Inspection on 14/01/09 for Ranvilles Nursing & Residential Care Home

This inspection was carried out on 14th January 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ranvilles Nursing & Residential... 23/02/10

Ranvilles Nursing & Residential... 28/01/10

Ranvilles Nursing & Residential... 03/11/09

Ranvilles Nursing & Residential... 26/02/07

Ranvilles Nursing & Residential... 07/10/05

Ranvilles Nursing & Residential... 23/06/05

Ranvilles Nursing & Residential... 01/10/04

Ranvilles Nursing & Residential... 18/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ranvilles Nursing & Residential Care Home 5/7 Ranvilles Lane Fareham Hants PO14 3DS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Craig Willis     Date: 1 4 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Ranvilles Nursing & Residential Care Home 5/7 Ranvilles Lane Fareham Hants PO14 3DS 01329842627 01329847743 ranvilles@brookvalehealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Visram Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 53 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Additional conditions: 53 53 The maximum number of service users to be accommodated is 53 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Dementia (DE) mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home The home offers nursing care to older people with mental health difficulties. It is a large converted house in a quiet rural area near Titchfield. The home offers accommodation in both single and double rooms. The house is set in its own gardens with car parking for visitors at the front of the house. The fees for the home currently range from 695 to 800 pounds per week. Care Homes for Older People Page 4 of 25 Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The evidence used to write this report was gained from a review of all the information we have received about the service since the last inspection and a visit to the home. The information included an annual quality assurance assessment completed by the manager and incident reports. A site visit was carried out on 14 January 2009 and lasted approximately eight hours. During the visit we spoke with people who live in the home and visiting relatives, staff members on duty and the manager. Documents relating to the running of the home were inspected and the homes communal areas were viewed. We received completed surveys from people who live in the home and staff. Care Homes for Older People Page 6 of 25 Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good systems to assess peoples needs before they move into the home. This helps to assure people that the home will be able to meet their needs. Evidence: The manager reported in the annual quality assurance assessment that a thorough assessment of peoples needs is completed before they are offered a place in the home. The assessment is completed by one of the trained nurses and they have received additional training in the process. We inspected the records of four people who live in the home. All four records contained a detailed assessment that was completed before the person moved into the home. The assessments covered peoples daily living needs, mobility, physical and mental health, social needs and relationships, medication, pressure care and a nutritional assessment. Where appropriate peoples relatives are involved in the assessment process and additional information is obtained from health professionals. Staff spoken with reported they were confident that the Care Homes for Older People Page 10 of 25 Evidence: information they receive is accurate. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are well met and staff treat people in a manner that maintains their privacy and dignity. Evidence: The manager reported that each person has a care plan that is developed from their needs assessment and updated at least monthly. We inspected four peoples care plans during the visit. Each person had a plan in place that had been reviewed each month and amended where peoples needs have changed. The plans set out how staff should meet peoples assessed needs and also contained an assessment of any risks people face. The risk assessments included action that should be taken to minimise the identified risks. Bedroom doors in the home are locked when people are not in them to prevent other people entering. One of the plans seen contained details of an assessment that it was safe for the person to hold a key to their room. There was no such assessment in place where it has been decided that it was not safe for the person to hold the key. The manager agreed to ensure these were put in place. The GP visits the home each week to hold a surgery and people are supported to Care Homes for Older People Page 12 of 25 Evidence: access other health professionals where necessary. Records are kept of peoples consultations, including any advice from the practitioner. Every three months the home holds a case conference for people in consultation with the consultant psychiatrist, community psychhiatric nurse, GP and pharmacist. This helps to ensure people are receiving all the health services they need. The home has medication procedures in place, although these were not inspected during the visit. Medication is stored in locked trolleys and cupboards in the treatment room. Controlled drugs were stored seperately in a suitable cabinet and the medication held matched the records for the one that was checked. The medication administration records had been fully completed, including any incidents where people have refused their medication. People spoken with during the visit reported that staff treated them well and maintained their privacy and dignity. Four people who live in the home completed a survey for us. All four said they always receive the care and support they need and that staff listen to them and act on what they say. One person commented, the staff are always friendly and very helpful at all times. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples social and cultural needs are well met by the home and people are supported to make choices. This helps people to retain as much control over their lives as possible. Evidence: The home has a programme of activities that are provided, including games, arts, music, reminiscence and visiting entertainers. Some people who live in the home go out to social groups and activities. Where people are not able to or dont want to take part in group activities they receive one to one support from staff. Examples seen included looking at photos, chatting and use of sensory equipment. A record is kept of what activities and interactions each person has taken part in. The home has an open visiting policy and visitors are welcome at any time. The son and daughter-in-law of one person who lives in the home were spoken with during the visit. They reported that they were always made welcome in the home and were very positive about the experiences of their relative. One person spoken with during the visit confirmed that they were able to make choices about what they participated in and how they spent their time. Staff spoken with demonstrated a good understanding of peoples needs and the importance of Care Homes for Older People Page 14 of 25 Evidence: supporting people to make decisions where possible. Four people who live in the home completed a survey for us, either by themselves or with support from family members. All said that they always like the meals in the home. The home has a planned menu that provides a choice of meals. People spoken with during the visit reported that the food was good and confirmed that they have a choice. Details of peoples specific dietary needs are recorded. The lunch time on the day of the visit was observed. Food was well presented and people who needed it were receiving appropriate support to eat their meal. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has good systems to investigate complaints and respond to allegations of abuse. This gives people confidence that any complaints will be taken seriously and responded to. Evidence: The home has received one complaint in the last year, concerning the actions of staff that compromised peoples privacy, dignity and confidentiality. The incident was reported to adult services under the safeguarding procedures, who asked the home to investigate the matter internally. As a result of the investigations the provider took action under the homes disciplinary procedures. People who live in the home are provided with a copy of the complaints procedure. All four people who completed a survey for us reported that they know who to speak to if they are not happy and how to make a complaint. One person spoken with during the visit reported they were confident that any complaint made would be taken seriously and investigated. The home has policies and procedures in place regarding keeping people safe from abuse and reporting allegations through the local authoritys safeguarding procedures. Staff have received training in these areas and those spoken with demonstrated a good understanding of types of abuse, signs of possible abuse and action to take if abuse is reported, witnessed or suspected. Care Homes for Older People Page 16 of 25 Care Homes for Older People Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and provides a comfortable and safe environment for people. Evidence: All of the communal areas of the home were viewed during the visit as well as a sample of the bedrooms. All areas were well maintained and clean, with no unpleasant odours. There is a programme of decorations that is being carried out, as some areas are starting to look tired due to chipped walls and worn flooring. The manager reported that all of the communal areas would be repainted and new flooring laid in the dining room in the next few months. All of the bedrooms seen were comfortably furnished and clean and people had the opportunity to personalise them with pictures and furnishings. Bathrooms are suitably equipped to support people with mobility difficulties and were clean and well maintained. People spoken with reported that the home is always kept clean. Staff spoken with reported maintenance issues are resolved quickly. The home has a separate laundry room, which was clean and well maintained. The machines are capable of washing soiled clothing and there are suitable infection control procedures in place. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well trained and deployed in sufficient numbers, which helps to ensure they are able to meet peoples needs. Some checks are completed on staff before they start work in the home, however, obtaining references from new staff members previous employer would provide greater protection to people. Evidence: Between 7.30am and 7.30pm the home has 8 carers and 2 nurses on duty and there are 5 carers and 2 nurses on duty overnight. In addition the home employs kitchen, domestic, laundry and administrative staff. Residents and relatives spoken with during the visit reported that there were suficient staff available at all times and staff respond quickly when the call bell is pressed. Staff spoken with felt there were sufficient staff on duty at all times to be able to meet peoples needs. Five staff completed a survey for us; all said there were enough staff to meet the individual needs of all the people who use the service. The records of four recently recruited staff were inspected during the visit. These demonstrated that the home had obtained an enhanced criminal records bureau disclosure about the person and confirmation that they were not on the protection of vulnerable adults list. Peoples identity was suitably checked. Two of the records contained only one reference, and that was not from the persons most recent employer. One of the records did not contain a full employment history for the person. Care Homes for Older People Page 19 of 25 Evidence: The manager said this was an oversight and that she would ensure the missing information was obtained. The home has an on-going training programme for staff, with courses including moving and handling, first aid, safeguarding people from abuse, managing challenging behaviour, infection control, health and safety, nutrition, fire safety and dementia awareness. The nursing staff reported that their professional development was given a high priority by the manager and organisation. All five staff who completed a survey for us said they receive training that is relevant to their role, helps them understand and meet peoples needs and keeps them up to date with new ways of working. New staff complete an induction based on the skills for care common induction standards and 15 of the 27 care staff have completed the National Vocational Qualification at level 2 or above. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good management and quality assurance systems, which help to ensure the home is run in the best interests of people who live there. Evidence: The manager previously worked at the home as deputy manager and took over in an acting capacity when the previous manager left. The manager is a second level registered nurse in mental health and has completed the registered managers award. As the manager is not a first level nurse, the deputy manager has been nominated as the lead clinical nurse and provides clinical leadership an advice on nursing issues. The manager reported that she and the deputy are involved in the assessment and reassessment of care needs, infection control matters, moving and handling, tissue viability and nutritional issues and ensuring that staffing levels are adequate for peoples needs. The lead clinical nurse takes the sole lead for medication matters within the home. The deputy manager was spoken with during the visit and reported that this arrangement was working well. This was also reported by staff spoken with, Care Homes for Older People Page 21 of 25 Evidence: who were complimentary about the management approach in the home. The manager has not applied for registration with us and must do this as soon as possible. The home has a quality assurance system in place to assess how they are performing and plan improvements that are necessary. Surveys are completed of people who live in the home, relatives and other stakeholders for example GPs. Concerns raised in these surveys are responded to individually, although at present the results are not collated to present an overall picture of the responses. Audits of the environment are completed and the provider visits the home each month to assess the quality of the service provided. Reports of these visits are made and include any actions that are required. There is a buisiness plan in place and the manager reported that she is able to access suitable funds to ensure planned improvements are implemented. The home does not operate any bank accounts for people, but does hold money for safekeeping where people want them to. The money of three people was checked and the records were found to match the cash held. Money is stored in a safe and records are kept of expenditure, including receipts. The servicing records for the fire alarm and extinguishers, lifts and gas systems were checked and demonstrated equipment is being suitably serviced and checked to ensure it is safe. There are systems in place to assess the health and safety measures in the home. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 The registered person must 14/03/2009 ensure that staff do not work in the home unless they have obtained all of the information and documents set out in Schedule 2 of the Care Homes Regulations 2001, including two written references relating to the person. This will help to ensure that people living in the home are protected by the homes recruitment checks. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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