CARE HOMES FOR OLDER PEOPLE
Ranelagh Grange 90 Stoney Lane Rainhill Merseyside L35 9JZ Lead Inspector
Miss Diane Sharrock Unannounced Inspection 13th January 2006 10.30 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 Ranelagh Grange DS0000066256.V288047.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Ranelagh Grange DS0000066256.V288047.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Ranelagh Grange Address 90 Stoney Lane Rainhill Merseyside L35 9JZ 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) 01214344747 Prime Healthcare UK Limited Miss Christine Jones Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (36), Physical disability over 65 years of age (3) of places Ranelagh Grange DS0000066256.V288047.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The service may admit up to 36 service users in the category of Old Age and up to 3 in the category of Physical Disability over 65 years of age. 27th October 2005 Date of last inspection Brief Description of the Service: Ranelagh Grange is registered to provide 39 beds for personal and residential care for older persons over 65 years of age. The home was privately owned at the time of this inspection by Mr and Mrs Wilkinson and the Registered Manager is Mrs Chris Jones Taylor. The home is situated close to Whiston hospital near to local amenities. The building is a large detached building which offers a highly decorated and maintained environment. Ranelagh Grange DS0000066256.V288047.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory requirements. The home has had no other visits since the previous inspection. Various Staff and Residents had general discussions with the Inspector. A sample of areas within the environment were seen during this visit and a review of various documents and care records was also undertaken. A sample of comment cards were left for people to complete and send into the Commission for Social care Inspection. What the service does well: What has improved since the last inspection?
The home continues to be refurbished and redecorated. Following the last inspection the main lounges have been redecorated and maintained to a high standard. The homes Staff have developed an internal audit of accidents to review each record to enable Staff to take appropriate action to reduce accidents. Ranelagh Grange DS0000066256.V288047.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ranelagh Grange DS0000066256.V288047.R01.S.doc Version 5.1 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 Ranelagh Grange DS0000066256.V288047.R01.S.doc Version 5.1 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): X These standards were not measured at this inspection. EVIDENCE: Ranelagh Grange DS0000066256.V288047.R01.S.doc Version 5.1 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): 7,8 & 10 Care plans are still being developed and do not yet meet these standards. Residents were complimentary about Staff and were happy their needs were being met. EVIDENCE: A sample of care plans showed details to help Staff identify the needs of Residents. However these records need further development and review to meet all parts of these standards. Some records needed updating, including risk assessments. One person who has falls had a last review date of 5/02. This assessment needs updating to ensure all actions are taken to reduce risks and are current to the persons needs. One care plan for moving and handling needed review and action taken by the manager following this inspection. Staff described some examples of when they ‘lift’ a Resident. This practice must be stopped and action taken by the Manager to ensure appropriate moving and handling techniques, which are in line with current legislation and practice. Appropriate training and updates to moving and handling assessments should be reviewed and implemented to improve current practice. Many Residents gave lots of positive comments about the home and how they live their lives. Some Residents keep their bedroom doors locked and were
Ranelagh Grange DS0000066256.V288047.R01.S.doc Version 5.1 Page 10 enabled to keep their possessions and bedroom private for any other visitors / Residents or Staff at the home. During the visit all Staff were observed interacting respectfully with Residents. Ranelagh Grange DS0000066256.V288047.R01.S.doc Version 5.1 Page 11 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): 13 & 15 Relatives and visitors felt they could visit at any time and are always made to feel welcome. Residents were happy with the meals and menus on offer. EVIDENCE: Relatives and visitors visiting at the time of this inspection felt they are always made to feel welcome at the home and can visit at any time. Over the Christmas period Staff had arranged for various visitors to the home including the local schools and churches. Various Residents and relatives expressed positive comments about the food and menus offered. The dining room was noted to be decorated and maintained to a high standard and all dining tables were attractively dressed. Ranelagh Grange DS0000066256.V288047.R01.S.doc Version 5.1 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 The home has an accessible complaints policy. EVIDENCE: During this visit the homes complaint record book was seen. It was noted that there had been two recorded complaints in 2005, with details of actions taken by the company representatives following each complaint. The policy has a 21-day timescale for investigating and providing an outcome to the complainant, so that they are aware of what actions the company have taken. Ranelagh Grange DS0000066256.V288047.R01.S.doc Version 5.1 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): 19 & 26 The home was clean, tidy and well maintained. EVIDENCE: A sample of areas of the environment were seen and noted to be clean, tidy and well maintained to a high standard. Residents and visitors stated they were happy with the facilities in the home and felt very comfortable. Since the last inspection the main lounge areas had been redecorated offering pleasant and comfortable living areas. Ranelagh Grange DS0000066256.V288047.R01.S.doc Version 5.1 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, 29 & 30 Staff rotas showed a current vacancy for one night a week and on occasions staffing levels had been lower than usual. Personnel files are detailed and stored in line with regulation. Some Staff had not received mandatory training for abuse awareness and records needed updating to meet this standard. EVIDENCE: Staff rotas seen during this visit highlighted a night carer vacancy for one night a week. On most occasions the homes Staff were able to cover this vacancy but on other occasions the rota showed a shortfall in the staffing levels. The home must always be staffed according to the needs and dependencies of the Residents. This issue was discussed in detail regarding the current advertising of the vacancy and the need to implement a risk assessment for occasions when the home was staffed with lower numbers than usual. The need to submit a regulation 37 report to the CSCI to keep them informed of these points was also discussed and brought to the managers attention. A sample of personnel files showed the detailed information necessary to evidence a through recruitment and selection policy to safeguard Residents. Staff were able to describe various training sessions they had attended recently. It was identified that some Staff had not yet received abuse awareness training. This must be arranged as a matter of priority including appropriate training for moving and handling. As stated at the homes previous inspection training records must be revised and updated to show evidence that all members of Staff have at least 3 days paid training each year and that they all have ongoing necessary mandatory training. Ranelagh Grange DS0000066256.V288047.R01.S.doc Version 5.1 Page 15 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): 31,36 & 38 The Manager has been at the home for many years and should be developing her managerial role to implement NVQ 4. Supervisions records still need to be developed for Staff. Health and safety procedures are in pace at the home. EVIDENCE: As stated at the previous inspection the Manager has worked at the home for many years and offers great stability and support to the home. However these standards point out as a basic standard that the Manager should have NVQ 4. This should be implemented for the current Manager. It was also noted that Staff do not have supervision sessions as laid out within the standards. All Staff should be enabled to have six sessions on a one-one basis each year to discuss their role and developments whilst at the home. The home has health and safety polices in place with detailed assessments to ensure the safety of Residents. Ranelagh Grange DS0000066256.V288047.R01.S.doc Version 5.1 Page 16 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X 2 X 3 Ranelagh Grange DS0000066256.V288047.R01.S.doc Version 5.1 Page 17 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 OP7 Regulation 15 Requirement The Responsible Person must ensure that all care plans are up to date and meet the needs of Residents, this must include moving and handling assessments and all risk assessments. The Responsible Person must arrange for mandatory training for all Staff including moving and handling and ‘abuse awareness’ The Responsible Person must provide suitable numbers of qualified competently trained Staff to support each Residents needs. They must submit an action plan to the CSCI stating what actions will be taken to meet these regulations. The Responsible Person must ensure that a risk assessment is implemented to identify any risks on any occasions were the appropriate staffing levels are not in place. A regulation 37 report must be submitted to the CSCI regarding any future incidences of this occurring. Timescale for action 11/05/06 2 OP30 18 11/05/06 3 OP27 18 11/05/06 4 OP27 37 11/05/06 Ranelagh Grange DS0000066256.V288047.R01.S.doc Version 5.1 Page 18 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 2 3 Refer to Standard OP30 OP36 OP31 Good Practice Recommendations To develop training records to record updates to all training needs inclusive of mandatory training and evidence at least three days paid training for Staff. To develop supervision sessions for all Staff so each person has at least six per year. The Registered Manager should undertake their NVQ 4 qualification to fully meet this standard. Ranelagh Grange DS0000066256.V288047.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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