Inspection on 06/09/06 for Raplea

This inspection was carried out on 6th September 2006.

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

Raplea 11/01/08

Raplea 17/01/06

Raplea 16/09/05

Raplea 28/02/05

Raplea 26/07/04

Raplea 04/03/04

Raplea 28/01/04

Raplea 02/05/03

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Raplea Farthing Green Lane Stoke Poges Bucks SL2 4JQ Lead Inspector Mr Rob Smith Unannounced Inspection 10:30 6 September 2006 th 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 Raplea DS0000023013.V299977.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. Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Raplea Address Farthing Green Lane Stoke Poges Bucks SL2 4JQ 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) 01753 644459 Mrs Lila Paterson Mrs Lila Paterson Care Home 3 Category(ies) of Old age, not falling within any other category registration, with number (3) of places Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th January 2006 Brief Description of the Service: Raplea is a care home for older people, which provides personal care for service users who are elderly. The home has three single rooms, two on the ground floor and one on the first floor. The home is annexed to the family home of the owners/manager, Mr and Mrs Paterson. It has a large garden. The home is situated half a mile from Stoke Poges village and three miles from Slough in a rural setting. Public transport is not easily accessible. The home was fully occupied at the time of this inspection. The home charged a a basic fee of £380 per week. Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over the course of one day. The inspection and visit comprised: • Submission by the home of pre-inspection and self-assessment information and comments cards completed by or on behalf of all three service users Discussion with the owners Discussion with the three service users Observation of practice and examination of the physical environment Scrutiny of a selection of key records • • • • What the service does well: What has improved since the last inspection? What they could do better: The home needed to ensure medication was administered and recorded accurately to ensure service users always received their medication at the right time and regularity. The training provided to staff in key basic areas needed reviewing to ensure it was up to date and training records needed to be improved. The manager needed to start relevant NVQ training for herself. Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 6 The manager needed to review services user care needs to ensure that any possible risks arising from the way their care was provided had been taken into account and addressed as far as possible. 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. Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&5 Quality in this outcome area is good. This judgement was made using the available evidence including a visit to this service. The home carried out assessments to check they could meet prospective service user needs. Service users could visit the home in advance of any decision to move in to carry out their own assessment of the home’s quality EVIDENCE: One new service user had been admitted to the home since the last inspection. Her file showed evidence of an initial assessment being carried out by the manager prior to final admission. In conversation the manager confirmed she had fully discussed the admission with the placing social worker in addition. The service user in question confirmed she was able to visit the home to check it out herself before committing herself to staying there. Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement was made using the available evidence including a visit to this service. Service user care needs were clearly identified in plans and known by staff to help ensure they were consistently met. Identified healthcare needs were being met consistently. Medication was generally being managed adequately, ensuring service users received correct medication in safe ways. The care for service users was provided in ways that was respectful and maintained their privacy. EVIDENCE: Individual service user care plans and associated risk assessments around moving and handling were seen to be in place and records indicated they had been regularly updated over the past year. The plans covered appropriate areas of care need. Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 10 Within the care plans there were clear indications of individual health care needs. Records of visits to or from the local doctors, with whom all three residents were registered, and visits from community nursing services indicated these needs were being met consistently. Discussion with the manager confirmed she had a good grasp of each service user’s particular state of health and the priority areas for their health care arrangements. Two service users did not manage their own medication the third received support from staff in ensuring she took her medication regularly. Medication was stored safely in the main part of the owners’ house and records of administration were seen to be fully up to date and indicated medication was being administered, with one exception, in line with prescribing instructions. The home was now using a monitored dosage system (MDS) for service users with regular and more complex medication needs, as advised at the last inspection to avoid the potting out of medication by the manager noted at that time. It was noted however that one dose for the previous day was still in the MDS box but had been recorded as administered. While this appeared to be a one–off error it was nonetheless serious and a requirement has been made to address this point. The manager confirmed that the pharmacy now supplying the MDS system would be carrying out monitoring visits and also offering training on medication administration. It will be important to ensure that records of this training are maintained in staff files as evidence of its completion. Although clear feedback was difficult to obtain from all service users they did indicate they felt well looked after and were treated respectfully at the home. Observation of staff management of service users confirmed a respectful and considerate approach. Feedback from service user representatives and relatives seen in questionnaires issued by the home earlier in the year similarly indicated service users were well looked after. Each service user had their own room to help provide a good degree of privacy if they wished to spend time on their own. Service user records were stored away from the day-to-day areas of the home to help ensure they were kept safe and confidential. Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement was made using the available evidence including a visit to this service. The lifestyle offered in the home appeared to meet the needs and wishes of placed service users. The home was supportive of ongoing contact between service users, their families and friends. Within the limitations posed by the size and location of the home, and by service user abilities, they were able to exercise some degree of choice in the way they were looked after. Menus and meals observed during the inspection indicated service users were provided with a good range of food and meals. EVIDENCE: The day to day organisation of the home appeared to meet the diverse and individual needs and expectations of service users and their families. Care was provided in ways that recognised and respected the cultural and social backgrounds of services users. Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 12 There were a limited range of activities on offer, determined in part by the abilities of service users and the small size and resources of the home. Most of the residents’ time appeared to be spent in the home relaxing watching TV, reading or completing puzzles etc. They were free to spend their time in the communal lounge area or in their own rooms. In summer periods the patio and extensive garden area offered opportunity for sitting outside and short walks. The manager indicated that occasional trips out to local shops and amenities and to the local pub were arranged and that some of the residents were also taken out by friends or relatives. This relatively quiet approach to life appeared to suit the service users spoken with. It was good to note that to meet the wishes of the new service user a new TV aerial had been installed to receive digital TV services for her new TV. The manager indicated, as previously, that friends or relatives were free to visit or make contact whenever they wished and this was confirmed in discussion with service users and by scrutiny of records. There had been a recent barbeque held at the home for one service user and their family members. Photos of this event were seen on the lounge wall. Service user records also confirmed good ongoing liaison between the home and service user families where there were any issues of concern or significant changes in their wellbeing. Service users were reported by the manager to be able to exercise choice over meals, activities and the organisation of their daily lives except in situations where their confusion or forgetfulness might lead to inappropriate choices being made. The new service user, who had been very independent until recently, admitted that she found the inevitable limitations on choice posed by living in a home frustrating but manageable. The menus seen indicated a good and varied range of meals and the lunchtime meal seen during this inspection was of good quality and attractively presented. Service users said they were generally happy with the quality and level of food provided although the new service user preferred food with more texture. This was pointed out to the manager. Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement was made using the available evidence including a visit to this service. An appropriate formal complaints process was in place to deal with any arising concerns, although no complaints were recorded as having been made by which to assess the effectiveness of the processes. Appropriate policy and guidance was in place with regard to protection of service users from abuse. EVIDENCE: The home had a formal written complaints process in place that the manager confirmed was brought to the attention of all relevant parties. The manager indicated no complaints had been received since the last announced inspection. No complaints had been received by CSCI with regard to the home. The home had the latest guidance on the protection of vulnerable adults from the area local authority and had its own policy and procedure within its range of staff guidance. The manager confirmed that she had undertaken adult protection training. It was however unclear from training records when such training had been undertaken by other staff. As a matter of good practice the manager was advised that a renewed round of training on adult protection for all staff working in the home should be arranged to take place within the next year. Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is good. This judgement was made using the available evidence including a visit to this service. The physical environment and facilities in the home were of an overall good standard and appropriately met the needs of service users. (Overall judgement for all the standards inspected) EVIDENCE: The home was located in an annexe to the owners’ own residence. The physical environment was well maintained and decorated to a high standard and was clean tidy and odour free throughout. Standards of cleanliness were high in toilet and bathroom areas. The home was well lit, ventilated and well heated. No evident safety risks were noted. Service users made use of the communal lounge/dining area to spend their day or could use their own rooms if they wished for more privacy and quiet. A combined toilet and bathroom was located adjacent to the lounge for use during the day and by night for the two service user living on the ground floor Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 15 as well as a separate toilet on the first floor, adjacent to the third service user bedroom. As already noted there was ready access, when the weather permitted, to the patio and garden areas. Because of the relatively straightforward physical care needs of the service users the home did not make extensive use of specialist equipment. A hoist was however available to assist with bathing if needed. Service users had individual bedrooms and these were seen to be comfortably furnished and well decorated and were personalised to the taste of each service user with a range of their own belongings and photographs etc. One service user was, through her own choice, preferring to sleep in a recliner rather than bed. An improved electric recliner chair was on order to make this arrangement more comfortable and safe. Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement was made using the available evidence including a visit to this service. The home had an adequate level of staffing input to support the needs of service user. Staff in the home had still not achieved the expected level of formal NVQ qualification to help ensure they were fully able to carry out their roles appropriately. Recruitment procedures were adequate to ensure inappropriate people were not engaged to work at the home. Training for staff had been provided for staff in the past but was in need of reviewing and updating to ensure service user needs would continue to be met fully. EVIDENCE: The staffing needs of the home were met largely by the two owners and by one additional member of staff who had been working at the home for many years. The two owners worked flexibly and indicated that one or other was around at all times to either assist with, or provide, direct care to service users. The two owners indicated they did not currently take holidays at the same time to avoid depleting staffing cover in the home. Plans were outlined however for a joint holiday next year and the inspector advised the manager Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 17 that details of interim management and staffing arrangements to cover their absence would need to be provided to CSCI in advance. The staff rota indicated that one member of staff was on duty at all times with back up from the owners as described above. This appeared to satisfactorily meet the care needs of current service users. The pattern of working weeks did mean that occasional long working hours were undertaken by all the staff in turn; while this evened out over monthly periods the owner will need to monitor the situation to ensure staff effectiveness and response is not affected by unduly long periods at work. The owners and additional main staff member were still in the process of completion of, or registration for, relevant levels of NVQ qualification and so the home fails to meet the expected standards in this area. While clearly the manager and main staff member have considerable experience of this area of work the continued delays in achievement of expected levels of qualification remains disappointing. The owner/manager was still exploring NVQ options with a local NVQ qualification centre with a view to taking up the training in the immediate future. A recommendation has been made to address this point. The main additional staff member was said to be at the final stages of completing her NVQ 2 qualification. Recruitment procedures were seen to be acceptable although in the absence of any recent staff appointments it was not possible to check how well these would be adhered to in practice. Relevant checks and information were in place for existing staff although renewal of the owner/manager’s CRB was again advised as a matter of good practice it was now over three years old. A system should also be put in place that will trigger renewals of any CRBs once they reach this stage. A recommendation has been made to address this point. The owners confirmed in response to the findings of the last inspection that their daughter would not be undertaking any tasks involving unsupervised contact with service users. In the light of that undertaking no CRB check will be required however the owners were advised that should the situation change and unsupervised contact commence then all relevant checks would need to be carried out. Any staff brought in cover the owners planned absence on holiday will of course need to have all relevant checks in place as well. A recommendation has been made to address these points. Information provided by the owners indicated staff working with service users had had training in key basic areas such as adult protection, manual handling, dementia care, first aid etc. However due to the unclear nature of the records kept on staff training it was difficult to establish objectively when all the training had actually been last carried out. The manager was advised to put in place clearer evidence of training undertaken by staff and arrange for updating training in any key areas where previous training was more than two years out Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 18 of date, except where formal certification might last for a longer period (e.g. for some forms of first aid training). This inspection did not identify any specific areas of service user need that indicated the need for more specialist training at this point in time. Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement was made using the available evidence including a visit to this service. The home’s owner/manager was a fit person to run the home although formal NVQ qualification had yet to be achieved. The home was developing improved quality assurance systems to ensure the needs of service users were being consistently met. The financial interests of service users were appropriately safeguarded The health and safety of staff and service users was being satisfactorily promoted. Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 20 EVIDENCE: The owner/manager was experienced in working with the needs of this group of service users and had undertaken relevant specific training in the past. As noted earlier the owner/manager had not yet commenced the expected level of NVQ training. Recommendation has been made to reinforce the importance of this issue if the home is to achieve the expected standard. The owners of the home were developing more detailed systems for regular quality assurance feedback from service users, their families and other key stakeholders in the service such as placing local authorities and local health services in contact with the home. Samples of questionnaire forms received back from service user families and representatives were seen with generally very positive comments noted. The owner/manager confirmed that the home and its staff still had no involvement with service users finances and that this area is managed entirely by family members or appointed representatives. Small amounts of spending money were said to be given to some service users by family members and this they kept hold of themselves. Good overall attention was paid to the physical safety and security of the home. Records of regular checks of water temperatures were seen and fire safety and electrical systems were also confirmed by the owner/manager to be subject to regular checking. Progress had been made on building up a comprehensive range of risk assessments to cover the environment and everyday working practices in the home. This will to continue to need to be to be built up and added to as new areas of potential risk are identified. Discussion was also held with the manager about the need to develop risk assessments related to individual service users over and above those carried out as part of the standard assessments conducted in the home. Examples were given of the particular mobility problems of one service user, and the potential risks that might pose, and similarly the risks attached to allowing one of the service users to self medicate. The manager was advised to review the care needs of service users and ensure that any areas of particular risk not covered by current assessments were addressed by new assessments. Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 21 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 X X 3 X 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 22 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 OP9 Regulation 13 Requirement That the manager ensures medication is consistently administered in line with prescription instructions and that records of administration are filled in accurately Timescale for action 31/10/06 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. 2. 3 Refer to Standard OP18 OP31 OP30 Good Practice Recommendations That the manager arranges for updating training for the staff team on matters of adult protection and prevention of abuse. That the manager undertakes a relevant programme of NVQ training. That the manager reviews the basic training undertaken by staff in recent years, arranges for updating of this training as appropriate and ensures more detailed and better evidenced records of training undertaken are maintained. That the manager reviews the care needs of service users to ensure that, where relevant, additional individual risk assessments have been put in place. DS0000023013.V299977.R02.S.doc Version 5.2 Page 23 4 OP38 Raplea Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Raplea DS0000023013.V299977.R02.S.doc Version 5.2 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!