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Inspection on 16/02/06 for Rangemore Nursing Home

Also see our care home review for Rangemore Nursing Home for more information

This inspection was carried out on 16th February 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The care needs of the residents living at Rangemore continue to be met to a good standard. The atmosphere at the home is warm and welcoming and comments made by residents and their relatives were complimentary. Staff were seen to treat residents with courtesy and kindness and appeared to have a good relationship with the residents in their care. The care plan documentation on the West Wing was detailed and gives care staff good direction as to the needs of the residents living at the home. Clear individual financial records are in place for all residents living at Rangemore. Staff are formally supervised on a regular basis. Residents said that they liked living at the home. Comments such as " the staff are lovely" and " the staff spoil me" were made.

What has improved since the last inspection?

Some bedrooms at the home have been decorated to improve the environment for the residents. Staff training is on going at the home and care staff working on the West Wing have had detailed training in dementia care to enable them to have a better insight in to the needs of the residents in their care. The requirements made regarding privacy locks on the bathrooms on the West Wing to maintain the privacy and dignity of the residents and appropriate locks on the laundry and satellite kitchen doors on West Wing to ensure the safety of the residents has now been met. The area identified in the corridor has now been re-plastered and re-decorated so that residents are living in a well-maintained environment. This outstanding requirement has now been met.

CARE HOMES FOR OLDER PEOPLE Rangemore Nursing Home Chester Road Bucklow Hill Knutsford Cheshire WA16 6RR Lead Inspector Joan Adam Unannounced Inspection 16th February 2006 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 Rangemore Nursing Home DS0000018779.V279788.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. Rangemore Nursing Home DS0000018779.V279788.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Rangemore Nursing Home Address Chester Road Bucklow Hill Knutsford Cheshire WA16 6RR 01565 830396 01565 830396 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) Mr Richard Dickinson Mrs Joyce Edith Healey Care Home 49 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (37), of places Terminally ill (1) Rangemore Nursing Home DS0000018779.V279788.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. This service is registered for a maximum of 49 service users to include: . Up to 37 service users in the category of OP (old age, not falling within any other category) . Up to 12 service users in the category of DE(E) (dementia over the age of 65 years) to be accommodated in the West Wing The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The registered provider must meet the agreed staffing levels at all times from 4 April 2005 Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection 9th August 2005 2. 3. 4. Date of last inspection Brief Description of the Service: Rangemore Nursing Home is situated in the Cheshire countryside, close to the towns of Lymm, Knutsford and Altrincham. There are 2 lounges, a conservatory and a quiet room, referred to as the sun room, as well as 2 separate dining rooms. Bedroom accommodation is provided on two floors with access between floors by passenger lift and stairways. The home provides nursing care for 49 older people, including12 people with a dementia related illness. Rangemore Nursing Home DS0000018779.V279788.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit of the home took place over six hours and was carried out as part of the yearly inspection process. Care records, fire records, staff personnel and training files and medication records were inspected. The service history of the home and the previous inspection report were read in preparation for the inspection. Four of the staff on duty, ten residents and one relative were spoken with during the inspection. An additional visit has been made to the home since the last inspection as concerns were raised about the lack of privacy locks on the bathroom doors on the West Wing and appropriate safety locks on the laundry and satellite kitchen on the West Wing. At this visit, the inspector for CSCI made a requirement for compliance with the Care Homes Regulations. Letters sent to the proprietor following this visit can be obtained from the CSCI office on request. What the service does well: The care needs of the residents living at Rangemore continue to be met to a good standard. The atmosphere at the home is warm and welcoming and comments made by residents and their relatives were complimentary. Staff were seen to treat residents with courtesy and kindness and appeared to have a good relationship with the residents in their care. The care plan documentation on the West Wing was detailed and gives care staff good direction as to the needs of the residents living at the home. Clear individual financial records are in place for all residents living at Rangemore. Staff are formally supervised on a regular basis. Residents said that they liked living at the home. Comments such as “ the staff are lovely” and “ the staff spoil me” were made. Rangemore Nursing Home DS0000018779.V279788.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Care plans in general at the home are detailed, however, plans of care looked at on the North Wing had not been reviewed and updated on a regular basis. The home does not employ an activities co-ordinator and although some social activities are now taking place these are limited. This was a requirement at the last two inspections and must be addressed. Recruitment procedures must be improved to ensure that the safety of the residents living at Rangemore is maintained. Requirements have been made regarding these issues. Please contact the provider for advice of actions taken in response to this Rangemore Nursing Home DS0000018779.V279788.R01.S.doc Version 5.1 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rangemore Nursing Home DS0000018779.V279788.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 Rangemore Nursing Home DS0000018779.V279788.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): EVIDENCE: The key standards were inspected and met at the last inspection. Rangemore Nursing Home DS0000018779.V279788.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): 7,9 Care plans on the West Wing were detailed and directed the care of the residents but plans of care on the North Wing did not address the changing care needs of the resident. Medication is administered, recorded, stored and disposed of correctly to maintain the safety of the residents living at Rangemore. EVIDENCE: Care plans were looked at on both units. The plans of care on the West Wing were of an acceptable standard. All plans of care were detailed and assessed areas of need such as mobility, falls, moving & handling, continence, pressure area & tissue viability, nutrition, mental health problems and general dependency. All were up dated and reviewed on a regular basis. A record was also made of support from, and visits by other health professionals such as GP’s. Rangemore Nursing Home DS0000018779.V279788.R01.S.doc Version 5.1 Page 11 Appropriate risk assessments were in place and these had been signed by residents or their relatives. Resident choices were documented such as times of rising and retiring and likes and dislikes of food. The care plans on the North Wing were of an acceptable standard, however, of the four care plans looked at only one had been reviewed and evaluated on a regular basis. Medication recording, management, storage and disposal were inspected and found to be satisfactory. Medicine Administration Records were examined and found to have been completed correctly. Rangemore Nursing Home DS0000018779.V279788.R01.S.doc Version 5.1 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 Social activities are limited and must improve to ensure stimulation is in place for the residents living at the home. Relatives and friends can visit at any time and resident choice is recorded in the care plans. EVIDENCE: The home has not yet employed an activities co-ordinator. Limited social activities are taking place but there are days within each week where no activities take place. The home has regular entertainment booked and a Thai Chi session takes place every few weeks, which the residents said they enjoyed. Activities are particularly important for people with dementia. It was discussed with the manager that as some residents are not able to join in the more structured type of activities that a more individual approach is applied. This was a requirement on the last two inspections and must be addressed. Residents spoken with said that they liked living at the home. Rangemore Nursing Home DS0000018779.V279788.R01.S.doc Version 5.1 Page 13 One resident spoken with said “ I was poorly when I came in here but I have put weight on and the staff spoil me. The food is lovely and if you don’t like anything you can always have something else.” Residents said that they like living at Rangemore but some said “ you get a bit fed up “ the staff are lovely but are busy, they don’t have time to do things with you” Visiting at the home is open and relatives and friends of residents are an important aspect of the home. Choice is recorded in the care plan with diet and food preferences and the likes and dislikes of residents are discussed with the relatives. Rangemore Nursing Home DS0000018779.V279788.R01.S.doc Version 5.1 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): EVIDENCE: The key standards were assessed and met at the last inspection. Rangemore Nursing Home DS0000018779.V279788.R01.S.doc Version 5.1 Page 15 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): EVIDENCE: The requirements made at the last inspection regarding the environment have been met. Rangemore Nursing Home DS0000018779.V279788.R01.S.doc Version 5.1 Page 16 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): 29 The recruitment procedures at the home need to be more robust to ensure residents safety. EVIDENCE: The files were looked at for three members of staff, one who had recently commenced work at the home and two existing staff members. The newly employed staff member contained all appropriate checks prior to employment, however the CRB in place was from a previous employer and these are not transferable. The records of the two staff members who had worked at the home for some time contained all appropriate checks prior to employment however, there was inadequate information on these staff files as required in schedule 2 of the Care Standards Act 2000. Rangemore Nursing Home DS0000018779.V279788.R01.S.doc Version 5.1 Page 17 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): 31,35,36,38 Clear individual financial records are in place for all residents living at Rangemore. The home is run in the best interests of the residents. Staff are adequately supervised. The management of the home ensures the health and safety of the residents. EVIDENCE: The registered manager is a trained nurse and is experienced and competent. She has not yet achieved NVQ level 4 in management. Clear individual financial records are in place for all residents living at Rangemore. Rangemore Nursing Home DS0000018779.V279788.R01.S.doc Version 5.1 Page 18 Formal supervision sessions for staff take place and supervision sessions are recorded. Residents who live at the home feel that their opinions are listened to and that they can make choices as to how they spend their time. The fire log was checked and staff training in fire safety has taken place and was recorded. Rangemore Nursing Home DS0000018779.V279788.R01.S.doc Version 5.1 Page 19 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 3 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x X X X X X X X x STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 X X 3 Rangemore Nursing Home DS0000018779.V279788.R01.S.doc Version 5.1 Page 20 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 op7 Regulation 15 Timescale for action Care plans must be reviewed and 31/03/06 up-dated on a regular basis (previous timescale of 9/09/05 not met) The social needs of the residents 31/03/06 must be met (previous timescale of 30/04/05 and 30/09/05 not met) All staff must have a POVA 1st 31/03/06 and CRB check by the home in place prior to commencing employment. Information as required in 31/03/06 schedule 2 of The Care Standards Act 2000 must be present in all staff files. Requirement 2. op12 16 3. OP29 18 4. OP29 9 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 OP31 Good Practice Recommendations The manager should have NVQ level 4 or equivalent Rangemore Nursing Home DS0000018779.V279788.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Rangemore Nursing Home DS0000018779.V279788.R01.S.doc Version 5.1 Page 22 - 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. 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