Inspection on 23/08/06 for Rangemore Nursing Home

This inspection was carried out on 23rd August 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 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

Rangemore Nursing Home 31/07/07

Rangemore Nursing Home 16/02/06

Rangemore Nursing Home 09/08/05

Rangemore Nursing Home 08/03/05

Rangemore Nursing Home 28/09/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Rangemore Nursing Home Chester Road Bucklow Hill Knutsford Cheshire WA16 6RR Lead Inspector Joan Adam Key Unannounced Inspection 23rd August 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.V304109.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rangemore Nursing Home DS0000018779.V304109.R01.S.doc Version 5.2 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 (12), Dementia - over 65 years of age registration, with number (12), Old age, not falling within any other of places category (37) Rangemore Nursing Home DS0000018779.V304109.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 49 service users to include:Up to 37 service users in the category OP (Old age, not falling within any other category) to be accommodated in the main house Up to 12 service users in the category of either DE (Dementia) or DE(E) Dementia over the age of 65 years to be accommodated in the West Wing including:* * Up to 9 service users in the category DE (Dementia) over the age of 60 years Up to 3 service users in the category DE (Dementia) over the age of 55 years 16th February 2006 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, including 12 people with a dementia related illness, accommodated within their own wing. The current charges for the home are £500 to £600 per week. This information has been provided by the home manager. Rangemore Nursing Home DS0000018779.V304109.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key inspection was unannounced and started at 9.30am and took place over eleven hours. The homeowner was also invited to provide evidence as part of this process. The registered manager was on holiday during the visit and feedback was given to her on her return from holiday. The Inspector spoke to the homeowner, four staff members and seven residents and their views were taken into account. Five residents’ records were examined as part of the inspection process, in respect of the care they receive. Records of medication, care plans, staffing rotas and training were also examined. A tour of the premises was undertaken. Examination of the homes documentation, policies and procedures formed the basis of the visit. Information was also provided by the home before the site visit. Questionnaires were sent to residents, relatives, visiting GP’s and social workers prior to the visit to the home. All comments received were positive. What the service does well: Good information is provided to prospective residents and they are actively encouraged to visit the home and stay on a trial basis prior to making a permanent choice. Full and comprehensive assessments are carried out and care plans are in place to ensure the home will be able to meet the residents’ needs. Medicines are well managed, ensuring that residents receive their prescribed medication. There is a good, friendly relationship between staff and residents and staff are mindful of service users’ privacy and dignity. Residents said that “ the staff are lovely” “ it isn’t a bad place to live”. Residents and staff said that the management of the home is open and positive. The home is well maintained and clean. It provides a comfortable and welcoming environment. Visitors are warmly welcomed into the home. The home is beginning to consult residents about their hobbies and interests and an activities programme has been commenced which the home intends to Rangemore Nursing Home DS0000018779.V304109.R01.S.doc Version 5.2 Page 6 build on. Residents commented that “we are starting to do things instead of just sitting here”. Residents receive good and varied food. Staff recruitment, training and supervision ensure that resident’s interests are promoted and protected. Adequate numbers of staff are on duty to ensure the needs of the residents are met. What has improved since the last inspection? 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. Rangemore Nursing Home DS0000018779.V304109.R01.S.doc Version 5.2 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 Rangemore Nursing Home DS0000018779.V304109.R01.S.doc Version 5.2 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): 2 The quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to the service. Assessments of people’s care needs are carried out before they move into the home so there is information to show that their needs can be met. EVIDENCE: The pre-admission documentation of one resident who had moved into the home in recent weeks was looked at. It contained assessments of dependency levels and likes and dislikes of the resident. The pre-admission assessments had been carried out by a senior member of staff. The home is not registered to take residents with intermediate care needs. Rangemore Nursing Home DS0000018779.V304109.R01.S.doc Version 5.2 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): 7,8,9,10 The quality rating for this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents’ health, personal and social care needs are met by staff who enable them to maintain their privacy and dignity. EVIDENCE: Five care plans were seen. Care plans identified areas of need such as pressure area care, mobility, continence, nutrition and general dependency. They contained sufficient information to provide staff members with the necessary information for them to look after a person’s needs. There was written evidence to confirm that care plans were being reviewed and where necessary re-written on a regular basis. The care plans seen showed that there had been consultation with residents or their families/advocates. Rangemore Nursing Home DS0000018779.V304109.R01.S.doc Version 5.2 Page 10 Two care plans looked at for residents who had developed pressure sores The care plans described the type of dressing to be used and how often it should be changed as well as the type of pressure relieving aids to be used. The care plan, however, did not describe the grade, size, colour and depth of the pressure sore. This information is needed to enable nursing staff to measure the improvement or deterioration of the wound. Medications were managed separately for each unit and storage arrangements were satisfactory. The home used a monitored dosage system. Staff were seen administering medication to residents in an appropriate manner. Medication Administration Record Sheets were completed appropriately. Audits were carried out for medicines liable to abuse and were found to be in accordance with the records. During the inspection staff showed respect for the residents by the way they spoke to them. Staff acted in a friendly and warm manner towards residents. Personal care was conducted in the privacy of their own bedrooms. A number of residents were spoken with and all said that they were happy living at Rangemore. They felt that the staff treated them with respect and dignity. One resident said “This is a nice place to live, the food is lovely.” Another resident said “This is a good place, the staff are really nice.” Rangemore Nursing Home DS0000018779.V304109.R01.S.doc Version 5.2 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): 12,13,14,15 The quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to the service. The routines of daily living are flexible and varied to suit residents’ expectations, preferences and capacities. EVIDENCE: The lack of regular social activities was a requirement on the last two inspection reports. The home has improved the activities available and a staff member co-ordinates activities for six hours per week. A personal file has been completed with each resident detailing likes/dislikes, and what activities they are interested in. Flower arranging, painting, quizzes, jigsaws, movement to music and thia chai are available. A hairdresser visits the home weekly and entertainers are booked on a regular basis. The residents said that they feel this aspect of their care is improving. Rangemore Nursing Home DS0000018779.V304109.R01.S.doc Version 5.2 Page 12 One resident said that “It is nice to be able to do things instead of just sitting.” Another said that they “look forward to the afternoons when we do something” The manager is interviewing an activities co-ordinator who will be employed for at least sixteen hours per week to enable a better service for the residents. The residents on the dementia care unit have a “memory box” which staff have made with help from residents families and friends. Items from the box are used to stimulate conversations with the residents. The residents’ religious preferences were noted in the care plan. The manager said that residents could see a minister of their choice. One resident attends a local church each with a family member. Staff said that residents could see visitors in private or in the shared areas. Residents spoken with confirmed this. There were no restrictions on visiting. Residents said that they were able to choose where they spent their day and what they wanted to do. During this visit a partial tour of the home was undertaken and bedrooms seen were personalised with mementoes, photographs of families and friends and pieces of residents’ own furniture. Meals can be taken in the dining room or in the privacy of residents’ own rooms. There is a menu that has the flexibility to meet individual needs and choices. All of the residents that commented said, “on the whole the food was good” and that “ you can’t please everybody but choices are available.” Special diets are prepared where necessary. Rangemore Nursing Home DS0000018779.V304109.R01.S.doc Version 5.2 Page 13 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): 16,18 The quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to the service. There is a complaints procedure in place and the residents are protected from abuse. EVIDENCE: The home’s complaints procedure provides appropriate guidance and information on how to make a complaint. There have been no complaints made to CSCI since the last inspection. One complaint had been made to the home and this had been investigated and recorded appropriately. This information was provided by the manager before the site visit and by looking at the complaints file. All of the residents spoken with said they knew the complaints process and would complain to staff if they needed to. The home has an Adult Protection procedure (including Whistle Blowing), which complies with the Public Disclosure Act 1998 and the Department of Health Guidance “No Secrets”. The manager has arranged for all staff to attend an up date on the protection of vulnerable adults within the next few months. Rangemore Nursing Home DS0000018779.V304109.R01.S.doc Version 5.2 Page 14 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 quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to the service. Rangemore provides a comfortable environment for those living there and visiting. EVIDENCE: A partial tour of the units was undertaken. All the shared areas and a selection of bedrooms were seen. The home was furnished in a domestic style with additional equipment such as grab rails, raised toilet seats and hoists provided as necessary to meet the residents’ needs. Decoration at the home is on going. The lounge/dining areas had a variety of seating affording choice of style of seating. Bedrooms were entered with the consent of the residents. They were personalised with residents’ own furniture and mementoes. All areas seen were clean and free from any unpleasant odours. Rangemore Nursing Home DS0000018779.V304109.R01.S.doc Version 5.2 Page 15 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 quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to the service. Staffing levels and skill mix are sufficient to meet the needs of the residents, Residents are protected by the home’s recruitment practices and staff training. EVIDENCE: Rotas revealed that staff numbers complied with agreed minimum staffing levels. Copies of courses undertaken were seen on the staff files. These included moving and handling, health and safety, fire awareness, pressure sores, drug administration, food hygiene. NVQ training in care is in place at the home and over fifty per cent of care staff have completed the qualification, which is in line with the national recommendation for care homes. Staff files were looked at for four newly employed staff members and all of these contained appropriate checks prior to commencement of employment. Rangemore Nursing Home DS0000018779.V304109.R01.S.doc Version 5.2 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): 31,33,38 The quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to the service. The systems for resident and staff consultation are good and the health safety and welfare of residents is protected. EVIDENCE: The home has an experienced and competent manager who has been registered with the Commission for Social Care Inspection. The manager has not undertaken the registered managers award. However, the deputy manager and general manager have commenced the award training. The residents and staff spoken with said that the home’s management team were approachable and supportive. Residents comments were positive and all spoken with felt that they could talk to the staff if they had any problems. Rangemore Nursing Home DS0000018779.V304109.R01.S.doc Version 5.2 Page 17 The home had various quality assurance systems in place. The proprietor is at the home on a daily basis and residents and staff said that he is “hands on”. Day to day supervision was good and staff said they were well supported. Formal supervision was given to staff and records showed that the manager and staff member signed these. A selection of staff session’s records were seen. Policies and procedures seen were up to date and accurate. These were kept secure within the home. During discussions some residents confirmed that they had access to information kept about them. The fire precautions record book was up to date and demonstrated that checks of the alarm system, emergency lighting, fire drills and staff training were taking place on a regular basis. The care staff checked the hot water in the home and this was recorded and an audit was completed by the manager on a monthly basis. Rangemore Nursing Home DS0000018779.V304109.R01.S.doc Version 5.2 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 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 2 X 3 X X X X 3 Rangemore Nursing Home DS0000018779.V304109.R01.S.doc Version 5.2 Page 19 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 Care plan sin place for residents with pressure sores must be more detailed to contain the size of the wound. Timescale for action 19/10/06 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.V304109.R01.S.doc Version 5.2 Page 20 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.V304109.R01.S.doc Version 5.2 Page 21 - 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!