Inspection on 04/09/07 for Ranyard at Dowe House

This inspection was carried out on 4th September 2007.

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

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Ranyard at Dowe House The Glebe Blackheath London SE3 9TU Lead Inspector Keith Izzard Unannounced Inspection 4th September 2007 10.00 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 Ranyard at Dowe House DS0000070182.V345223.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. Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ranyard at Dowe House Address The Glebe Blackheath London SE3 9TU 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) 020 8488 2222 020 8488 2228 Ranyard Charitable Trust Mrs Fiona Alison Taylor Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP 2. Physical Disability - Code PD The maximum number of service users who can be accommodated is: 51 5th December 2006 Date of last inspection Brief Description of the Service: The Ranyard at Dowe House is a care home with nursing for older people, managed by the Ranyard CharitableTrust, a Company limited by Guarantee. Care and support is provided for up to 48 service users. Staffing arrangements include a registered care manager or matron, 11 registered nurses, and 39 care staff. The home is located approximately five minutes walk from Blackheath Village, in a predominantly residential street, and has pleasant grounds to the rear. It is located on three floors. On the ground floor there is a large lounge and dining room with a conservatory and 14 bedrooms. There are 17 bedrooms on each of the first and second floors, providing solely nursing care, and there are lounges and dining areas on each of these floors. All bedrooms have en-suite shower or bath and toilet, and all are single occupancy, although three rooms could accommodate two people. The home’s stated aim is to provide the highest standard of care within a happy, loving and dignified environment, to adopt a sensitive and individual approach, to promote health and independence and to deliver appropriately individualised care. There is a dedicated team of staff for each floor, although staff members from other floors do interchange when there are shortages on any one floor. The provider’s email address is: dowe@ranyard.org Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 5 Information about the service provided is made available to current and potential service users in the homes Statement of Purpose and Service Users Guide, which are given to all service users. The recent CSCI report is kept at each nurse’s station in the home and also in the reception area, and new service users are informed of this. All residents are issued with their own personal copy of the Service User Guide. The fees cover all of the homes charges including food. Residents have to pay extra for other personal expenses such as hairdressing, transport, personal shopping, private health services such as chiropody, and escort services when accompanying service users on hospital trips. Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was completed in one day over a period of seven hours, and was facilitated by the registered care manager and several staff members. A visiting GP and the relatives of a resident contributed positive views of the home on the day of inspection. Additionally, a number of residents, relative and visiting professional questionnaires were returned to CSCI that were equally complimentary of the service provided. One exception was an anonymous suggestion that a verbal complaint made, had not been addressed, the complaint was not specified. Four care staff members and one senior nurse were formally interviewed. Three staff employment files were examined to evidence recruitment practice, training and supervision. Requirements to improve practice were made in respect of both induction training and supervision of care staff members. The inspection involved a tour of the premises and an examination of a range of management documentation, including staffing records resident care plans and health and safety records. Overall, residents spoken to were content within their home and staff members were observed to be both caring and professional in their manner towards residents. What the service does well: The premises are modern, well maintained, with good natural lighting and in good decorative order. The building and grounds provide good wheelchair access, and have two large modern lifts between floors, which is important for this group of residents. The home is well maintained and decorated, with good heating and well ventilated. All rooms have en-suite shower or bath and toilet, which provide comfort and privacy. All residents interviewed expressed satisfaction with their personal rooms. Residents are now all accommodated in single occupancy rooms, as previous double rooms have now been adapted for sole occupancy. This is commendable and meets current standards in respect of affording privacy for residents. Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 7 The home carries out good assessments of health care needs, before admitting new residents, and there is a practice of having trial visits, to help people make decisions about whether they live there. The home shows commitment to helping service users stay at the home through periods of ill health and has good regular involvement of a range of external health care professionals. There is a commitment to good staff qualification and almost 80 of the care staff members possess NVQ qualifications. Adequate staffing levels distributed appropriately across each floor were noted on the rotas examined. Good wholesome food is provided and residents are involved in deciding on the menu and are offered choices of meals. What has improved since the last inspection? What they could do better: It was not evident that residents/relatives meetings were being held on a regular and consistent basis. Such meetings should be held at least quarterly and minutes recording actions to be taken by the home and the outcomes reviewed at subsequent meetings. It would be good practice to retain copies of the minutes of the meetings in the information provided in the reception area of the home. Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 8 All staff should be reminded of the importance of logging any verbal complaints made as part of the tools available within the quality control of the home and enable such complaints to be made in an open and responsive manner. The remaining 40 of staff, not so trained, must receive updated adult protection training as soon as this can be arranged. The formal supervision of nursing and care staff members is not being conducted on a regular basis. The homes management agrees that this is an area where the home must improve. All potential supervisors need some training before delegated supervision can take place and adequate improvements can be made. Requirements to improve practice were made in respect of both induction training for staff members and the formal supervision of nursing and care staff members. 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. The summary of this inspection report can be made available in other formats on request. Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 9 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 Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,& 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have their needs assessed by senior staff before moving in to the home. Residents and their relatives are encouraged to visit the home, prior to any formal admission for reassurance that the home will meet their needs, prior, to their moving in. EVIDENCE: Standard 1 The home has a good Statement of Purpose and Service Users’ Guide. The documents are well written and contain all the information required within this Standard including how the home conducts care reviews, this was a shortfall noted at the previous inspection. Service User Guides are given to service Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 11 users during the admission process and also on display near the reception desk in the home, alongside several other useful documents about living in a care home, this is good practice. Evidence was seen within several residents’ rooms checked that the guides had been made individually available. Standard 2 Following a requirement made at the previous inspection the home has now clearly stated the fees to be paid within residents’ contracts, what services are included and details of who is responsible for paying the fees. This standard is now met. Standard 3 The home carries out good assessments of health and social care needs prior to admission of new service users, and there is a practice of having trial visits, to help people make decisions about whether to become permanent residents. The manager, together with one of the sisters in charge, carry out detailed pre admission assessments as to the care needs of service users. A full assessment document is available on each service users file, and these are available to service user. The assessments form the basis of the care planning system within the home and improvements have been implemented in planning the individual support needs around the social and leisure care needs of residents. Service users funded by a local authority also have care manager social services assessments of needs on the care file. Standard 6 This Standard was not assessed at this inspection, as the home does not provide, an intermediate care service. Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health and social care needs are set out in an individual care plan, and health care needs are being fully met. They are protected by the homes policy and procedures for managing medicines and, where risk assessed as possible, allowed to retain their own responsibility for their medication. Residents are treated with respect and their right to privacy is upheld. EVIDENCE: Standard 7 An examination of resident’s files showed that all care plans are produced from care assessments provided by social services and additionally from information obtained from pre admission assessments conducted by senior staff and this Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 13 supplemented by updating needs information from admission onwards. Care plans have improved in the area of social care needs and activities, and the home’s activities co-ordinator continues a process of systematically up-grading care plans. The care plans now include a social and medical history, current medication needs, drugs and food allergies, mobility, behavioural issues and activities of daily living. The activities co-ordinator is in the process of including life history and preferred leisure and social activities in the plans for all service users. The home has made substantial progress to ensure that all the residents receive annual reviews and the Inspector was shown a computer record that assists the manager to be prompted when reviews are due. Standard 8 The home produces good health care plans for all residents that are very detailed, addressing all areas of health care needs. There are very good health support plans on all service users’ files addressing areas such as oral hygiene, pressure sore management and a range of health care needs. The visiting GP was interviewed by the Inspector and he stated that the home managed health care needs very well and there is good involvement from a range of health care professionals including other specialist Doctors, Occupational Therapists, Physiotherapists, Dentists, Opticians and some specialist input from MacMillan Nurses when required. The home has achieved the Gold Standard Framework for end of life care and has support and training from the Care Homes Support Team, and training in care of the elderly. Staff training records reflected adequate training in all aspects of health care. Standard 9 The medication system was examined and was appropriately organised; medication was stored in a locked cabinet within the lockable clinical room and quantities and dosage of medication tallied with the MAR sheets examined and the amount remaining within the storage system. The home had a policy and procedure for medication that was comprehensive. Nursing staff members administer all medication and good storage and administration records were being kept. The manager stated that advice was readily available from the supplying Pharmacist and had a homely remedies procedure in place signed by the GP for the home. Standard 10 Staff members were seen to respect residents privacy and dignity when assisting with personal care, ensuring that bedroom and toilet doors were closed and knocking before entering rooms. All the residents interviewed and a further responses received via questionnaires from both residents and their Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 14 relatives commented positively on the way that staff treated residents in terms of maintaining their dignity and privacy. Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides for residents’ individual expectations and preferences regarding social, cultural, religious, and recreational needs. Contact for residents is encouraged and maintained with family and friends, and residents are supported to exercise choice and control over their lives. The home provides a good diet and meals are served in a flexible manner. EVIDENCE: Standards 12-13 Flexible routines are offered and residents are supported to exercise personal autonomy and choice. Residents are assisted to maintain and develop relationships with family and friends and are encouraged to manage their own finances where possible. The home has consulted with both residents and their relatives about the provision of group and individual activities. Care Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 16 plans now have a section for leisure activities and there is a dedicated activities co-ordinator who works for 20 hours each week developing this area of care planning. Two residents who were interviewed by the Inspector confirmed that they are aware of who the co-ordinator is, and that she had had spoken to them about their care plans. The home caters well for service users with dementia support needs, through its staff-training programme and in care planning. Following a recommendation made at the previous inspection has put in place a weekly social leisure activities plan identifying specific activities and when they should happen, this was clearly advertised in strategic places within the home. The home’s Statement of Purpose refers to residents’ rights to have visitors at reasonable hours. When illness occurs family or friends can visit at any time of the day or night, which is especially helpful given the nature of the care provided. Several residents said “we can have visitors whenever we want to”. There is no restriction on the times that residents return to the home when they have been out, and where possible the home will provide a place for family to stay over in difficult circumstances if there is a room available. Standard 14 Within the total of residents accommodated the home only manages the finances for three residents. The registered manager does not have direct access the bank accounts, as these are managed by an independent administrator who works within in the head office of Ranyard and to whom the manager has to request monies from, whenever needed by the resident. The manager said that she is not aware of how the service users have agreed or authorised the provider to manage their funds and is not sure whether the service users receive statements. It is again recommended that the manager get copies of signed agreements regarding this arrangement that is retained on the individual care filet on file for all three service users and that regular statements are provided to them regarding the conduct of their accounts. The manager was able to produce evidence of money withdrawn for individuals and a clear audit trail existed, including itemised receipts and the balance retained in a countersigned ledger. See Restated Recommendation 1 Standard 15 Residents are offered a choice of food on a daily basis and are given specific food that has been requested by them. Four residents interviewed confirmed that they are offered this choice and that the food within the home was generally of a good standard. Good records are being kept of food eaten by residents and the chef retains records of service users’ individual dietary needs. Menus examined suggested that a good variety of nutritious food is provided by the home. Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 17 Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 7 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear complaint process readily available to residents, relatives and involved professionals and all can be confident that complaints will be investigated and acted upon. The home has a Safeguarding Adults policy and procedure. Staff members interviewed had received training and displayed a good understanding in this area. However, staff members still awaiting training should receive this as a priority. EVIDENCE: Standard 16 The complaints procedure complies with The Care Homes Regulations 2001. Information about the contact details for the CSCI had been updated and there were timescales for staff to follow when investigating concerns. Guidance was provided about the stages that complainants could follow if they were not satisfied with the response provided by the home. No complaints had been received directly by CSCI nor recorded within the complaints log retained Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 19 within the home since the previous inspection. The complaints procedure was clearly displayed within the entrance area for the home. However, one questionnaire returned anonymously implied that a verbal complaint (unspecified) had not been addressed. The home should ensure that all complaints including verbal are recorded with relevant information and the outcome and any action taken. All staff should be reminded of the value of the complaints procedure and the part this plays in the provision of a quality control mechanism. See Recommendation 2 Standard 18 The home has a policy and procedures in place with regard to the protection of vulnerable adults. There was evidence of staff training in this area on the files looked at and there was evidence of ongoing training in this area for staff, however, a further 40 still require to be updated and the manager stated that this was scheduled for later this year. It is important that this occurs. A previous recommendation regarding protection of three residents’ personal money had not been fully addressed and this should now be addressed as a matter of good practice. See Standard 14 See Recommendation 1 Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents live in a safe and well-maintained and comfortable environment, which is clean pleasant and hygienic. EVIDENCE: Standard 19 The location and layout of the home is suitable for the service provided to service users. The home is well maintained and there is an internal system for reporting and carrying out maintenance. The grounds of the home are kept safe and tidy, and the home is completely wheelchair accessible. The building meets the requirements of the local fire officer and the last report from the environmental health department inspection of the kitchen area reported it was Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 21 maintained to a high level of hygiene and safety. The home has consulted with service users regarding their preferences as to where to eat their meals and there is reference to this on each service user’s care plan. The home is of a modern design and is clean and kitted out with lifts, hoists and a well maintained fire alarm system. There is now no sharing of bedrooms within the home and all service users have their own bedroom with en suite facilities. Standard 26 The home employs three full time cleaners and a separate window cleaner. Clinical waste is collected under contract and this includes pharmaceutical waste such as sharps. There is sufficient laundry facilities that include sluice machines and a macerator for disposal of incontinence materials. The home is maintained to a very high standard of cleanliness and was so on the day of inspection. Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of the staff meets residents’ needs. Staff induction training records do not evidence that staff members are fully trained and competent to do their jobs. EVIDENCE: Standard 27 The home employs adequate numbers of staff to provide for the needs of service users; currently, 61 staff in total that comprising 11 nursing staff and 39 care staff. The remainder are house keeping and maintenance staff. This staff team provides for the needs of 48 service users. There have been no changes to staffing levels since the previous inspection. The home is divided over three floors with the high dependency service users situated on the middle floor. On the ground floor there is one senior carer and two carers during the day providing support for 14 service users, while on the first floor there is one registered nurse and four care assistants providing support for 17 service users between 8.00 am and 2.00 pm. The second floor also has a registered nurse in charge supported by three health care assistants between Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 23 8.00 am and 2.00 pm supporting a maximum of 17 service users. Absence of staff is always covered by staff within the home and with minimal use of agency staff. There are currently thee care staff member vacant posts, these t posts should be filled with permanent staff members as soon as possible. See Recommendation 3 Standard 28 A high percentage of staff members are qualified to NVQ level 2 or 3 (approximately 80 of care staff), and 11 registered nurses are employed by the home. However, the TOPPS induction training is still not fully in place, and the manager said that this is an area that needs significant improvement. The home or provider does not employ a separate training officer or department and the training responsibilities currently lay with the manager. The manager is totally responsible for staff induction and training but does not have adequate training or experience to fulfil this role. The home must ensure that all staff are registered on a recognised induction programme from commencement of employment and the manager is adequately supported to provide training. The Inspector met the recently appointed general manager on the day of inspection, who stated that there would now be support to the registered manager to ensure compliance with this Standard. See Restated Requirement 1 Standard 29 The homes recruitment policy is up to date and is being fully implemented. Examination of three staff files showed good adherence to best practice in recruitment practice and in ensuring that all pre-employment checks are carried out prior to commencing work including CRB checks and two written references obtained. The manager has partially addressed a previous shortfall regarding updating of CRB’s for some long standing staff members, however it was noted that all were underway excepting those currently not working in the home for various personal reasons, the Inspector felt this was acceptable. Standard 30 The home does not adequately provide for staff induction or training in a manner that meets the National Training Organisation Workforce requirements. As noted at the previous inspection none of the new staff induction records have been formally kept on file and for all of the files inspected there were no staff training plans or records maintained in an orderly or traceable manner. This must now occur. Please see Standard 28. See Restated Requirement 1 Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an experienced and qualified manager who is fit to be in charge. The home must address the implementation of internal quality control audits in order to demonstrate that the home is run in the best interests of residents. Service users financial interests are safeguarded, but staff members are not supervised at the required frequency. The health, safety and welfare of staff and service users are promoted and protected. EVIDENCE: Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 25 Standard 31 The registered manager is a qualified registered nurse and has many years of experience in managing older persons’ care homes. She has also now completed NVQ level 4 in Care and Management. The manager also demonstrates a good working knowledge of individual service user’s needs. It was evident that both the residents and staff members interviewed felt positively about the manager and all stated she was approachable, neither the residents or staff members interviewed would hesitate to speak to her should they have any concerns regarding the running of the home or the welfare of residents. Standard 33 There was a requirement at two previous inspections for the home to put in place an annual development plan. This has not yet been met and this requirement is repeated. See Restated Requirement 2 It was not evident that residents/relatives meetings were being held on a regular and consistent basis. Such meetings should be held at least quarterly and minutes recording actions to be taken and their outcomes reviewed at subsequent meetings. It would be good practice to retain copies of the minutes of the meetings in the information provided in the reception area of the home See Requirement 3 & Recommendation 4 The home has a system for carrying out annual quality assurance audits that are carried out by external consultants. An annual report is produced and the home’s management does act on its findings. However, this audit system does not adequately assess the home’s systems for assessing the quality of care, care plans, risk assessment or staff development and is therefore not a complete quality audit system. There was a recommendation made at the previous inspection for the home to development the current annual audit system to include such areas as care and support. This recommendation was not complied with and should also include risk assessments conducted and also an audit of staff development. This is now the subject of a requirement. See Requirement4 The Inspector met the recently appointed general manager on the day of inspection, who stated that there would now be support to the registered manager to ensure compliance with this Standard. Standard 35 Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 26 The home does not manage or control residents’ finances or benefits, except for three residents. The accounts for these residents were viewed and found to be accountable and have a clear audit trail. However, a restated recommendation was made within Standard 14 regarding the administration of the finances of the three residents concerned in order to promote good practice. See Restated Recommendation1 Standard 36 There was a requirement made at the previous inspection of the home to ensure that all nursing and care staff are formally supervised at least six times a year and that written records be kept of these supervisions. This was not met. There was also a recommendation that the home should plan for the development of care staff supervisors in relation to their supervisory skills. This recommendation was not met. The staff files inspected and comments from staff showed that supervision is not formalised and records are not being kept regarding staff supervisions. The manager agreed that this is an area requiring implementation and that nursing staff and senior care staff members require training in order to provide adequate supervision. The Inspector met the recently appointed general manager on the day of inspection, who stated that there would now be support to the registered manager to ensure compliance with this Standard. See Restated Requirement 5 & Restated Recommendation 5 Standard 38 The home adequately caters for the health, safety and welfare of service users and staff. Staff members receive moving and handling, fire safety and first aid training as part of their training programme and the home employs a full time chef who manages the health and safety of the kitchen area. The last report from the Environmental Health Officer for Lewisham stated that kitchen area was maintained to a high level of hygiene. Fire safety equipment is contracted for servicing and all hoists are serviced every six months. The home’s lifts are also maintained under contract. There have been no reports under RIDDOR and there are good records being maintained on accidents and incidents. The fire officer for Lewisham visits regularly and the last visit was three months ago and showed that no requirements were made. The home has on record a valid electrical system certification that is within the required five-year inspection date and the water system has been certificated as fit for use. Water temperatures are regulated and radiators are maintained at a safe surface temperature level. Health and safety within the home is good. Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 27 Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 28 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 3 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 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 1 X 3 Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP28 Regulation 18.1 a and c Requirement Timescale for action 01/12/07 2 OP33 24.1 (a &b) 3 OP33 12.2 & 12. 3 &24 The Registered provider must ensure that all new staff are registered on a recognised induction programme from the commencement of employment and that the manager is adequately supported to provide for this induction, including maintaining adequate records for each member of staff. 01/01/08 The Registered provider and manager must put in place an Annual Development Plan based on information gathered from audits, surveys and management observations, and make the published results available to service users. This was a requirement made at the last three inspections, timescales 28/02/06 and 30/04/06 and 31/03/07 not met. Now repeated Resident/Relatives meetings 01/12/07 must be held at least quarterly. Minutes of meetings must be produced showing actions to be taken by staff members and the outcomes reviewed at subsequent meetings. DS0000070182.V345223.R01.S.doc Version 5.2 Ranyard at Dowe House Page 30 4 OP33 24 (1-3) 5 OP36 18.2 The Registered manager must develop the current annual audit system to include such areas as care and support and should also include risk assessments conducted and also an audit of staff development. The Registered manager must ensure that all nursing and care staff are formally supervised at least six times a year and that written records are kept. This was a requirement made at the last three inspections, timescales 31/12/05 and 30/04/06 and 28/02/07, not met, now revised. 01/01/08 01/12/07 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 OP14 Good Practice Recommendations It is recommended that the registered manager get a copy of signed agreements between three service users and the provider in respect of management responsibility for their financial accounts. It is also recommended that the registered manager request that regular financial statements be provided regarding their finances. The home should ensure that all complaints including verbal are recorded with relevant information and the outcome and any action taken. All staff should be reminded of the value of the complaints procedure and the part this plays in the provision of a quality control mechanism. The three existing care staff vacancies should be filled by permanent appointments as soon as is practicable. Copies of the minutes of resident/relatives meetings should be retained in the information folder in the reception area. The manager and senior nursing staff should receive DS0000070182.V345223.R01.S.doc Version 5.2 Page 31 2 OP16 3 4 5 OP27 OP33 OP36 Ranyard at Dowe House training to provide adequate formal supervision of care staff and the provider should ensure that additional resources are provided to ensure this happens as soon as possible. Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 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 © 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 Ranyard at Dowe House DS0000070182.V345223.R01.S.doc Version 5.2 Page 33 - 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. 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