Inspection on 09/08/07 for Ramping Cat House Nursing Home

This inspection was carried out on 9th August 2007.

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 04/07/06

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 Marie Carvell Unannounced Inspection 9th August 2007 11 am 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.V343407.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.V343407.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.V343407.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 4th July 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 scales of charges as at August 2007 are between £542.00 and £700.00 per week. Service users pay for outings, toiletries, chiropody, hairdressing and newspapers. Ramping Cat House Nursing Home DS0000064639.V343407.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 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘key Inspection’. The inspector arrived at the service at 11am and was in the service until 3.45pm. It was a thorough look at how well the service was doing, and took into account detailed information provided by the service’s manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the service and other people seen during the inspection. One service user, relatives of four service users and four General Practitioners responded to surveys that the Commission had sent out. In addition the inspector contacted two relatives by telephone. 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 standards of the service. Time was spent with the manager, many of the service users and staff on duty, a tour of the premises was carried out and a sample of records required to be kept in the home were examined, including the case tracking of three service user’s files. At the last inspection undertaken one requirement and eleven good practice recommendations were made, these are referred to in the body of the report. Feedback was given to the manager throughout the inspection. What the service does well: Staff on duty were observed to interact with service users in a respectful and appropriate manner. Serviced users were observed to be well groomed and appropriately dressed. Comments made on surveys completed by relatives included: ‘Whilst many of the local staff have left the home it still has a caring feeling’ ‘X is very happy at the home. So I think that says everything’ ‘I feel the homely atmosphere of this home is important to my X’ Healthcare needs are provided by several local GP practices. Surveys completed by four GPs confirmed that they were satisfied with the overall care provided to service users within the home. One survey completed by a GP commented that the Ramping Cat was a ‘ Very good nursing home’. Ramping Cat House Nursing Home DS0000064639.V343407.R01.S.doc Version 5.2 Page 6 Menus demonstrate that service users are provided with a varied, nutritious and balanced diet. Staff were observed to be attentive and assisting service users as necessary in a discreet and dignified manner. In discussion with the cook, it was clear that she was familiar with the food preferences of all the service users. ‘When I have had problems (which have been few). Jane (the manager) is always there to listen and help all she can’. The Commission has not received any information concerning complaints about this home since the last inspection. No adult protection investigations have been undertaken since registration and no referrals have been made for inclusion on the POVA (Protection of Vulnerable Adults) list. Staff were observed to be courteous, patient and cheerful in their approach to service users, colleagues and visitors. The inspector gained the impression of a staff team that works well together and that staff morale is good in the home. Staff confirmed this and felt this was because of the size of the home and a small staff team. In discussion with a relative he/she described the staff team as ‘ Wonderful, very caring staff, they are remarkable’. What has improved since the last inspection? What they could do better: It is not evident how the social or recreational needs of those service users who would benefit from one to one attention are met. The home should obtain a copy of the Oxfordshire Multi-Agency Protection of Vulnerable Adult codes of Practice and that all staff should be made aware of these. The home’s policy on ‘Whistle blowing’ and Protection of Vulnerable Adults procedures should be revised and all staff should receive copies of the General Social Care Council (GSCC) Code of Conduct. The usual staffing levels are one registered nurse and two care assistants, on duty in the mornings until 1pm, all other times there is one registered nurse Ramping Cat House Nursing Home DS0000064639.V343407.R01.S.doc Version 5.2 Page 7 and one care assistant. The staff on the afternoon and evening shift are required to prepare and serve the evening meal and attend to the laundry. At week ends there are no cleaning or laundry staff on duty. In discussion with service users’ several commented that there is regularly only two staff on duty and because the lounge does not have a nurse call system, service users have to shout for assistance. This is particularly bad in the afternoons and evenings, when less staff are on duty. Recruitment procedures need to be more robust. One member of staff appears to have been in post almost three months before the police check clearance was obtained. The manager said that a fast track check to the Protection of Vulnerable Adults list (POVA) would have been undertaken. This was not evidenced. None of the staff files seen contained evidence of a formal interview, induction or for the two registered nurses copies of their Statement of Entry to the nurses’ register. The manager is frequently required to provide nursing care to service users as the registered nurse on duty and has very few hours free to undertake her management responsibilities for the home. Not all staff receive planned formal supervision. This has recently commenced and evidence was seen that one care assistant had received supervision in May 2007. All registered nurses are to undertake supervisory skills training in order to supervise care assistants. The home does not have an annual business and development plan in place. Quality assurance processes are not evidenced as to how the views of service users, relatives and other stakeholders are sought on a regular basis. 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. The summary of this inspection report can be made available in other formats on request. Ramping Cat House Nursing Home DS0000064639.V343407.R01.S.doc Version 5.2 Page 8 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.V343407.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3. Standard 1 was subject to a good practice recommendation at the last inspection. Quality in this outcome area is adequate. Service users and their families are given information about the home to make a decision as to whether the home is able to meet their needs. Service users are assessed prior to admission to ensure that their needs can be effectively met by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection a recommendation was made that the home’s Statement of Purpose and Service User Guide. The manager advised the inspector that this was being addressed. Prospective service users and relatives/advocates are encouraged to visit the home before making any decisions about moving in. The manager undertakes Ramping Cat House Nursing Home DS0000064639.V343407.R01.S.doc Version 5.2 Page 10 a pre- admission assessment of all service users to ensure that the home is able to meet their needs. A survey completed by a service user confirmed that he/she had received enough information about the home before moving in so that they could decide if it was the right place for them. The inspector looked at three service user’s pre- admission assessments. Where appropriate the manager will involve health and social care professionals in the assessment process. Ramping Cat House Nursing Home DS0000064639.V343407.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10. Standards 7,8 and 9 were subject to good practice recommendations at the last inspection. Quality in this outcome area is good. Service users’ health, personal and social care needs are met. Service users feel that they are treated with dignity and respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three service user files were case tracked and evidenced that the home is proactive in meeting the health, personal and social care needs of service users in a dignified and caring manner. At the last inspection a good practice recommendation was made that care plans should include sufficient detail so that care staff can meet all aspects of the health, personal and social care needs of the service users. The home now uses a commercially produced document system, so that the records are much better organised, instructions are clearer for staff to refer to. The manager has agreed to ensure that care plans are agreed by the individual service user and signed. Appropriate risk assessments are in place. Ramping Cat House Nursing Home DS0000064639.V343407.R01.S.doc Version 5.2 Page 12 At the last inspection, a good practice recommendation was made that the home should use a research based nutritional screening tool to assess the nutritional status of all service users. This is to be implemented. A survey completed by a service user confirmed that he/she ‘always’ received the care and support needed. Surveys completed by a four relatives commented that the home ‘usually’ meets the needs of service users. Staff on duty were observed to interact with service users in a respectful and appropriate manner. Serviced users were observed to be well groomed and appropriately dressed. Comments made on surveys completed by relatives included: ‘Whilst many of the local staff have left the home it still has a caring feeling’ ‘X is very happy at the home. So I think that says everything’ ‘I feel the homely atmosphere of this home is important to my X’ Healthcare needs are provided by several local GP practices. Surveys completed by four GPs confirmed that they were satisfied with the overall care provided to service users within the home. One survey completed by a GP commented that the Ramping Cat was a ‘ Very good nursing home’. A survey completed by a service user confirmed that he/she ‘ always’ received the medical support needed’. Service users confirmed that they are able to see the doctor in private. Registered nurses administer medication. Medication administration records were seen to be well maintained with no obvious gaps in recordings. Medication storage is satisfactory. At the last inspection a good practice recommendation was made that if MAR sheets are handwritten by a registered nurse and not checked or countersigned by the doctor, then a second registered nurse should check and countersign the first nurse’s directions to reduce the risk of errors. That the temperature of the medication storage room should be below the maximum temperature of 25c and that prescribed creams and lotions should only be used for the individual prescribed for and discarded when the expiry date has passed. These have been addressed. All of the bedrooms are currently used for single occupancy and in discussion with service users this was appreciated. The home has a cordless telephone for service user’s use and visitors can be seen in private. Service users’ confirmed Ramping Cat House Nursing Home DS0000064639.V343407.R01.S.doc Version 5.2 Page 13 that they are referred to by their preferred name and this is discussed at the time of admission. As in many other care homes, there is a wider range of racial, ethnic and faith backgrounds represented within the staff group compared with the current service users. From discussion with the manager, the inspector considers that the home would be able to provide a service to meet the needs of individual service users of various religious, racial or cultural needs. Ramping Cat House Nursing Home DS0000064639.V343407.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15. Quality in this outcome area is good. Service users are encouraged to maintain contact with friends, family and the local community. Routines are flexible to meet the wishes of the service user. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An activities organiser works in the home from 9.30am until 12.00 pm, for four or five days per week. When the inspector arrived at the home, several service users were playing skittles in the lounge. It is not evident how the social or recreational needs of those service users who would benefit from one to one attention are met. A survey completed by a service user confirmed that ‘ sometimes’ there are activities that he/she could take part in. ‘But I don’t choose to as I stay in bed’ Activities planned are displayed on the notice board and a record of all events is kept. Communion is brought to the home on a monthly basis. One service user attends a local church and a member of staff arranges this. A hairdresser visits the home each week and the home has regular visits from the mobile Ramping Cat House Nursing Home DS0000064639.V343407.R01.S.doc Version 5.2 Page 15 library. The home has a good selection of board games, jigsaw puzzles and videos for service users use. Service users said that visitors are always made welcome and can visit at any reasonable time. The inspector joined service users for the midday meal. The meal was tasty and served attractively. Service users said that there was always a choice and the food as ‘very nice’, ‘tasty’ and ‘good’. Menus demonstrate that service users are provided with a varied, nutritious and balanced diet. Staff were observed to be attentive and assisting service users as necessary in a discreet and dignified manner. In discussion with the cook, it was clear that she was familiar with the food preferences of all the service users. Ramping Cat House Nursing Home DS0000064639.V343407.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Standard 18 was subject to a good practice recommendation at the last inspection. Quality in this outcome area is adequate. Service users and relatives are confident that complaints made will be taken seriously and addressed. The home’s policies and procedures to protect service users from abuse need to be developed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints procedure has been developed since the last inspection. This is to be further reviewed and developed. The manager agreed to consider displaying the home’s complaints procedure in the entrance hall and introducing a ‘comments and suggestions book’ for service users and relatives use. A survey completed by a service user confirmed that he/she knew how to make a complaint and added ‘My family would help’. Two surveys completed by relatives stated that they knew how to make a complaint and two surveys completed stated that they did not know how to make a complaint. One relative commented: ‘When I have had problems (which have been few). Jane (the manager) is always there to listen and help all she can’. Ramping Cat House Nursing Home DS0000064639.V343407.R01.S.doc Version 5.2 Page 17 At the last inspection a good practice recommendation was made that the home should obtain a copy of the Oxfordshire Multi-Agency Protection of Vulnerable Adult codes of Practice and that all staff should be made aware of these. The home’s policy on ‘Whistle blowing’ and Protection of Vulnerable Adults procedures should be revised and all staff should receive copies of the General Social Care Council (GSCC) Code of Conduct. All staff have been booked to attend Vulnerable Adults training and the home’s policies and procedures are to be updated by the home’s Operations Manager. The manager has not obtained a copy of the Oxfordshire Multi-Agency Protection of Vulnerable Adults code of practice. The two copies in the home were dated 1998 and 2002. There was a copy of the GSCC code of conduct in the home, but it was not evidenced that all staff have been given a copy. The Commission has not received any information concerning complaints about this home since the last inspection. No adult protection investigations have been undertaken since registration and no referrals have been made for inclusion on the POVA (Protection of Vulnerable Adults) list. Ramping Cat House Nursing Home DS0000064639.V343407.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 22 and 26. Standard 19 and 26 were subject to good practice recommendations at the last inspection. Quality in this outcome area is adequate. The home is clean and comfortable. The provider accepts that the accommodation is below standard and a major refurbishment is due to commence in October 2007. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Communal areas are comfortable and homely. Since the last inspection, some bedrooms have been refurbished with new flooring and soft furnishings. New non slip flooring has been fitted in the bathroom. Some new beds and new bedding have been purchased. Good practice recommendations were made at the last inspection to remove old or damaged items of furniture and replace old bedding. This has been addressed. Ramping Cat House Nursing Home DS0000064639.V343407.R01.S.doc Version 5.2 Page 19 There is no nurse call system in the lounge, in discussion with service users and relatives; this caused some service users anxieties when needing staff assistance. Since the last inspection the waste bins have been repositioned to reduce the risk of infection from contamination from bird droppings. Bar soap is not shared by service users in the communal bath or shower room. These were subject to good practice recommendations. The home was found to be clean, fresh and homely. Bedrooms are appropriately furnished and personalised by their occupants. The communal lounges are cramped and shabby however, this was not raised by service users as a concern. It is understood from discussion with the manager that the building work to the new extension will be starting in a few months time. Staff are provided with protective clothing, such as disposable gloves, aprons. Alcohol hand wash is available throughout the home. The manager confirmed that all staff have completed a distance learning course in Infection Control. Ramping Cat House Nursing Home DS0000064639.V343407.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30. Standards 29 and 30 were subject to good practice recommendations at the last inspection. Quality in this outcome area is adequate. Staffing levels appear to be adequate to meet the needs of the service users. Recruitment procedures need to be more robust. Induction, training and supervision of staff need to be documented. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection, the manager and one care assistant were working from 8am until 4pm. The manager said that she was providing hands on care to service users. A registered nurse was also working 8am until 10pm. A second registered nurse was rostered to work from 4pm until 10pm. In addition there was an activity organiser working 9.30am until 12pm, a cook working 8am until 1pm and a laundry/cleaner 9.30am until 3.30pm. A registered nurse and a care assistant were rostered to work from 10pm until 8am the following morning. The manager agreed to identify on the duty rosters a hand over period at the start of each shift. The usual staffing levels are one registered nurse and two care assistants, on duty in the mornings until 1pm, all other times there is one registered nurse and one care assistant. The staff on the afternoon and evening shift are required to prepare and serve the evening meal and attend to the laundry. At Ramping Cat House Nursing Home DS0000064639.V343407.R01.S.doc Version 5.2 Page 21 week ends there are no cleaning or laundry staff on duty. At the time of the inspection the manager advised the inspector, that due to annual leave and staff vacancies registered nurses are covering some care assistant shifts. The home currently has vacancies for two full time care assistants and bank care assistants. A survey completed by a service user confirmed that there was ‘usually’ staff available when he/she needed them. In discussion with service users’ several commented that there is regularly only two staff on duty and because the lounge does not have a nurse call system, service users have to shout for assistance. This is particularly bad in the afternoons and evenings, when less staff are on duty. Staff were observed to be courteous, patient and cheerful in their approach to service users, colleagues and visitors. There are currently six care staff in post, two care staff have completed NVQ level III and one care assistant is an Assessor for NVQ level II. One care assistant is due to commence NVQ level II training at the end of August and two care assistants are hoping to recommence NVQ level II training. At the last inspection a good practice recommendation was made that 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. A sample of three staff personnel files were examined. All files contained a completed application form, two written references and enhanced police checks. One member of staff appears to have been in post almost three months before the police check clearance was obtained. The manager said that a fast track check to the Protection of Vulnerable Adults list (POVA) would have been undertaken. This was not evidenced. None of the files contained evidence of a formal interview, induction or for the two registered nurses copies of their Statement of Entry to the nurses’ register. None of the staff has a training and development programme. The manager said that in addition to distance learning training in Infection control undertaken by all staff, staff had also completed moving and handling training and the registered nurses have all completed a one day first aid course. Communication systems in the home appear to be work well, with staff handovers taking place at the beginning of each shift. Staff meetings take place and minutes of meetings were available for examination. The inspector gained the impression of a staff team that works well together and that staff morale is good in the home. Staff confirmed this and felt this was because of the size of the home and a small staff team. In discussion with a relative he/she described the staff team as ‘ Wonderful, very caring staff, they are Ramping Cat House Nursing Home DS0000064639.V343407.R01.S.doc Version 5.2 Page 22 remarkable’. The relative also commented that the staffing levels are very low and sometimes only two staff on duty. Ramping Cat House Nursing Home DS0000064639.V343407.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33,35 and 36. Standards 31 and 36 were subject to good practice recommendations at the last inspection. Quality in this outcome area is adequate. The manager is not provided with sufficient time to carry out her management role in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is a well qualified and experienced nurse who has completed the Registered Managers Award. Service users, staff and relatives describe the manager was supportive, kind and is a good manager. The manager is frequently required to provide nursing care to service users as the registered nurse on duty and has very few hours free to undertake her management responsibilities for the home. This was subject to a good practice Ramping Cat House Nursing Home DS0000064639.V343407.R01.S.doc Version 5.2 Page 24 recommendation at the last inspection. The Operations Manager is to work with the manager to move the home forward by reviewing and developing all policies and procedures in the home, quality assurance systems and staff training and supervision. The manager now has a computer, but as yet does not have e-mail or Internet access to enable her to manage her workload and communications more effectively. None of the service users are able to manage their own finances. The service users relatives or representatives undertake this task. The manager advised the inspector that the home has no involvement in service user’s finances. Not all staff receive planned formal supervision. This has recently commenced and evidence was seen that one care assistant received supervision in May 2007. All registered nurses are to undertake supervisory skills training in order to supervise care assistants. This was subject to a good practice recommendation at the last inspection. The home does not have an annual business and development plan in place. Quality assurance processes are not evidenced as to how the views of service users, relatives and other stakeholders are sought on a regular basis. Reports written by a representative of the company that owns the home, following monthly visits to the home, were available for examination by the inspector. It is understood that the Operations manager will undertake this role in the future. A sample of records relating to fire, health, safety and welfare were examined and found to be up to date and well maintained. Ramping Cat House Nursing Home DS0000064639.V343407.R01.S.doc Version 5.2 Page 25 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 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 17 x 18 2 2 x x 2 x x x 3 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 2 x 2 x 3 2 2 3 Ramping Cat House Nursing Home DS0000064639.V343407.R01.S.doc Version 5.2 Page 26 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. This is a repeat requirement from the inspection carried out in July 2006 and has not been fully complied with. Timescale for action 20/09/07 2 3 OP22 OP27 23 19 An appropriate nurse call system is installed in the lounge. 20/09/07 4 OP30 17(4) Sufficient staff must be on duty 20/09/07 at all times to meet the physical, emotional and social care needs of all service users. In addition catering, cleaning and laundry staff must be employed in sufficient numbers. All staff must receive training 20/10/07 appropriate to the work that they perform. That a staff training and development programme is put in place. Including an induction Ramping Cat House Nursing Home DS0000064639.V343407.R01.S.doc Version 5.2 Page 27 programme in line with Skills for Care. 5 OP31 10(3) The registered manager must have sufficient supernumerary time to carry out the additional managerial, supervisory and assessment tasks required of her role. The home should have e-mail and internet connection to enable the manager to manage her workload and communication more effectively. 6 OP33 24 Quality assurance processes must be developed to evidence that the home is run in the best interests of the service user. Including the home’s annual business and development plan. All staff must receive formal one to one supervision at least six times per year, by staff that have received appropriate supervisory skills training. All records required under this regulation must be maintained, up to date and accurate. 20/10/07 20/09/07 7 OP36 18(2) 20/10/07 8 OP37 17 20/09/07 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 home should obtain copies of the Oxfordshire MultiDS0000064639.V343407.R01.S.doc Version 5.2 Page 28 2. OP18 Ramping Cat House Nursing Home agency 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. 3. OP29 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. Ramping Cat House Nursing Home DS0000064639.V343407.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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