enrolled to undertake the Registered Managers Award this year as part of the formal qualification for her role as manager. Mrs Pocock has worked at this home for many years with the previous owner/managers and has extensive experience in care of older people. Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 23 The manager said that the home is just starting to develop a quality assurance programme through questionnaires to residents and relatives to get their opinions of the home and service provided. The manager is readily available to residents and relatives to listen to their suggestions and comments about the home. Relatives or independent appointees deal with residents’ finances where the resident is unable, or does not wish to do so themselves. The home records any additional expenditure for services such as chiropody and hairdressing and these are invoiced to the family or representative responsible for paying fees. There were no copies of individual residents’ contracts or fee payments in the home: these are held at the company head office. Regular formal supervision meetings with staff have still not started. The training body had just postponed the planned training about supervision, and the manager said she would attend the re-arranged sessions before starting to implement supervision sessions with all the care staff. The proprietor has appointed an operations manager, whom it is planned will assist registered managers in the care homes owned by the company, to implement the policies and procedures, including supervision. There was evidence of regular fire safety equipment checks and maintenance. The home employs a maintenance man who undertakes day-to-day repairs and a range of local companies provide routine checks and specialist maintenance to fire alarms, call bell and laundry, stair lift, hoists and electrical equipment. Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES 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 OP29 Regulation 19 Schedule 2 Requirement The home must obtain confirmation of all the information required before employing people to work at the home. Timescale for action 06/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose should be updated to include the details set out in Schedule 1, including the arrangements made for dealing with complaints and timescales for these. * The care plans should include sufficient detail so that care staff can meet all aspects of the health, personal and social care needs of the residents. * Care plans should contain written evaluation comments to indicate the extent to which the planned care has achieved the goals of care for the resident. 2. OP7 Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 26 3. OP8 4. OP9 5. OP18 * The home should use a researched based nutritional screening tool to assess the nutritional status of all residents on admission and periodically thereafter. * Wounds should be assessed and the appropriate wound care treatment documented and evaluated. * If MAR sheets are handwritten by a registered nurse and the doctor has not checked and countersigned this, a second nurse should check and countersign the first nurse’s directions to reduce the risk of errors. * The ventilation of the medication storage room should be improved to reduce the temperature to below the maximum recommended temperature of 25°C. * Prescribed creams and lotions should only be used for the person for whom they were prescribed and should be discarded when the expiry date is passed. * The home should obtain copies of the Oxfordshire Multiagency Protection of all Vulnerable Adults Codes of Practice and staff should be made aware of these. * The homes policy on ‘whistle-blowing’ for staff, and protection of vulnerable adults, should be revised. * All staff should receive training in adult protection issues. * All staff should receive copies of the General Social Care Council (GSCC) Codes of Conduct. The proprietor and registered manager should ensure that there are frequent audits of the standard of cleanliness, furniture and décor and prompt action taken to remedy any shortfalls. Old and damaged items of furniture and bedding should be removed and replaced. * Thorough cleaning of waste bins should be undertaken to reduce the risk of infection from contamination from bird droppings. * Bar soap should not be shared by residents using the shared bath and shower rooms, as it may be a source of contamination and infection between residents. The records of recruitment and induction of new staff should be improved, with an audit trail demonstrating that a systematic and thorough system of vetting of applicants has taken place prior to their appointment to work in the home. All staff should have infection control training. * The registered manager should have sufficient supernumerary time to carry out the additional managerial, supervisory and assessment tasks required of DS0000064639.V301055.R01.S.doc Version 5.2 Page 27 6. OP19 7. OP26 8. OP29 9. 10. OP30 OP31 Ramping Cat House Nursing Home 11. OP36 her role * The home should have a computer, e-mail and internet connection to enable the manager to manage her workload and communication more effectively. * The inspector recommends that appropriate members of staff should attend supervision training. * Formal supervision should be implemented for all staff as soon as possible. This recommendation is outstanding from the announced inspection on October 10th 2005. Ramping Cat House Nursing Home DS0000064639.V301055.R01.S.doc Version 5.2 Page 28 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.V301055.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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