CARE HOMES FOR OLDER PEOPLE
Ranelagh Grange 90 Stoney Lane Rainhill Merseyside L35 9JZ Lead Inspector
Miss Diane Sharrock Unannounced Inspection 24th March 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.V288053.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.V288053.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.V288053.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. 13th January 2006 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 is now privately owned by Mr Patarra of Prime healthcare LTD.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.V288053.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 and the first inspection of the home since the new providers Prime Healthcare LTD, took over. 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 general review of various documents and records was undertaken. A sample of comment cards were left for people to make additional comments to the CSCI of they wished. What the service does well: What has improved since the last inspection?
Following the previous inspection the Manager had arranged ‘abuse awareness training’ for Staff on the 27/04/06 and moving and handling training on the 24/4/06. Five Staff have recently completed their NVQ training. The home continues to be redecorated and at the time of the inspection the maintenance person was painting a bedroom corridor. Ranelagh Grange DS0000066256.V288053.R01.S.doc Version 5.1 Page 6 What they could do better:
Full feedback was given to the Manager with written feedback also supplied. A number of issues were noted to be outstanding from the previous inspection and other points were in need of action to be taken by the Responsible Person to improve on current practice. 1) Personal allowances and details around the recording and management of this were not available in full. The new Provider and Manager must review the current management of residents finances and take appropriate actions to evidence they are in line with the Care Homes Regulations 2001. Referrals must be made to Residents Care Managers if the current records indicate this to be necessary. The CSCI must be informed of all actions taken following this inspection. 2) Personnel files must be reviewed and all records necessary to meet the regulations must be in place including, POVA and CRB (police) checks. 3) The current recording storage and administration of medicines must be reviewed with actions taken by the company to improve current practice. Seven Staff still need update training in the administration of medicines. 4) The activities programme needs complete review and the home has still not recruited an activities organiser. 5) The home did not have a statement of purpose of service or user guide on the premises. These legal documents must be accessible at all times to all parties at the home. 6) The Manager has not always been supernumerary as she explained that they had recently struggled with covering for staffing. This must be reviewed as a matter of priority to enable the Manager to develop initiatives to evidence all parts of the National Minimum Standards and to demonstrate the day-to-day management of the home. Staffing levels submitted by the provider prior to registration must be maintained at all times. 7) Mandatory training must be up-to-date and provided for all Staff to ensure they are appropriately training to support all Residents at the home. 8) All Staff must have six supervisions sessions a year. 9) The home should develop and provide a developmental plan and maintenance and decorating plan for the home. These documents should help keep Residents and all parties informed of developments at their home and enable them to give comments of how they would like the home to be developed.
Ranelagh Grange DS0000066256.V288053.R01.S.doc Version 5.1 Page 7 10) 11) Residents and Relatives meetings should be developed and implemented to provide on-going and open communication about the home. It was established at this visit that the owner was not at the home each week. Prior to registration the Owner proposed to be at the home one day per week. During this inspection it was established that this did not always take place. It was demonstrated that the Manager and Staff need the support and input from the Provider to maintain the ongoing management of the home and establish developments. The CSCI would be agreeable to meet the Provider to discuss the issues noted at the inspection and the points raised within this report. 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.V288053.R01.S.doc Version 5.1 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 Ranelagh Grange DS0000066256.V288053.R01.S.doc Version 5.1 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 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.V288053.R01.S.doc Version 5.1 Page 10 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 Care plans are still being developed and do not yet meet these standards. A number of Staff need update training in medication and the administration, recording and storage of medication needs review. EVIDENCE: Care plans continue to be developed by the homes Staff, however they are still to meet all parts of the standards. As this is an on-going issue in the homes inspections it would indicate that training would need to be accessed and the current practice reviewed. The medication was reviewed at this inspection and identified a number of issues for the Manager to address to improve current practice. Some handwritten entries were seen for a Residents eye drops and some had been used past their 28 days. The Manager explained that they do carry out checks but no written evidence or audit tool was being used. The Manager identified approximately seven Staff in need of updated training in the administration of Medicines. This should be arranged as a matter of priority. Ranelagh Grange DS0000066256.V288053.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): 12 & 15 The home did not have a planned programme of activities. The menu on the day of this inspection was seen with various compliments about lunch and the meal provided. EVIDENCE: Staff were able to explain previous activities and occasional trips out, however all necessary action to evidence this standard was not in place. The home did not have a planned programme of events and the Manager acknowledged that they do not have minuted Resident and Relatives meetings. This should be developed to provide an open and transparent process for all parties to be informed of developments at the home and to ascertain peoples opinions as to what they would like, particularly regarding activities. The home should provide an experienced person to organise activities appropriate to the needs of Residents at the home. The menus on the day of the inspection looked wholesome and balanced with lunch being well presented and looking appealing. The dining room remains attractively maintained offering a pleasant environment. Ranelagh Grange DS0000066256.V288053.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): X These standards were not measured at this inspection. EVIDENCE: Ranelagh Grange DS0000066256.V288053.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 The home continues to be well maintained. EVIDENCE: A sample of the bedroom areas were seen and noted to be well maintained, with the maintenance person in the process of painting a bedroom corridor. Some radiators were noted to be uncovered but cold to touch. The maintenance person explained the uncovered radiators are controlled by the boiler and cannot be individually switched on to a high temperature, enabling the home to monitor them to a safe heat setting. Ranelagh Grange DS0000066256.V288053.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 Staff rotas continue to show a vacancy for the weekend and night time post. Personnel files needed reviewing to ensure all necessary records are stored. Some Staff had not received mandatory training. EVIDENCE: Staff rotas seen during this inspection highlighted a need for vacancies for a night carer of 20 hours per week and 15 hours a week at the weekend. The home does not have an activities organiser and the Manager continues on occasions to be included in the numbers and is unable to plan her managerial hours as supernumerary. The home must be staffed according to the staffing levels submitted by the present Owner during his registration. An action plan must be put in place to address ongoing vacancies at the home to ensure it is staffed appropriately. As stated at the previous inspection a risk assessment must be implemented to identify appropriate actions to take to reduce any associated risks to lowered staffing levels. A regulation 37 report must be submitted to the CSCI to keep them informed of the company’s actions in these incidences. To date none of these have been received following the previous inspection. A sample of personnel records identified that not all files had evidence of a POVA check prior to employment. The Responsible Person must take action to ensure all necessary records are provided to meet these regulations.
Ranelagh Grange DS0000066256.V288053.R01.S.doc Version 5.1 Page 15 Training records as noted at the previous inspection must be revised and updated to show evidence that all Staff have at least 3 days paid training a year. Some Staff were identified by the Manager to still need updated training in medication administration. This should be implemented as a matter of priority. Other mandatory training noted at the previous inspection had been organised by the Manager for April 2006. Ranelagh Grange DS0000066256.V288053.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35 & 36 The management of the home needs review and support by the present Owner to develop the home. Supervision sessions for Staff still need to be implemented. The management of Residents finances need complete review by the company. EVIDENCE: As already stated the Manager has been unable to consistently apply her managerial role as she has been working within the team to assist the current vacancies. The provider must identify measures to support the management team at the home and implement measures to develop the home in the best interests of Residents. He should ensure the manager has managerial hours and the necessary resources to demonstrate day-to-day management of the home. This includes providing a developmental plan, maintenance programme and access to the statement of purpose and service user guide as examples of on-going correspondence and communication with Residents regarding their home.
Ranelagh Grange DS0000066256.V288053.R01.S.doc Version 5.1 Page 17 Personnel files and information from Staff identify that six supervision sessions per year are still not in place. A review of a sample of Residents finances managed by the home was unable to ascertain if the home was meeting these regulations. Prior to the new Owners purchasing this home the previous Owners managed the finances and the current Manager was not involved in this process. The Manager was able to ascertain that the Owner now manages the finances for 7 Residents but it was unclear if he had applied to be appointee and whether each Resident was receiving their full personal allowance from the authorities. The manager is currently unable to access records transferred to the new Owner and could not clarify whether any further accounts are managed for Residents or whether any personal monies are kept in any other accounts. The above issues were verbally discussed by phone with Mr Patarra the Owner during this inspection. The management of Residents finances must be reviewed as a matter of priority. The Responsible Person must take appropriate action to ensure the ongoing management meets standards and regulations. The Manager must have access to all records and should ensure that referrals are carried out to Care Managers if any finances need further review and input in the best interests of Residents. Ranelagh Grange DS0000066256.V288053.R01.S.doc Version 5.1 Page 18 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 X 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X X STAFFING Standard No Score 27 1 28 X 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 1 2 X X Ranelagh Grange DS0000066256.V288053.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP27 Regulation 18 Requirement The Responsible Persons 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 Persons 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. The Responsible Persons must take action to ensure the management of Residents finances are in line with the Care Homes Regulations 2001 and National Minimum Standards. An action plan must be submitted to the CSCI stating what actions will be taken to meet these regulations.
DS0000066256.V288053.R01.S.doc Timescale for action 11/05/06 2 OP27 37 11/05/06 3 OP35 20 11/05/06 Ranelagh Grange Version 5.1 Page 20 4 OP29 19 The Responsible Persons must take actions to ensure all personnel files meet the Care Homes Regulations 2001 and that POVA checks are in place prior to employment. To submit an action plan to the CSCI stating what actions will be taken to meet these regulations. 11/05/06 5 OP1 4 The Responsible Persons must 11/05/06 ensure that the home always has an accurate and accessible statement of propose and service user guide on the premises. The Responsible Person must arrange for mandatory training for Staff including the administration of medications. Actions must be taken to ensure on-going safe practice with the administration of medications. To submit an action plan to CSCI to state what actions will be taken to meet these regulations. The Responsible Persons must ensure that all care plans are up to date and meet the needs of Residents. To submit an action plan to the CSCI to state what actions will be taken to meet these regulations. 11/05/06 6 OP30 13 18 7 OP7 15 11/05/06 Ranelagh Grange DS0000066256.V288053.R01.S.doc Version 5.1 Page 21 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 OP30 Good Practice Recommendations To develop training records to record updates to all training needs, inclusive of mandatory training and evidence of at least 3 days paid training for all Staff. To develop supervision sessions for all Staff so each person has at least 6 per year. The Registered Manager should undertake their NVQ qualification to fully meet this standard. Supernumerary hours must be implemented to demonstrate day-to-day management of the home. The Owner must take actions to develop the home and ensure on-going appropriate management. The Owner should contact the CSCI to arrange a meeting to discuss all issues contained within this report. To develop an appropriate activities programme and the provisions of a suitable experienced activities organiser. TO develop on-going Resident / Relative meetings to elicit all parties opinions. To provide a maintenance and decorating plan and development plan for the home accessible to everyone. 2 3 OP36 OP31 4 OP12 5 OP33 Ranelagh Grange DS0000066256.V288053.R01.S.doc Version 5.1 Page 22 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
© 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 Ranelagh Grange DS0000066256.V288053.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
