Inspection on 23/02/10 for Ranvilles Nursing & Residential Care Home

This inspection was carried out on 23rd February 2010.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

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

Ranvilles Nursing & Residential... 14/01/09

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 17/07/2010.

Random inspection report Care homes for older people Name: Address: Ranvilles Nursing & Residential Care Home 5/7 Ranvilles Lane Fareham Hants PO14 3DS zero star poor service 03/11/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sue Kinch Date: 2 3 0 2 2 0 1 0 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): Name of registered manager (if applicable) Mrs Debra Mills Type of registration: Number of places registered: Conditions of registration: Category(ies) : Visram Limited care home 53 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 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 Care Homes for Older People Page 2 of 16 1 4 0 1 2 0 0 9 Brief description of the care home 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 3 of 16 What we found: The home was last inspected on 3 November 2009 after a key inspection. The rating for that inspection was poor. Outstanding requirements outlined below were raised following the previous key inspection in November 2009 and were not assessed at this random inspection. The purpose of this random unannounced inspection was to monitor the homes current provision of health and personal care to people living at Ranvilles Nursing and Residential Care Home. Three inspectors attended and this included a pharmacy inspector. The inspection included conversations with staff and people living in the home, observing care practises, discussion with the manager and nursing adviser, viewing samples of polices, records, care plans, daily recording and monitoring sheets. Feedback was given at the end of the visit and this was also attended by a representative of the responsible individual. Information received since the last visit from five health and personal care professionals, was also taken into account. We found that care plans had been written in a new format and were in place for all of the people we requested to see files for with one exception. The management were reminded that in order to meet the needs of people newly admitted to the home care plans of immediate support must be available on admission. We looked at aspects of care for eleven people and mostly found care plans for identified needs. However, the plan for one person only contained some risk assessments and therefore put them at risk of having needs unmet. The plan for another did not include social needs and activities. Staff asked told us that they know how to care for people through handovers, they did not mention care plans as a source of information and none were seen to enter the office to read care plans during our visit. Feedback from health and care professionals indicated that the home is seeking help regularly from them and following advice given. We considered some key areas of health care in the home, nutrition, wound management, moving and handling and medication. These are addressed in turn but demonstrated that staff must be more closely monitored and supervised to ensure that care plans are followed and training is always put into practice. We sampled training plans and noted that 11 out of 12 nurses, 5 kitchen staff and 16 out of 25 carers had received training about nutrition. We sampled five files for people who have been identified as needing a nutritional care assessment. We found that plans are in place to meet needs including offering additional items of food other than at mealtimes and evidence that weight loss or gain is monitored regularly with some evidence of both. We observed at lunchtime and found that two people we were monitoring were receiving the support with eating as identified in the care plan. Staff confirmed that they are allocated specific people to support at mealtimes and that one staff member was identified to record food provided for lunch. Care Homes for Older People Page 4 of 16 When we checked the food records we noted that there is recording and food and fluid charts for the people at risk nutritionally. However, although we observed a variety of foods on the trolley being offered with the morning drink, we found that recording did not always show that the extra food in the nutrition plans is offered often enough especially when meals had been refused. This is necessary for close monitoring of food intake especially when people have been identified as being at risk of malnutrition. We noted however, in the sample of files checked for people at risk of malnutrition there is regular monitoring of weight gain and loss. A health professional was also of the opinion that nutrition and weight is monitored. At lunchtime we observed the use of drink thickeners and discussed the needs of one person with a member of staff. They were aware of the needs and prepared it as per care plan. During morning refreshments being offered to people in the lounge we talked with staff providing it. They had fortified milk and supplements on the trolley. They had information about these and drink thickeners that individuals require. They told us that fortified milk was being offered first to people who needed it and if they did not have that they would have supplements. A staff member had difficulty in explaining this in English and it was therefore discussed with the manager who told us that after training in use of a specific nutritional tool it had been agreed with the doctor that this approach could be taken. We found through observation of records, that mostly no record of the provision of fortified drinks or supplements had been recorded effectively since 13/2/10 and none since 17/2/10 despite two sets of record sheets available for this purpose. This puts people at risk of not receiving their prescribe supplements in order to maintain nutritional health. We also found that there was no written instruction from the doctor about substituting fortified milk and the manager agreed that staff had not recorded this in peoples files. The manager said that she would be able to get the information within two days of the inspection. Subsequent to our visit the representative of the responsible individual confirmed that the information was still being sought from the doctor. We observed moving and handling practices and viewed records of individual needs and found that some people are not always being moved safely or as planned. Some examples follow.One person was viewed being moved by two staff members by being lifted with one hand under the shoulder and another under a leg to be moved back into a chair instead of that person moving independently, with a sling or hoist. In another situation two staff were viewed to drag lift (moving someone using a hand or arm under the armpit) a service user from a wheelchair to lounge chair without use of the brakes. The person was not able to take much weight as their knees buckled under them. Staff lifted the person under their armpits putting the person at risk of injury. The wheel chair could have moved as a result of the brakes not being applied. The care plan for this person stated that they can weight bear and is assisted with a handling belt to standing and transferring to chair. This care plan had been reviewed on 18/2/10 and recorded no changes, continue with same care plan indicating that staff observed were not following the plan. A third incident was of staff placing their arms under a persons armpits to lift them to standing. This was witnessed by an inspector and the homes nursing adviser. The person was then moved to a wheelchair and the brakes were not used. We viewed moving and handling training records for staff and discussed it with one of the staff members trained to deliver moving and handling training in the home. We also discussed records and training with the manager who said that all staff had moving and handling Care Homes for Older People Page 5 of 16 training in induction. We found that there were records of ongoing updates of training in the home. However training records had not been signed by both trainer and recipient. Also the management of the home had recognised that the records did not indicate details of the training received and had started new recording sheets to address this. However, when we discussed this with the manager of the home during giving feedback she agreed that some staff have poor moving and handling skills. We considered wound management, as we noted that several people in the home had dressings on their legs, and prevention and management of pressure sores as the home had notified us recently of one deteriorating to a level four which is very serious. Training records sampled showed us that 8 out of the 12 nurses had received tissue viability training. We observed that one person had a dressing missing from their foot which was at risk of being knocked, when we first went into the lounge, but the care plan identified a need for this to been addressed and when we looked again it had been covered. We looked at the pressure mattress settings and recordings in five rooms and noted that four were completed correctly. However,we looked at the care plan for one person and it said that the person should have their pressure mattress on active 2.We went to the room to check the recording and noted that on three days in the previous week the record overnight stated active 3 and was returned to active 2 in the day time. This was raised with the management who agreed to check it out. Following our inspection we were informed by the representative of the responsible individual that the inconsistent readings was a result of human error. We also found that the pressure cushion required, for someone when in the lounge, had not been provided. We found in another care plan wound care very well documented with clear action plans but the recording did not always state if a dressing had been replaced. The manager told us that staff appraisals had taken place and next steps would identify training needed. Some training is planned for March including wound management. The safe handling of medicines was assessed by a Commission specialist pharmacist inspector. They looked at the storage of medicines, records kept in the home, care plans, policies and procedures and talked to the manager and nursing staff. The medication administration records and supplies were looked at in detail for nine people. Clear records were kept to show when people had their medicines. Together with receipt records these showed that most of the time people get their oral medicines correctly. One person had not had one of their medicines for 8 days as the pharmacy had not supplied this medicine. The manager informed us after the inspection visit that this medicine had been discontinued by the GP. Prior to this the manager and staff in the home had not been aware of this and had failed to either obtain a supply of medication or confirm with the doctor whether the medicine was still prescribed for this person. This could have put this persons health at risk. When people are prescribed creams and ointments there were care plans and body maps to show the care staff how and where to apply the treatments. However there was no record kept to show that the creams and ointments were being applied and so these people may not have been receiving the treatments that were prescribed for them. When people were prescribed a medicine to be given only when needed there were clear Care Homes for Older People Page 6 of 16 and detailed care plans describing when the medicine was to be given. This means that people should get these medicines when they need them. People who use the service have their medicines given to them by registered nurses. We watched two nurses giving some people some of their medicines. They followed appropriate and safe practices when giving people their tablets and capsules. However the administration of liquid medicines did not follow best practice. Liquids are all preprepared together in the clinical room into named lidded pots and then taken together and placed on top of the drug trolley. Pots of liquid medicines were seen to be left unattended on top of the trolley whilst the nurses took medicines to people in other rooms. The practice of pre-preparing medicines is not in line with best practice guidance, as described in The Handling of Medicines in Social Care, produced by The Royal Pharmaceutical Society of Great Britain. Medicines that are liable to misuse, called Controlled Drugs, were not all being stored in the Controlled Drugs cabinet as required in law. This left some medicines at an increased risk of being misappropriated.On the day after the inspection the representative of the responsible individual told us that this had been addressed and sent documentary evidence to support this. He also confirmed that liquid medication would be in smaller bottles when new prescriptions are received. What the care home does well: What they could do better: We have made requirements about medication: that controlled drugs must be stored in a Controlled Drugs cabinet which complies with the Misuse of Drugs (Safe Custody) Regulations; that complete and accurate records must be kept of all prescribed medicines ointments, creams and nutritional supplements; that all medication must are administered directly from the original labelled container to the service user and not placed into any secondary container for later administration; and systems must be put in place to ensure that people do not run out of medicines and that they at all times have access to medicines and treatments that have been prescribed for them. This is so that people receive the medicines and treatments that have been prescribed for them. We have also required that care plans are in place for all people living in the home including any person newly admitted to the home. The registered persons must have a system in place to ensure that all staff use the moving and handling techniques identified for each person. The registered person must Care Homes for Older People Page 7 of 16 ensure that clear records are maintained of moving and handling training provided to staff to demonstrate that they are receiving the training required to support people living in the home. Whilst the home has overall improved the quality of the care planning and recording -an area that they need to improve further is in recording of food offered and provided, other than at mealtimes, especially for those with identified nutritional needs.This is to ensure that there is more evidence that care plans are followed fully to meet nutritional needs. 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 2. Care Homes for Older People Page 8 of 16 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered Person must ensure that care plans are sufficiently detailed and supported by adequate risk assessments to ensure that needs are met. This is to ensure that peoples needs are met consistently 16/12/2009 2 8 12 The Registered Person must 16/12/2009 ensure that health needs are met through effective care planning processes which are monitored for their effectiveness. This is to ensure that health needs are routinely met. 3 9 13 The Registered Person must ensure that proper arrangements are made for the recording, safekeeping,safe administration and disposal of medicines received into the care home. This is to ensure that people are receiving all prescribed medication. 16/12/2009 4 10 12 The Registered Person must ensure staff promote dignity and privacy at all times in 16/12/2009 Care Homes for Older People Page 9 of 16 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action care pratices and maintain confidentiality. This is to ensure that the dignity and privacy of people living in the home is respected. 5 15 12 The registered manager must ensure that action plans are put in place following nutritional assessments and that a system is in place to ensure that they are carried out This is to ensure that all special diets are followed and fully monitored. 6 18 13 The Registered manager was 16/11/2009 required to make an immediate referral through the safeguarding procedures. This was to ensure that a specific matter was followed up. 7 18 13 The registered person must 16/01/2010 ensure that all staff are clear about their responsibilities regarding safeguarding through provision of training and supervision. This is to ensure that concerns are promptly followed up. 8 26 13 The registered manager 16/12/2009 must ensure that all staff are aware of their responsibilities regarding infection control Page 10 of 16 16/12/2009 Care Homes for Older People 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action and ensure that matters such as aspects of cleaning, unpleasant odours and ensuring bins have lids, are addressed promptly. This is to ensure that people are living in a clean environment 9 27 18 The registered manager 16/01/2010 must ensure that a system is in place to monitor the overall skill mix of the care and nursing staff and ensure that sufficient regular training is provided. This is to ensure that Staff are provide with the skills to meet needs. 10 28 18 The registered manager 16/12/2009 must ensure that a system is in place to monitor staff levels and ensure that sufficiently trained care and nursing staff are in place to meet needs. This is to ensure that sufficient staff with the appropriate skills meet needs. 11 29 19 The registered person must 16/12/2009 ensure that pre -employment checks include references from most recent employers and recent previous care employers. This is to ensure that people living in the home are Care Homes for Older People Page 11 of 16 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action protected by the homes recruitment checks. 12 31 24 The registered persons must 16/01/2010 use an effective quality assurance system to monitor care and nursing needs. This is to ensure consistency in meeting needs is maintained. 13 38 18 The registered manager must ensure all aspects of health and safety is implemented and monitored . This is to ensure that needs are routinely met. 16/01/2010 Care Homes for Older People Page 12 of 16 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, 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 7 15 The registered person must 09/06/2010 ensure that a care plan is in a place for for all people living in the home at all times including people newly admitted. This is to ensure that information is available for staff to follow at all times and monitored. 2 8 13 The registered persons must 09/06/2010 have a system in place to ensure that all staff use the moving and handling techniques identified for each person . This is to minimise the risk to service users. 3 9 12 Systems must be put in 09/06/2010 place to ensure that people do not run out of medicines and that they have access to medicines and treatments that have been prescribed for them. This is to ensure that people recieve the medicines and Page 13 of 16 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 treatments that have been prescribed for them. 4 9 13 In the interests of safe 19/04/2010 medication handling all medication must be administered directly from the original labelled container to the service user and not place into any secondary container for later administration. This is to minimise the risk of people receiving the wrong medication 5 9 13 A complete and accurate 09/06/2010 record must be kept of all prescribed medicines and treatments given to people. This includes preparations such as creams ointments and nutritional supplements. This is to ensure that that are receiving their medication at the right frequency. 6 9 13 All Controlled Drugs, including Temazepam, must be stored in a Controlled Drugs Cabinet which Complies with the Misuse of Drugs (Safe Custody) Regulations. In order to comply with the law. 7 27 18 The registered person must 09/06/2010 ensure that clear records are maintained of staff training Page 14 of 16 09/06/2010 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 in moving and handling techniques. This is to ensure that people are moved safely at all times. 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 15 of 16 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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