Inspection on 09/08/05 for Rangemore Nursing Home

This inspection was carried out on 9th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

Other inspections for this house

Rangemore Nursing Home 31/07/07

Rangemore Nursing Home 23/08/06

Rangemore Nursing Home 16/02/06

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 WA16 6RR Lead Inspector Joan Adam Announced 9 August 2005 9:00 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 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 F51 F01 S18779 Rangemore V235984 090805 Stage 4.doc Version 1.40 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 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 Old age, not falling within any other category registration, with number (37) Both of places Terminally ill (1) Male Dementia - over 65 years of age (12) Both Rangemore Nursing Home F51 F01 S18779 Rangemore V235984 090805 Stage 4.doc Version 1.40 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 2 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 3 4 Date of last inspection 22 February 2005 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 F51 F01 S18779 Rangemore V235984 090805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced visit of the home took place over six and a half hours and was carried out as part of the yearly inspection process. A tour of the home was carried out and care records, fire records and staff training files were inspected. The service history of the home and the previous inspection report were read in preparation for the inspection. Before the day of the inspection comment cards for residents and their families were sent to the home and a number were returned completed to the inspector. The manager completed a detailed pre-inspection questionnaire. Comment cards were also sent to the G.P for the home and to placement officers with social services. These were returned completed and positive comments were made. Residents, visitors and staff were spoken to during the inspection. Four of the staff on duty, eight residents and one relative were spoken with during the inspection. What the service does well: Residents living at Rangemore continue to have their healthcare needs met to a good standard. Bedrooms at the home are well personalised with residents own ornaments furniture and pictures. Staff employed at Rangemore have been at the home for some time and they are aware of the individual needs of residents and have training to enable them to be well informed. The manager at the home is experienced and competent. Residents described staff as “ Helpful and pleasant” “ Kind and nice”. The atmosphere at the home is warm and welcoming. The residents said that the standard of food is good. Rangemore Nursing Home F51 F01 S18779 Rangemore V235984 090805 Stage 4.doc Version 1.40 Page 6 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 F51 F01 S18779 Rangemore V235984 090805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Rangemore Nursing Home F51 F01 S18779 Rangemore V235984 090805 Stage 4.doc Version 1.40 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 standard(s) 3,6 Assessment procedures before residents move into the home are thorough and allow family members to be part of the process of assessing needs. The home only admits those people whose needs are in keeping with the skills and knowledge of staff working within the home. EVIDENCE: Care plans of four recently admitted residents contained preadmission assessments in their files. Additional assessments carried out by other health or social care workers, for example where people had been admitted from hospital, were available. Pre-admission assessments had been carried out by the home manager or the unit manager. Notes were taken following discussion with family members to obtain a full picture of the resident’s needs prior to their admission. Two of the residents said that the manager had visited them prior to their admission to the home. Rangemore does not provide intermediate care. Rangemore Nursing Home F51 F01 S18779 Rangemore V235984 090805 Stage 4.doc Version 1.40 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 standard(s) 7,8,10 Care plans in general at the home are detailed but one plan of care looked at did not address the changing care needs of the resident. Staff members working at the home are aware of the needs of the residents. Locks are to be put on the bathroom doors in the West Wing to enable the residents’ privacy to be respected. Residents are treated with dignity. EVIDENCE: Care plans from both units were examined. The care plans at the home are detailed and identify areas of need such as hygiene and tissue viability which states the type of mattress required and gives instruction to staff as to the prevention of pressure sores, psychological needs and swallowing difficulties. Dental assessment forms, nutritional assessments and risk assessments for bed rails, risk of falls, maintaining a safe environment and moving and Rangemore Nursing Home F51 F01 S18779 Rangemore V235984 090805 Stage 4.doc Version 1.40 Page 10 handling are completed on all residents. Relatives had signed risk assessments. Times of rising and retiring are recorded in the plans of care. Of the six care plans looked at five had been reviewed and evaluated on a monthly basis or as needs changed, however one care plan on North Wing had not been evaluated since January 2005. (See requirement 1) Residents spoken with said that they were happy with the care they received. Three residents spoken with said that they liked to stay in their bedrooms and that “No one tried to make you sit downstairs” One resident said that their buzzer was answered fairly quickly. Staff were observed to speak to the residents in a courteous manner and were seen to knock on doors before entering bedrooms or bathrooms. All residents spoken with said that staff were” Helpful and pleasant”, “Kind and nice”. Comment cards received from relatives said that “ I have the utmost admiration for the staff and it is comforting to see the owner regularly working within the home ” Another said “ the care is adequate and cheerfully and caringly carried out.” On the site visit to the new West Wing extension on 16th March 2005 the registered provider was requested to fit over-ridable locks on bathroom doors to maintain the privacy of the residents. At this inspection it was found that this work had not yet been attended to despite his assurances that it would be done. (See requirement 2) This matter has also been followed up with the provider under separate correspondence. Rangemore Nursing Home F51 F01 S18779 Rangemore V235984 090805 Stage 4.doc Version 1.40 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 standard(s) 12,15 There are limited social activities on offer at Rangemore. Residents can choose where they spend their day. The residents enjoy a good and varied choice of wholesome and well presented meals. EVIDENCE: The home does not employ an activities co-ordinator and social activities are not well managed as there are days within each week where no structured activities take place. Residents are frequently left to sit in small groups without any distraction or stimulation from staff. This was a requirement on the last inspection and must be addressed. Activities are particularly important for people with dementia. (See requirement 3) Care staff try to spend time with the residents on a one to one basis but their time is limited and this can not always take place. One resident said that the “ days get so they are a bit long, there is nothing much going on” Another resident said that “ the staff are nice and do their best but they are busy, we sometimes have a sing a long” Residents have been out in the garden enjoying the fine weather and the residents on West Wing had a strawberry tea at the end of Wimbledon. Rangemore Nursing Home F51 F01 S18779 Rangemore V235984 090805 Stage 4.doc Version 1.40 Page 12 The home has recently purchased a mini-bus to enable them to take the residents out. The owner and administrator have been insured to drive the mini-bus. A menu is in place which offers choice and residents said that the food is tasty. Some residents said that they “get sick of sandwiches for tea “ An alternative is always available. Rangemore Nursing Home F51 F01 S18779 Rangemore V235984 090805 Stage 4.doc Version 1.40 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 standard(s) 16,18 Complaints at the home are dealt with in accordance with the company’s complaints policy and residents and relatives know who to raise concerns with. The policies, procedures and management at the home protect the residents from abuse. EVIDENCE: There have been three complaints made to the home since the last inspection. All have been dealt with under the home’s complaints procedure and the outcomes and actions taken are recorded. One complaint was referred under Adult Protection and the home has dealt with this appropriately. A policy on the protection of vulnerable adults is in place. Members of staff spoken with confirmed that they were aware of the policy and the No Secrets guidance issued by the Department of Health. New up to date documentation regarding No Secrets has been received by the home. Staff have received training in adult protection and this was recorded in the staff training files. Rangemore Nursing Home F51 F01 S18779 Rangemore V235984 090805 Stage 4.doc Version 1.40 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 standard(s) 19,26 Some areas of the home require attention to ensure that residents live in a safe and well-maintained environment EVIDENCE: The bedrooms are well personalised with residents own belongings and the home was clean and free from unpleasant smells. The corridor ceiling and walls outside bedroom 24 are stained and the plaster is peeling off. The ceiling and wall in that area requires replastering and redecoration. This was a requirement on the last inspection. (See requirement 4) Provision of appropriate locks for the laundry room and satellite kitchen to maintain residents health and safety was agreed with the registered provider at a site visit for the new West Wing extension on 16th March 2005.At this inspection this work remained outstanding despite the providers assurances that it would be done. (See requirement 5). This matter has also been followed up under separate correspondence. Rangemore Nursing Home F51 F01 S18779 Rangemore V235984 090805 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,30 Residents’ benefit from a service that provides adequate staffing levels and well-informed and knowledgeable staff. EVIDENCE: The staffing numbers at the home are adequate to meet the needs of the residents. Trained nurses are on duty twenty fours hours a day supported by care staff. Duty rotas were seen and agreed staffing levels were being maintained. Agency staff are being used, however the manager requests the same member of agency staff to be sent to ensure continuity of care for the residents. Staff spoken to were aware of the needs of the residents in their care. A number of staff had worked at the home for some time and had a good relationship with the residents. The staff were aware of the different personalities of the residents. Staff training files were looked at and staff had received training in Moving and Handling, health and safety, infection control, food hygiene and fire safety. Fifty per cent of care staff are qualified to NVQ level two in care which is in line with the national recommendation for care homes. Rangemore Nursing Home F51 F01 S18779 Rangemore V235984 090805 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,38 The home must address the issue of appropriate locks on the laundry and satellite kitchen doors to ensure that the safety of residents are protected. EVIDENCE: Residents living at the home said that their opinions are listened to. Residents’ choices are recorded in the individual plans of care. Accidents are recorded appropriately. Safety certificates were in place for items such as hoists and passenger lifts. The fire log was checked and staff training had taken place in fire safety procedures. The manager at the home is experienced and competent. Rangemore Nursing Home F51 F01 S18779 Rangemore V235984 090805 Stage 4.doc Version 1.40 Page 17 Provision of appropriate locks for the laundry room and satellite kitchen to maintain residents health and safety was agreed with the registered provider at a site visit for the new West Wing extension on 16th March 2005.At this inspection this work remained outstanding despite the providers assurances that it would be done. (See requirement 5) This matter has also been followed up under separate correspondence. Rangemore Nursing Home F51 F01 S18779 Rangemore V235984 090805 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x x x x 2 Rangemore Nursing Home F51 F01 S18779 Rangemore V235984 090805 Stage 4.doc Version 1.40 Page 19 yes 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. 2. 3. 4. 5. Standard op7 op10 op12 op19 op38 Regulation 15 4 16 23 4 Timescale for action Care plans must be reveiwed and 9th up-dated on a regular basis September 2005 Over-ridable locks must be put 9th on the bathrooms on the west September wing 2005 The social needs of the residents 30th must be met September 2005 The ceiling and walls identified 30th must be repaired(timescale of September th 30 April 2005 not met) 2005 Appropriate locks must be put 30th on the doors to the laundry amd September sattelitte kitchen on the west 2005 wing. Requirement 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 Good Practice Recommendations Rangemore Nursing Home F51 F01 S18779 Rangemore V235984 090805 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection 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 F51 F01 S18779 Rangemore V235984 090805 Stage 4.doc Version 1.40 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. 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