Inspection on 19/10/05 for Ranelagh House Residential Care Home

This inspection was carried out on 19th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ranelagh House Residential Care... 09/07/08

Ranelagh House Residential Care... 04/06/07

Ranelagh House Residential Care... 15/01/07

Ranelagh House Residential Care... 03/01/06

Ranelagh House Residential Care... 28/10/04

Ranelagh House Residential Care... 14/04/04

Ranelagh House Residential Care... 26/11/03

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

CARE HOMES FOR OLDER PEOPLE Ranelagh House Residential Care Home 533 Aigburth Road Liverpool Merseyside L19 9DN Lead Inspector John McCabe Unannounced Inspection 19th October 2005 09:30 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 House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ranelagh House Residential Care Home Address 533 Aigburth Road Liverpool Merseyside L19 9DN 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) 0151 427 4486 Prima Health Care Limited Margaret Lilian Martin Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th October 2004 Brief Description of the Service: Ranelagh House is situated in the Aigburth area of Liverpool and is in close proximity to local amenities and has easy access to bus and rail routes into the city centre. Ranelagh House is registered with the CSCI to provide care for 26 residents within the category of old age. The home provides both single and double rooms. Most of the bedrooms have an en suite facility. All the rooms are situated on two floors and are accessible via stairs, passenger lift or, in the instance of one part of the building stair lift only. The home has parking to the side of the house, and a secure well-tended garden to the rear. Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place with the registered manager of the home. Files and documents relating to residents and staff were reviewed, and a full tour of the building took place. The inspection was done over a period of four hours. The home was clean tidy and adequate staffs were on duty to care for the residents. Staff and residents told the inspector that the home was happy place to live and work in. What the service does well: What has improved since the last inspection? What they could do better: The residents pre admission assessment document lacks detail and does not adequately provide sufficient information about the residents care needs before they are admitted to the home. Specialist training for staff in the home is needed as many of the residents’ medical and psychological needs have deteriorated since they were admitted to the home. Specialist training in these areas would help staff to continue to support residents as their needs change. Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 6 Documented supervision of staff is still not being undertaken, even though this was highlighted in the inspection report of one year ago. Corrosive chemicals (Bleach) should not be left where residents with cognitive impairment can access them. Any such chemicals must be safely stored when not in use thus avoiding possible incidents of ingestion. The homes policies, some dated 2000, need to be reviewed and updated especially the policies on Adult Protection, and infection control. The home needs to prepare a planned programme of maintenance, to ensure the home environment remains comfortable and safe for residents. 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 House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. The residents’ preadmission assessment documentation is not comprehensive; It does not sufficiently identify residents care needs, and does not ensures that the skill mix of the workforce in the home can meet the residents’ identified care needs. EVIDENCE: All residents in the home are provided with a statement of terms and conditions, plus a contract when they move in to the home on a permanent basis. Residents are able to visit the home or have an overnight stay before they move in on a permanent basis. The Home’s Statement of Purpose needs to be updated, and must now include the correct information the address and telephone number of the CSCI. At the time of the inspection the inspector observed pre-admission assessment documentation. This consisted of one A4 page, which only related to the prospective residents GP, next of kin, and funding arrangements. Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 9 Some of the residents recently admitted to the home have cognitive impairment and early Dementia, yet no care needs of the resident were recorded before they were admitted. A robust and comprehensive pre admission document would ensure that the correct category of resident is admitted to the home, and consequently this would also be reflected in the home providing the right skill mix of care staff to care for the resident. The management of the home must formulate a suitable document to address both of these points. Care staff in the home must be involved in Specialist Training, to ensure that the assessed and changing care needs of the residents are met. Specialist training might include, dementia care, awareness of confusional states, Diabetes Mellitus, Osteoporosis, and visual impairment (especially macular degeneration) amongst others depending upon resident need. All training sessions should be recorded in the personal file of the carer. This would allow a portfolio of evidence to be kept detailing each person’s individual development as well as the organisations commitment to training. Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 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,,9,10. Residents’ individual health, personal and social care needs are clearly recorded, and provide care staff with the information they need to meet the residents care needs. EVIDENCE: All residents in the home have an individual care plan, which is formulated on admission to the home, and which is reviewed by the senior carers on a monthly basis. Residents and family also contribute to the formulation of the plan. Daily health records are documented for each resident, this also includes any critical incidences plus any visits from GPs, specialist nurses etc. The daily health records are completed throughout a 24-hour period. The entry should include a 24 –hour clock entry. Staff in the home would benefit from having some instruction on report writing, as many of the recordings lack any detail that would tell the reader what the individual residents experience was for that day. i.e. slept well, had a good day, comfortable etc. Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 11 All residents in the home can access their NHS entitlements, which include dentists, opticians, and chiropodists. No resident in the home self medicates subsequently all medications are administered by the carers in the home. The protocols for the receipt, storage, disposal, and documentation of medications in the home are in accordance with the National Minimum Standards (NMS). Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 12 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. Residents are encouraged to exercise choice and flexibility about how they spend their day in the home and staff work at encouraging independence whilst respecting individuality and accommodating personal preferences. Residents receive a balanced diet offering variety while reflecting resident’s preferences. EVIDENCE: Residents in the home are asked on admission, about their previous lifestyle, choice of foods, and choices and preferences of the social activities that they would like to participate in. On admission to the home the resident with, help from a family member if needed, completes a “Getting to know you” questionnaire. This is a “Work life History” of the resident, and includes their experiences of schooling, work, hobbies, food likes and dislikes etc. This information is used to organise activities for the resident and to inform care planning based upon the residents needs and wishes. It is recommended that when residents opt to participate in organised activities, it would be useful to record to what extent this occurs. This should be done on their daily health record sheet. This would then reflect more transparently the experience of the resident whilst living at the home. Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 13 Recently residents had been to the theatre, and another theatre trip is planned for Xmas. Visitors are allowed in the home at any reasonable time of day and residents may entertain their visitors either in the communal lounges, or in their own bedroom. Residents told the inspector that they enjoyed the variety of food in the home, and were looking forward to lunch, as it was “gammon and roasties.” Some of the residents prefer to take their meals in their own room rather than go to the dining room. This choice is respected and catered for. Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 14 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): 16,17,18. The home has a satisfactory complaints system with evidence that residents feel their views are being listened to and acted upon. The homes policy and training programmes for POVA, and Whistle blowing, needs reviewing and updating to ensure that the homes residents are protected from any potential abuse. EVIDENCE: There have been no internal complaints, or complaints to the commission since the last inspection. The home has robust complaints procedures, which are documented in the residents guide and the staff handbook. The contact details of the CSCI and the address of the Liverpool/Wirral office need to be included in the details printed. Many of the residents used their postal vote in the Local Elections. The care home maintains information on the Protection of Vulnerable Adults (POVA). This information is communicated to new employees on their induction course although the policy needs to be reviewed and updated if necessary as it is dated 2000. There was evidence that many of the staff in the home had undertaken training on POVA protocols, and the Whistle Blowing Policy. Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 15 Care staff were able to tell the inspector about the Whistle Blowing policy and were able to demonstrate a satisfactory awareness of what action to take if required. Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 16 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): 19,20,21,22,23,24,25,26. The standard of décor and maintenance in the home needs to improve although generally the home does present as a homely, and comfortable environment for the residents. Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 17 EVIDENCE: Although a main corridor and bedroom have been re painted the homes management needs to establish a clear programme of maintenance and decoration in order to continue to provide a homely, comfortable environment. There are grab rails throughout the house, and ramps for wheelchair access. The home’s kitchen needs to be refurbished. A number of wall and floor tiles are missing and it would benefit from an intensive cleaning. During the tour of the building, a 5 Litre carton of bleach was observed to be stored outside the kitchen door. Residents with cognitive impairment have access to this area; corrosive poisons are an obvious hazard to these residents. The rear gardens are well cared for and tended, and offer seating for the service users to enjoy. The homes infection control policies need to be updated and must include the necessary information to support the practices for the prevention and spread of Methicillin Resistant Staphylococcus (MRSA), and Hepatitis B. Most of the residents have personalised their own bedrooms with photographs and memorabilia. This encourages a sense of homeliness and belonging. Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 18 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. The standard of vetting and recruitment practices is safe and ensures appropriate checks are being carried out on all new staff. This means that the residents are not put at risk. EVIDENCE: Staff personal files were reviewed and all files contained confirmation that CRB/POVA enhanced clearance certificates had been obtained. All staff had signed their induction document to confirm they have been instructed on Adult Protection protocols and what to do in the event of observing any potentially abusive practice. Mandatory staff training is ongoing i.e. manual handling, first aid, as evidenced from the personal files of staff. This demonstrates a commitment to developing staff that in turn should see benefits for the residents in the standards of care provided. Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 19 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): 31,32,33,34,35,36,37,38. Staff morale is high in the care home, resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. Documented supervision of care staff needs to be regularly conducted for all staff otherwise this could result in training needs of staff not being identified, and the care needs of residents not being met. EVIDENCE: The home manager has had thirty years experience with Liverpool Social Services, and has been the registered manager of the home for six months. At present the manager is not yet enrolled on an NVQ Level 4 care home management course. The home’s policies and procedures have been taken from a commercially produced Home Care Manual. Unfortunately most of the homes polices used Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 20 for reference are dated 2000. Consequently there is an urgent need to review and up date all policies, especially those that deal with Adult protection and infection control so that they reflect current best practice. All care staff in the home must have formal documented supervision at least six times per year in line with the NMS. Documented supervision should ensure that care staff have the opportunity to discuss with the manager, and other senior carers, any issues that can effect or improve the care for the residents. Documented supervision of care staff also provides the staff and managers with opportunities to discuss their own /or others identified training needs. There was some evidence in the home that staff appraisal was being undertaken twice yearly. Currently, in the home there are no formal regular meetings with either staff or residents. Regular recorded meetings with both groups are an integral part of the quality assurance monitoring of the home and need to begin in the near future. Fire drills for night staff must held at three monthly intervals and evidence must be provided of staff members participating in the drill. Where possible residents look after their own financial affairs as the home does not hold any bank accounts for residents. Both residents and staff personal files are kept secure in the home in accordance with the Data Protection Act 1998. The home certificates of insurance and worthiness for the gas and electrical installations in the home could not be evidenced. The manager of the home needs to be able to evidence that all required checks have been undertaken and that certificates of worthiness are up to date. Failure to do so can unnecessarily put residents at risk. Action is needed to ensure all checks have been completed. Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 21 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 3 3 2 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 18 2 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 2 3 2 Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 22 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 OP3 Regulation 14 Requirement The registered person must ensure that a pre-admission assessment is undertaken on each resident before they are admitted to the home. The registered person must ensure that Specialist Care Training for care staff is commenced, to ensure that the assessed and changing care needs of the residents are met The registered person must ensure that when residents engage in organised activities, how they part participate in the activity is recorded in their daily health record sheet The registered person must ensure that the home’s policy on Adult Protection/Abuse is up dated, and this information communicated to all staff. The registered person must ensure that the home’s kitchen is cleaned, painted and tiling replaced on the walls and floor The registered person of the home must ensure that corrosive poison (Bleach) is securely DS0000025364.V259137.R01.S.doc Timescale for action 30/11/05 2 OP4 19 30/11/05 3 OP12 12 30/11/05 4 OP18 13 30/11/05 5 OP19 23 31/12/05 6 OP19 23 30/11/05 Ranelagh House Residential Care Home Version 5.0 Page 23 7 OP19 23 8 OP26 13 9 OP33 24 10 OP33 21 11 OP33 13 12 OP36 19 13 OP38 16 14 OP38 19 locked away when not in use, so as to protect the residents. The registered person must ensure that a planned programme of maintenance and re-decoration of the home is submitted to the CSCI Liverpool/Wirral Office within one month from the receipt of this report. The registered person must ensure that home’s Infection Control policy is up dated to include the prevention and spread of Methicillin Resistant Staphylococcus Aureus (MRSA) and Hepatitis B. The registered person must ensure that there are regular formal meetings held in the home for the residents. The registered person must ensure that formal meetings for staff are held at regular intervals in the home. The registered person must ensure that the home’s policies and procedures for both residents and staff are up dated The registered person must ensure that formal documented supervision of care staff is undertaken at least six times per year. The registered person must ensure that the up to date certificates of insurance and worthiness for gas and electrical installations in the home, are forwarded to the CSCI Liverpool/Wirral office within two weeks of receipt of this report The registered person must ensure that night staff participate in a fire drill every three months. 31/12/05 30/11/05 30/11/05 30/11/05 31/12/05 30/11/05 30/11/05 30/11/05 Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 24 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 OP7 Good Practice Recommendations It is recommended that care staff in the home receive training on report writing. Ranelagh House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 House Residential Care Home DS0000025364.V259137.R01.S.doc Version 5.0 Page 26 - 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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