Inspection on 12/12/07 for Ranyard at Mulberry House

This inspection was carried out on 12th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Ranyard at Mulberry House Blessington Road Lewisham London SE13 5EB Lead Inspector Sean Healy Unannounced Inspection 12th December 2007 09:45 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 Mulberry House DS0000070181.V356373.R02.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 Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ranyard at Mulberry House Address Blessington Road Lewisham London SE13 5EB Telephone number Fax number Email address Provider Web address: mulberry@ranyard.org Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8463 9890 020 8463 9899 Ranyard Charitable Trust Ms Tina Orme Care Home with Nursing (CRH-N) 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home with Nursing - Code N To service users of the following gender: Either Whose primary care need on admission to the home are within the following categories: 2. Old Age, not falling within any other category - Code OP The maximum number of service users who may be accommodated is: 48 1 March 2007 Date of last inspection Brief Description of the Service: Ranyard at Mulberry House is run by the Ranyard Charitable Trust, which is a registered charity and Limited Company that has been involved in care services in South East London since the 1930’s. The Trust has just recently also become a company limited by guarantee. The management are accountable to a board of trustees. Mulberry House is a 48-bed, purpose built nursing home, which was opened in August 2002. The home provides care to up to 48 older adults, both male and female, many of who require nursing care. More than 80 of these are from a white English background with approx. 10 Caribbean and 4 are Irish. Approx. 50 of beds are contracted by Lewisham Primary Care Trust to provide care for residents on discharge from hospital. The accommodation is on three floors, and each resident has a single room with ensuite shower and toilet facilities. There are also two accessible bathrooms on each floor. Each floor has its own lounge and dining room and there are two passenger lifts. There are separate kitchen and laundry facilities, which are staffed by a catering and housekeeping staff. There is a large accessible garden to the rear of the building. The home is staffed by an experienced Registered Care Manager, 13 staff nurses, and 34 support/care staff. Approx. 48 of these are from an African background, 27 Caribbean with the remainder being Indian and white British. The home is situated in a quiet road between Lewisham and Blackheath. There is off road parking to the front of the building, and ample on street parking also available. The home is a few minutes walk from local bus routes and about 15 minutes from the nearest Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 5 railway station. Information about the service provided is made available to current and potential residents 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 new residents are told where it is kept. The provider’s email address is: ranyard.office@tiscali.co.uk At 12/12/07 the homes fees range from £599- per week for publicly funded residents, to £799 per week, for privately funded residents. These 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 Mulberry House DS0000070181.V356373.R02.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 over one day. The inspection ended on the 29/12/07 following receipt of information from the home and from the Expert by Experience. This inspection was conducted by a lead inspector from CSCI and was supported by an Expert by Experience who’s role was to interview residents and relatives about their experiences of living at the home, and to observe staff working with residents. The registered care manager facilitated it. Three separate relatives of service users contributed their views of the home. The homes cook and maintenance manager also gave information relative to their work in the home. Two care staff and two nursing staff were informally interviewed, one of who was the nurse in charge. Four staff employment files were examined to check that they had been properly recruited, trained and supervised. Six residents and more than three visiting relatives of residents gave their views on the home to the Expert by Experience who supported the inspector. Six residents files were examined including assessments and care plans. There were four residents’ vacancies. The inspection involved a tour of the premises and examination of a range of management documentation. What the service does well: The home’s building and facilities are modern, spacious and well maintained with good lighting and full wheelchair accessibility throughout. The home pays good attention to maintaining high hygiene standards, with all areas being clean and well decorated. The manager is well respected by staff and residents, and is qualified and committed to developing the quality of care offered to residents. Care planning is good, and residents feel that they are able to ask the staff and manager about any concerns or problems and will be listened to in a relaxed and friendly manner. Two relatives assured the Expert by Experience that if they had cause to complain they would know how to go about this. One resident said he did not know how to complain, but if however he felt that something needed sorting out, he would find out what to do by asking around. A reasonable range of activities are offered in the home and one resident said the activities were very good at the home, and that she had enjoyed flower arranging, ‘armchair aerobics’, and craft sessions making Christmas cards and calendars. Residents are supported to keep regular contact with family and friends and everyone to whom the Expert by Experience spoke to said they Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 7 were able to see their relatives and friends whenever they wanted. “ They make everyone feel welcome here” was one comment. Food is good and the staff regularly ask residents what they want on the menu. The home tries hard to provide culturally appropriate dishes for residents. Two of the six residents said they would like to see mushrooms and bacon sandwiches on the menu but on the whole comments regarding food provided were good. The home has a commitment to training staff, and staff say they feel very happy with the way the home is managed, and that there is a good atmosphere in the home. Three staff commented that the home is well run and the organisation is good to work for. Staff are sensitive and caring in how they support residents and comments form the Expert by Experience regarding her conversations with residents were as follows: “ I have no reason to think that staff were anything other than kind with residents especially in view of the many very positive comments I received back about them. The following is a sample of comments I received: “ I love the carers, they are my family”. “ The carers are very kind and efficient. They looks so smart, it really cheers you up!” “Matron is a great asset” The support and information offered to residents and their families when moving to the home is good, and new residents are made to feel welcome. What has improved since the last inspection? What they could do better: Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 8 The home must consider whether the level of dementia care now being provided should be included in the homes registration, and a reference to dementia care and staff training regarding dementia must be included in the home Statement of Purpose. The home must ensure that residents and their families are now being offered consistent opportunities to be involved in their care planning. A clearer description of residents dementia care needs should be included in their care plans, and activities should be planned for times the best suit these residents. Care plan guidance for staff in how to support residents with dementia should also be reviewed. Some residents commented that they would like additional food items, which they prefer, to appear on the menu, and also commented about activities that they would like to see maintained or introduced. The home should consider these comments and include them when reviewing the food and activities offered. (See page 17,18 and 19 of this report for further details) The home should consider reviewing staffing levels, as there are more residents with higher dementia support needs now living at the home. The home must ensure staff always support residents who need help with mobility safely. 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 Mulberry House DS0000070181.V356373.R02.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 Mulberry House DS0000070181.V356373.R02.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 and6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each Resident has a written contract explaining the terms, conditions and costs of living in the home. Their needs are fully assessed and they feel confident that the home can provide a good standard of health care and support. Intermediate care is not provided and therefore this was not inspected. EVIDENCE: The home has a Statement of Purpose and Service Users Guide, which use upto-date and explain this being is and objectives of the home, and the terms and conditions for living at the home. It also outlines the type of services to be provided including the accommodation and the staff training. However over the past year there has been an increase in the number of residents described as having dementia support needs. The home now has 37 residents described as having dementia, some of these have a formal diagnosis, while others have developed symptoms, which have not been formally diagnosed as dementia. It is the case that a proportion of these residents have developed symptoms Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 11 while in residence at the home, and it is not the practice for the home to at the residents whose primary care need is dementia support. However given the level residents who are described as now having dementia support needs, the home must include dementia in the Statement of Purpose and include the training that staff will receive to equip them to provide this care. (Refer to Requirement OP1) It is also recommended that the homes management consider in consultation with CSCI registration requirements, whether it is now appropriate to have dementia included as a registration category on the home’s certificate of registration. (There has been an increase in the number of residents described as having dementia, and as the home is not registered for dementia, admission of residents with formal dementia diagnosis should not be happening as a matter of routine.) (Refer to Recommendation OP1) Six residents contracts were examined and all were found to have written contracts in place, which explained the service to be provided, the fees to be paid, and the support from staff that they could expect while living at the home. The contracts described the rooms to be occupied by residents, and the notice period is required on the side of residents, and the home. Fees for the majority of the residents are a set at £599 per week for publicly funded residents, with privately funded residents paying £799 per week. There was a recommendation made at the last inspection asking that the home more clearly explain the reason for the difference in the charges made to privately funded residents, and publicly funded residents, in the residents contracts. This has now been done. Six residents files were examined, and all were found to have a good assessments of care needs provided by the referral agency, and another separate assessment was carried out by the home itself. These were seen to be complete, and included good details of health and social care needs, and activities to be provided by the home to help service users to have activities, which were of interest to them. The homes main work is in the provision of care for old age, and end of life care. There is a high level of expertise in providing this type of care in the home, including a range of other external health care professionals being used. These include regular attendance by the GPs, dentists, tissue viability nurse, and support and training from the Care Home Support Team. This support is reflected in the assessments. Ranyard at Mulberry House DS0000070181.V356373.R02.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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health, personal care and social care needs are set out in a personal care plan and are generally being met. However dementia support needs are not always adequately described in residents care plans, and daily records are not consistently completed for all residents. Residents are protected by the homes policy and procedures for dealing with medicines, and they feel that they are being treated with respect and that their right to privacy is upheld. EVIDENCE: Of the six care plans examined all were seen to be well organised, and contain good information about health and social care needs. Monthly reviews have been taking place however there is uncertainty as to the extent to which care planning fully involves residents or their families. The following is an extract from the report written by the Expert by Experience who supported the inspection: Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 13 “Care Planning: Of the residents and relatives I spoke to, only one resident confirmed that she had seen her own care plan. She could not recall contributing to it, but she said that if she felt anything needed altering, she would feel confident to sit down with matron and discuss things through with her. One relative was not sure whether she had been involved in the formal care planning process or not but said she had discussed some of her needs with Matron. Relatives of another resident said they had not been involved in the care planning process. Another resident did not seem to understand the question but did answer other questions and made his feelings known. Other residents and relatives were hesitant when asked about care planning and may have been unfamiliar with either the process or the term.” (It is noted that the home conducts regular meetings with relatives and keeps minutes of these meetings) It is recommended that the home review the system for inviting and involving residents and their families in the care planning process, and for recording their response to this invitation and their subsequent involvement. (Refer to Recommendation OP7) The home uses daily records to record how residents care is progressing, and generally good notes are being kept which inform the planning and review process for health and social care provision. However one of the files examined showed that there were substantial gaps in the recording of personal care for a resident whose care plan includes personal hygiene, breathing, continence and mobility support. For this resident the handover notes for personal care had not been recorded since the 20th of November 2007 and a child for recording the resident’s participation in personal care had not been recorded since the 18th of November 2007. Discussion with staff on duty suggested that this was an oversight on behalf of a key worker, who it was suggested was responsible for keeping this residence records up to date. However it is the case that it is the responsibility of all staff will provide support for this resident to keep these records up to date. The home should ensure that all residents care plan records are kept up-to-date, and that regular checks by supervisors are done to ensure that this is happening. (Refer to Recommendations OP7) One of the resident’s files examined included dementia care needs. This resident was receiving good interactive support from the nurse in charge and clearly was very comfortable sitting down with the nurse in conversation with her. This resident’s care plan included activities, which were relevant to her, but the daily records showed very few activities having been taken up by her. The nurse in charge suggested that there are good times of the day to include her in activities, and that morning is about time to offer these activities. However this information was not included in the care plan. It is recommended that a clear description of what is meant by dementia is included in the care plan for each resident described as having dementia, and that the planning of Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 14 activities is tailored and targeted towards the best times for engaging each individual resident in activities. (Refer to Recommendation OP7) The following is an extract from the report written by the Expert by Experience who supported the inspection: “Mealtimes and Food The logistics of getting the residents into the compact dining rooms and around the dining tables is made problematical by the number of wheelchair users in the home, it seems.” I sat with residents in one of the dining areas both before many of the residents arrived, and during the meal, up to the time when the majority of the residents had finished their meal. After the lengthy process of manoeuvring residents into position, many of whom were wheelchair users, there was approximately a half hour spent eating/being supported to eat. While staff did treat residents with respect at all times it was clear that having a seating plan and guidance to follow may have helped to avoid the need to move some residents out of the way after having been already in place at a table. This can have the unintended affect of focusing of their disability, and takes additional time. One residents care plan who has dementia support needs did not include specific information about her eating support needs, and the inspectors observations of mealtime support offered to residents showed that there was some difficulty in ensuring that all residents who used wheelchairs were seated in the right place in a dining area, which is limited in space available. This impacted on the time left for staff to support residents, and although the staff were very sensitive in the way they interacted with residents, it is clear that there would be potential benefit for residents who have greater support needs when eating, to have this described in their care plan, including where they should sit and how staff should provide this support. It is recommended that the home review the care plans and guidance for staff in how to provide this support for all residents described as having dementia support needs. (Refer to Recommendation OP7) Good risk assessments are also included in care plans, and these out details and have been reviewed once a month in some cases, and all have been reviewed at least every six months with changes made when necessary. As at the last inspection there is a range of health care professionals involved in the provision of specialised support for the home, with GPs visiting on a weekly basis to provide clinics in the home. Specialist nursing care is provided, and the home specialises in the end of life care support. The Care Home Support Team is involved in providing training and in developing care plans within the home. These are a holistic, and there is a good level of understanding of the health care needs of residents, many of whom have higher levels of personal Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 15 care support, pain management, and moving and handling support needs. Overall health care for residents is well managed with a high quality of care being provided. Medication is well managed by the home, and residents are asked whether they would like to manage their own medication. Each floor has a clinical room, in which the medication is stored securely. The supplying pharmacist does regular checks on the storage medication. An examination of the storage room and the medication records showed that the medication has been well managed and administered in the home. The homes medication policy was reviewed in October 2007, and there has been a change of pharmacy provision since last inspection. The manager feels that the service provided is now much more efficient, six monthly audits are now being carried out by the providing pharmacist. Residents are treated with respect by the care staff who are aware and sensitive in the way they provide support for residents. The following is an extract from the report written by the Expert by Experience: “I spent almost seven hours in this home, interviewing residents for most of that time. I have no reason to think that staff were anything other than kind with residents especially in view of the many very positive comments I received back about them. The following is a sample of comments I received.” I love the carers, they are my family”. “ The carers are very kind and efficient. They looks so smart, it really cheers you up!” “Matron is a great asset, she’s excellent”. One carer, impressed me with her cheerful and kindly attitude to the residents and I saw patience and good humour from other staff also.” Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 16 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): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents feel that the lifestyles experienced in the home matches their preferences and expectations. They are supported to keep good contact with family and friends, and to make choices and keep control in key areas of their lives. Good food and a healthy diet are provided by the home. EVIDENCE: The home includes residents’ social and leisure interests in their care assessments and in the care planning system. Each resident’s care plan now includes a range of leisure activities. An activities coordinator has been employed by the home to develop the activities programme and to ensure leisure and social interests are planned for and with each individual resident. The following extracts from the Expert by Experience report and examination of residents care plans demonstrates the home provides activities, which are enjoyed by many residents, but that there is a need for the home to take account of the specialist activities and exercise needs of people with dementia to ensure that their opportunities for participating in exercise and other beneficial activities such as using puzzles are maximised: Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 17 “The homes manager says she is hoping to increase the dementia –tailored activities in the home throughout 2008. She mentioned one item of equipment currently in use: a sensory light, which can be taken to residents’ rooms to help calm them if they are agitated. A small theatre group had performed a pantomime at the home the day before the inspection and several residents said how much they had enjoyed this. Choirs and local schoolchildren have visited the home also. A library service comes to the home, as well as a Pat A Dog project.” “One resident said the activities were very good at the home. She had enjoyed flower arranging, ‘armchair aerobics’, and craft sessions making Christmas cards and calendars. Another resident commented that an arranged trip to the seaside was too far for some residents to enjoy and would prefer more local trips say to Greenwich Park. Another resident says she used to enjoy walking, but the capacity to do this was limited now partly through visual impairment and partly because she is not familiar with local streets.” “Two residents said they used to enjoy singing old time songs with a lady who visited with a portable keyboard. They wished that this could be re-instated. A long list of forthcoming activities over the Christmas and New Year period was in evidence.” “I asked residents and relatives for their thoughts on what would improve their life in the home: One resident said she would like to be at home but does receive daily visits from her family! Another resident commented that his remote control had gone missing. The daughter of a new resident said she would like the staff to ensure her mother’s feet were kept warm with socks. One resident would have liked more contact with pets. One resident said an ‘Old Time Music Hall’ evening might be nice.” It is recommended that the home take into account the views expressed by residents about activities and explore whether action can be taken to test out whether these views are generally held, and to try to make improvements or adjustments if needed for individuals or groups of residents. (Refer to Recommendation OP12) Examination of residents file who had dementia support needs did not show good evidence of activities being targeted for this resident at times most suitable for her needs, and a recommendation has been made for the home to look at this issue for all residents who have dementia support needs. (Refer to Recommendation under Standard 7 of this report.) The home has a visitors policy showing no restrictions on visitor’s times. The Expert by Experience report said: “Everyone to whom I spoke who was capable of answering said they were able to see their relatives and friends whenever they wanted. They make everyone feel welcome here was one comment.” Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 18 The residents and relatives who spoke with the Expert by Experience assured her that there was no problem in accessing their money. All residents or their families manage their own finances including bank accounts and benefits. All records are stored safely, and residents or their families are involved in monthly care plan reviews for this too. All files examined showed that these had been signed and agreed by the residents or their family. A good range of food is offered on a menu, which is posted up daily. The home has conducted surveys on resident’s views and opinions about the food. Training for staff on the provision of different kinds of food has been provided. The home has also surveyed carers and friends to see what the preferred dishes are. The chef interviewed showed a good knowledge of residents individual preferences and dietary needs. Excellent records are being maintained on the food eaten by residents. The following extracts from the Expert by Experience report: “Three residents indicated that they were unhappy with the food at the home. One said she preferred her Afro Caribbean food, as did another, however relatives of this resident assured me that her diet had been discussed with the home and that the home does try to meet her dietary needs. They also said that she would be happy with other foods such as spaghetti at any time. Another resident said she was happy with the food and when she didn’t like something she could always have something else. Another resident said she missed mushrooms and another resident missed bacon sandwiches!” It is recommended that the home consider these comments when next reviewing the homes menus. (Refer to Recommendation OP 15) Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 19 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident that their complaints will be acted on within reasonable timescales, and that they are protected from abuse by the homes policies and practices. EVIDENCE: The homes complaints procedure is displayed in reception and in the Service Users Guide. Resident’s notice boards advertise advocacy, postal voting promoting resident’s rights. There is a detailed policy and guidance on Mental Capacity Act, and staff are trained to assume residents have capacity unless assessment proves otherwise. The homes complaints policy was reviewed in October 2007, and been three complaints since last inspection. All of these concerned a relative complaining about staff attitude, alleging the their relative was left waiting for personal care for a lengthy period of time. This was fully investigated by the homes manager and good notes and records were kept. The investigation of the complaint included meeting with the family and the complaint was withdrawn. Another complaint was from a relative who was concerned that her father was still in his nightclothes in the early afternoon. The manager’s investigation found that it was a necessary part of the current personal care plan for this resident. When the relative understood this they were happy with the outcome of the investigation. Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 20 Another complaint concerned an allegation by a resident of being hit by staff. This was investigated and no evidence was found to support the accusation. It is believed that the accusation was concerned with a mental health issue. It is recommended that the home agree a process with social services for how to deal with persistent allegations made by this resident, and to agree a system for recording and reporting regular accusations made, so that the resident can be best protected. (Refer to Recommendation OP16) The adult protection policy for the home was reviewed in October 2007, and there have been no referrals made to the Adult Protection team or to the POVA register. The staff training schedule shows that all of staff and had training in adult protection, and have a copy of the GSCC code of practice. Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 21 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): 19,23,24 and 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, comfortable, clean and well-maintained home, and their own rooms are safe and comfortable and suit their own personal needs. EVIDENCE: The physical environment is of a high quality and is unchanged since the last inspection. The following comments remain relevant: The home is accessible, and is completely wheelchair accessible with two lifts to take residents from the ground floor to the first and second floors. These lifts can accommodate a hospital bed if necessary, and are new and well maintained. The home is purpose-built, with excellent kitchen, laundry facilities and good dining room space. All rooms have en-suite toilet and shower facilities, are spacious and well decorated, with good views of the garden area. There is good natural light throughout the home. The laundry room includes a special laundry chute for taking soiled laundry from all floors, without having to Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 22 pass through any other area within the home. This helps to reduce risk of cross infection. One full-time maintenance man is employed to deal with maintenance, health and safety and has been trained for this role. There is a fire risk assessment in place and there is a rolling rota for carrying out a range of maintenance jobs. All equipment is subject to a maintenance contract and the maintenance man monitors this. There is CCTV at the external entrance area of the building. Excellent communal spaces are provided for residents. The building is new and is in excellent condition with large rooms and wide corridors, purpose-built for the use of wheelchairs and mobile beds. All residents have individual ensuite facilities with lockable room doors. Locks are at lower level to facilitate wheelchair users needs, and hospital beds are in place in all rooms, and are needed for the majority of the residents. Excellent hygiene standards are maintained throughout the home. Resident’s bedrooms were seen to be very clean and well maintained, and there is minimal damage to walls and doors, despite the use of wheelchairs. Repairs are carried out quickly when necessary, and special materials are used to prevent damage to the plaster on the walls. Under floor heating is used throughout the home to prevent risk of residents accidentally burning themselves. The Expert by Experience report said: “One resident commented that the temperature in the home was a bit variable. (On the day of the visit the temperature in one room seemed almost chilly but the resident herself was perfectly comfortable, she assured me. Another resident told me that the previous day the under floor heating had been so hot that she felt her bare feet in the bathroom were almost burning. “ They sorted this out quickly” she assured me.)” It is the homes practice to allow each resident the facility to control the temperature of their own room to suit their individual needs. New tables have been purchased for all of the dining areas, and new floor covering has been put down in many areas of the home since the last inspection. Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 23 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): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff meet the resident’s needs and residents are in safe hands at all times. They are protected by the home’s recruitment practices, and staff are trained to do their jobs. EVIDENCE: The home is currently staffed by 13 staff nurses and 34 carers, providing care and support for 44 residents (There are four residents vacancies). The rota showed three staff nurses and nine carers on shift between 8am and 2pm, two staff nurses and six carers between 2pm and 8pm, and two staff nurses and six carers throughout the night, between 8pm and 8am. Generally feedback from residents and families showed a feeling that this is adequate staffing. 25 of residents are male while only one out of 34 care staff is male. The home takes care to ensure that sensitive personal care is provided. At the last inspection the manager commented that she has noticed that some men do prefer male staff to help them in personal care, especially when shaving. The home had higher levels of male residents than previously experienced. It was recommended that the home carry out a survey of all residents regarding the standard of personal care, to include specific reference to whether they would prefer same sex personal care, and act on it’s findings. This has been done and Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 24 residents felt happy with opposite sex personal care happening. Those who wish to same-sex personal care have had this written into their care plan. At least one resident commented that it would be good to have more staff available, and it is the case that the ratios of staff to residents, although are within the required safe levels, there is now good grounds for considering reviewing these levels especially in light of the numbers of residents who have dementia support needs. (Refer to Recommendation OP27) The following are comments from the Expert By Experience report: “I spent almost seven hours in this home, interviewing residents for most of that time. I have no reason to think that staff were anything other than kind with residents especially in view of the many very positive comments I received back about them. The following is a sample of comments I received: ” I love the carers, they are my family”. “ The carers are very kind and efficient. They looks so smart, it really cheers you up!” “Matron is a great asset, she’s excellent”. One carer, impressed me with her cheerful and kindly attitude to the residents and I saw patience and good humour from other staff also.” There are 34 care staff and 90 of these are qualified to NVQ level 2/3. A number of nursing staff and the manager are NVQ assessors and 13 qualified nursing staff are employed. This represents a high level of achievement in qualified staff. Staff recruitment processes are generally good, and the home’s manager is fully involved in the interview process. At the last inspection there was a requirement made for the home to ensure that CRB checks were being carried out and completed for all new staff prior to commencement of employment. No new staff have been employed since last inspection, and therefore there is no evidence to check that this is now been done. Over the home was manager gave assurances that all future staff would have a CRB completed before being employed. Examination of recruitment documentation for five staff showed that all employment documentation is in order, and that nurses registration is up-to-date. The manager now checks directly on the NMC website to see that nursing staff registration is up to date. The system for provision of staff training and induction is of a high quality and is supported by an annual appraisal for all staff where training objectives are set. The home has a system in place for the induction of new staff, which meets the requirements for this sector; however at the last inspection no formal record of this induction had been kept for four staff, and a requirement was made for these to be brought up to date. This has now been done . The home has a comprehensive training and development plan for staff, which include training in health and safety, infection control, movie and handling, first aid, alzheimers, and challenging behaviour. The manager has introduced a Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 25 new induction process, which is now being maintained for all staff, which meets the Skills for Care requirements. Records show that all staff receive at least three days training per year and there is additional training provided by the Care Home Support Team regarding care of the elderly. The following are comments from the Expert By Experience report: “I have a few minor concerns. Not all staff moving residents into one dining room checked that footplates were in place on wheelchairs. One wheelchair had no footplates and staff asked the resident to hold her feet in the air whilst the chair was moved. A member of staff encouraged a resident to rise from her chair by gently holding out both hands to her as if to pull her up from the chair. This seemed to work without discomfort for this resident, but I do not think it is best practice. The member of staff had a very sympathetic manner to the residents and I would not fault commitment to caring.” (These issues were discussed with the manager to ensure clarity about who was involved) The home must ensure that the staff concerned is supervised regarding moving and handling so that consistent safe practices are maintained to protect residents. (Refer to Requirement OP30) Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 26 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): 31,33,35,36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s manager is fit to be in charge, is of good character and is able to fully discharge her responsibilities. The home is run in the best interests of residents, and their financial interests are safeguarded. The staff are regularly supervised, and health and safety is promoted. EVIDENCE: As at the last inspection: The registered manager is experienced, qualified as a Registered General Nurse and also has attained NVQ level 4 in Care and Management. She has been managing the home for over 12 years and is experienced in accessing the network of healthcare available in the area. She demonstrates an open and Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 27 honest approach to managing the home, and is progressive in her attitude to managing the many challenges and changes within the home. Residents and relatives comment highly on the quality of management provided, and residents say that she is constantly available in the home, and is very approachable if they need to talk to her. In reaction to changes within the care sector over the recent years she has ensured that there are more than the basic requirements of qualified care staff available, and that there is good quality training available for staff including the local Care Home Support Team who provide good training in care of the elderly and management of dementia. The manager strongly feels that the new administrator support has been very beneficial in relieving her time to be more involved in residents care. It is recommended that this post be maintained in order to ensure valuable management time is maintained in residents care. (Refer to Recommendation OP31) The home has a quality assurance system in place. Monthly surveys or questionnaires are sent out regarding food satisfaction, and other relevant issues and the results now being published for residents. There is an annual audit and a report is produced, and this is posted on all the three notice boards in the home. This report also includes an action plan, which is in effect a development plan for the home. At the last inspection it was recommended that the home expand the annual audit to include more detailed analysis of the service users care plans, and the review system, including risk assessments, staff induction, supervision and training. This is now being done and the new system has been applied by an independent quality assurance consultants. A recent audit has been carried out in the report is pending. The manager also has a separate quality assurance system for auditing care with in the home, which contains all of the areas included in the Care Standards Act. The manager conducts part of this audit on a monthly basis and plans to complete it annually in this manner. Currently the home does not act as appointee for managing finances for any of the residents. There are good systems in place for managing the small amounts of money being held by the home for residents use. The provider has a bank account which is solely for the management of residents finances should the need arise. Informal supervision of staff in the home is good, and responsibilities are delegated to nursing staff for supervision of care staff. All staff receive formal supervision at least every two months, and written records are kept. Five file examined confirmed this and four staff interviewed also commented very positively on the homes management and supervision. The home has an up-to-date health and safety policy, which was last reviewed in October 2007. The health and safety responsibilities are shared between the registered manager and the maintenance operative, who have had training in Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 28 health and safety management. The portable appliance tests have been done and certified, and electrical and gas certificates and are up-to-date. The maintenance man, the registered manager and the administrator carry out the fire risk assessments. There is a detailed action plan in place following this. Fire tests are done weekly with drills taking place every few months. This includes an evacuation drill and a contingency plan in for relocating residents in the event of damage to the home. There is an excellent piece of equipment in place for smothering flames in the kitchen in the event of a fire. Hoists and lifts are under maintenance contract, and all were done in September 2007. Schindler’s maintenance company carries out maintenance on lifts. Another maintenance company carry out an annual audit of lifts and hoists and harnesses. An annual maintenance of wheelchairs is also carried out. Health and safety issues are taken very seriously by the home and excellent records are kept. Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 29 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 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X 3 X 4 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 4 Ranyard at Mulberry House DS0000070181.V356373.R02.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 Requirement Timescale for action 30/06/08 2 OP30 13.4 & 18.1 c The registered provider and manager must ensure that care of dementia is included in the homes Statement of Purpose and also include core training for staff in the care of dementia in this document The registered provider and 29/02/08 manager must ensure that the staff described in this report Standard OP30 receive supervision and training regarding safe moving and handling practices. 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 OP1 Good Practice Recommendations The registered provider and manager should consider in consultation with CSCI whether it is now appropriate to have dementia included as a category in the homes registration document DS0000070181.V356373.R02.S.doc Version 5.2 Page 31 Ranyard at Mulberry House 2 OP7 3 4 OP7 OP7 5 OP7 6 OP12 7 OP15 8 OP16 9 10 OP27 OP31 The registered provider and manager should include a clear description of the residents dementia care needs in their care plans, and plan activities in line with known best times for engaging these residents The registered provider and manager should review care plans and guidance for staff in relation to providing dining room support for residents who have dementia care needs The registered provider and manager should check that the system for inviting and involving residents and their families in care planning is effectively offering them ample opportunity to participate as discussed in this report Standard OP7 The registered manager should ensure that all residents care plan records are kept up-to-date, and that regular checks by supervisors are done to ensure that this is happening as discussed in this report. The registered provider and manager should reflect on the views of residents expressed in this report under Standard 12, and explore opportunities for including these views in planning the homes activities The registered provider and manager should consider comments made by the residents in Standard 15 of this report, regarding the food provided, and if appropriate include in the menu review process The registered provider and manager should consult with social services and agree a process for responding to regular complaints made by one resident to best ensure that this resident is protected The registered provider and manager should review staffing levels in light of the increased numbers of residents with dementia support needs The registered provider should consider maintaining the administrators post in order to provide very beneficial support for the registered manager as discussed in this report Standard 31 Ranyard at Mulberry House DS0000070181.V356373.R02.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. 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