Inspection on 19/03/08 for Rathgar Residential Care Home

This inspection was carried out on 19th March 2008.

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

Rathgar Residential Care Home 05/09/06

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Rathgar Residential Care Home 349 Kettering Road Spinney Hill Northampton Northants NN3 6QT Lead Inspector Stephanie Vaughan Unannounced Inspection 19th March 2008 09:00 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 Rathgar Residential Care Home DS0000066316.V361192.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. Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rathgar Residential Care Home Address 349 Kettering Road Spinney Hill Northampton Northants NN3 6QT 01604 499003 01604 499003 avedd@hotmail.com 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) Golden Care (UK) Limited Position Vacant Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (23) of places Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No one falling within the categories of OP and DE(E) may be admitted to Rathgar Residential Care Home where there are 23 persons within the categories of OP and/or DE(E) already accommodated. The maximum number of persons to be accommodated within Rathgar Residential Care Home is 23. 5th September 2006 Date of last inspection Brief Description of the Service: Rathgar is situated in a residential area on the main road to Kettering near to the town’s boundary. The home provides 9 single rooms and 7 shared rooms all with washbasin facilities. Some rooms have en-suite toilets and wash hand basins. On the ground floor residents have access to a small seating area in the hallway from the hall there is access to a large lounge and separate dining room. A further communal area is available in the conservatory. Residents have access to a range of bathroom facilities that are equipped with bath lifts. There is a small rear garden and courtyard that some of the ground floor bedrooms over look. The provider makes information available to residents and their representatives through regular meetings. The Commission for Social Care Inspection reports are available on request and people are informed about the reports along with the Statement of Purpose and Service Users Guide prior to admission. The current fees range form £348.55 to £440.00 per week, a top up rate of £20 - £30 per week may be charged depending on the individual circumstances and additional charges are made at variable rates for hairdressing, podiatry, newspapers, toiletries and other personal items. Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is a 0 star. This means the people who use this service experience poor, quality outcomes. Prior to this statutory inspection, a period of three hours was spent in preparation. This comprised reviewing the previous inspection reports and associated requirements, the service history, the Annual Quality Assurance Assessment and other documentation. Four comment cards were returned from residents and eight from their representatives, three comment cards were returned from staff, in general feedback was positive and the comments have been used to inform our inspection activity. Specific comments are addressed in the main body of the report. The Commission have received eight concerns and two Safeguarding Adults allegations about this service. A random inspection was conducted on the 14th February 2008 in response to concerns raised about this service, as a result four requirements were made and compliance was reviewed during this unannounced key inspection. The findings are included in the body of the report. The Commission have a focus on Equality and Diversity and issues relating to this are also included in the main body of the report. This site visit to the home was conducted over a period of nine and a half hours during which the inspector made observations and spoke to residents and staff. Rathgar residential care home specialised in the care of people with dementia, as such their abilities to recall and communicate information is limited, in these circumstances observations are used to inform the inspection process. A limited tour of the premises was conducted which involved viewing the communal areas and a selection of the private accommodation. Case tracking is the method used during inspection where of a sample of three residents were selected and all aspects of their care and experiences reviewed, including individual plans of care and associated documentation. The Acting Manager was present during most of this visit, however the Responsible Individual was present throughout. Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 6 What the service does well: Admission processes are managed well and people have the right information, including a visit to the home, to help them make a decision as to whether they would like to live there. The service makes sure that it has the right information to be sure that people can be looked after properly. Individual plans of care are reviewed on a regular basis and there is evidence that residents are assessed as to their wishes and ability to be involved in the care planning process. Residents have access to the right health care professionals such as doctors and specialist nurses. Residents who have in put from the District Nursing Service have assessments in place for the risk of pressure and appropriate pressure relieving equipment. There is evidence that most residents are weighed on a regular basis and that nutritional assessments are in place for the associated risks. Medication systems were reviewed and were found to be well managed. Residents appeared to be well cared for and staff are respectful of their privacy. Staff relate well to residents and have a good understanding of their needs. Routines are flexible in the home; residents are consulted about their times of rising and retiring to bed and the use of their preferred names. Individual plans of care contained some information about the resident’s previous lifestyles and this helps staff interact with residents and to provide activities, which are consistent with their previous lifestyles. Residents are supported to maintain their faith through contact with local churches and visiting clergy. The service employs a cook for six days a week; menus appeared to offer a varied and balanced diet. One resident was able to confirm satisfaction with the food provided. The service has a complaints procedure with appropriate timescales for acknowledgement and response; this is also included in the Statement of Purpose and Service Users Guide. Staff files showed that staff have the right training to make sure that they are able to care for the residents properly. The service seeks the views of residents and their relatives through regular meetings and satisfaction surveys. The information is used to develop the service and make improvements. Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? The service has access to a hoist, which enables more dependent residents to be moved appropriately, moving and handling techniques were observed and seen to be consistent with good practice. The service has obtained a lockable medication trolley, which is secured to the wall when not in use. The service has appointed a member of staff to coordinate actives. There are generally three organised activities a day, which residents can choose to join in with or to opt out of. In addition there are also seasonal celebrations such as an Easter party with a buffet to which relatives and friends were invited. Residents had decorated their own Easter bonnet for a competition. Staff have received training in the Safe Administration of Medication and the Safeguarding of Adults, management were also able to confirm that they have received a copy of the new Local Authority Guidelines. Significant improvements have been made to the environment since the last inspection and there is a development plan, which is on going. The sitting room has been redecorated and refurbished. The conservatory and dining room have been refurnished. Other improvements have been made to the hall, corridors, main bathroom and kitchen. In addition several of the bedrooms have had screening provided to promote privacy in shared rooms; several bedrooms have been redecorated and recarpeted. Following a Requirement made at the last inspection an item of broken bedroom furniture has been withdrawn form use and been replaced, the management confirmed that the decoration of bedrooms was on going and that some of the other furnishings were due to be replaced. The laundry room has been refitted with new industrial equipment. Following a Requirement made at the last random inspection a wooden ramp is now in place to enable residents to access the courtyard and arrangements are being made to ensure that there is wheel chair access to the garden. Additional improvements have been made to the exterior of the building. Staffing levels appear to have stabilised and the duty rota shows that there are staff on call and there is no evidence current use of agency staff. The service have appointed a new acting manager who is about to seek registration with the Commission, since her appointment the number of concerns raised about this service have declined. Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 8 What they could do better: Each person living in the home has their own plan of care, which sets out how they need to be supported and cared for. Following changes in ownership of the service the management have sought to improve the plans of care. However these still need more information to make sure that they are specific to the individual and show how residents are supported to make choices in their daily lives and also include appropriate information about the management of specific problems such as continence. The accident records indicate that the home has a high number of falls and the management need to make sure that they take further action to reduce and manage these risks. They also need to review the systems to make sure that people have routine checks after an accident and that that this is documented and also that the relatives are consistently notified of incidents that affect the well being of their relative. People also need to have all the right checks in place for the use of bedrails to protect them from further injury and potential restraint. Residents who cannot be weighed by the use of scales should have a recognised alternative method of assessing their well-being. The management need to make sure that all residents have appropriate documented assessments for the risks of pressure. The storage of controlled medication needs to be reviewed to make sure that it complies with new guidance issued by the British Royal Pharmaceutical Society. The complaints policy needs to be consistently displayed in order that residents and their relatives have access to appropriate information. There is evidence that the management liaise with the right health care professionals and where appropriate the police, about the Safeguarding of Adults incidents. However the management need to make sure that they also seek guidance and refer safeguarding incidents to the specified Local Authority contacts, in line with the Local Authority Guidelines. They also need to make sure that the appropriate action taken to prevent reoccurrence. Where residents are known to have participated or exhibited in challenging behaviours the management need to make sure that the appropriate risk assessments are in place to protect the individual and others. The radiators are of a standard domestic type within the communal areas and residents bedrooms. There are no radiator guards fitted and the management confirmed that no risk assessments were in place to prevent or manage the risks of burns. The management confirmed that the heating has a central Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 9 thermostat and individual radiator controls. However this means that the heating cannot safely be adjusted to accommodate cold weather conditions. The management need to review the storage of equipment, one of the double rooms had three wheelchairs stored in it, and only one resident required the use of this equipment. In addition another resident had a vacuum cleaner stored in the ensuite lavatory. The lavatory seat was also missing. The general standard of furnishing in the bedrooms is basic, in two of the three rooms viewed the surfaces of chest of drawers and bedside cabinets were damaged, which although not unsafe present difficulties with keeping the surfaces clean. Some of the rooms have carpets, which are stained and worn, and these need to be replaced. In general rooms appeared to be clean and free form offensive odour. One of the rooms had a faint smell of urine, despite the bed linen being clean and the carpet recently having been replaced. It was established that staff do the laundry and sometimes overfill the machines, which may result in the linen retaining some odour. The laundry room was not locked and the washing powder was easily accessible to residents. The powder contained instruction to be stored securely. This was brought to the attention of the management who arranged for the door to be locked at all times when staff were not working in there. Staffing levels need to be reviewed to ensure that they comply with the guidance issued by the Department of Health at all times including when staff are deployed to other duties, such as food preparation or when there are a new member of staff. Staff files show that staff recruitment stills falls short of what is required. One of the new members of staff did not have the appropriate checks done before employment was commenced in the home. A Requirement was made as a result of the random inspection dated 14/02/07, however the management stated that they had not received a copy of this report, this has now been reissued and the Requirement is therefore restated. The management need to develop better systems for supporting residents for whom they handle money and to ensure they keep information about money that comes in, money that is spent, including receipts and accurate balances. The management need to make sure that records are kept in good order, that they are accurate up to date and appropriately maintained and stored. Following the last random inspection dated 14/03/08 the freezer continues to be stored with a damp cellar. This is raised with a layer of bricks and there is a raised dry pathway to the freezer. However this has the affect of reducing the already limited headroom for the staff who use it. The Commission have referred this matter to Environmental Health Officer. Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 10 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. Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 11 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 Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has robust admission procedures, which ensure that residents needs and expectations can be met. EVIDENCE: The service has an up to date Statement of Purpose and Service Users Guide, which complies with the criteria set out in the National Minimum Standards. The service makes information available to prospective and existing residents and their relatives through residents and relatives meetings. The Commission for Social Care Inspection reports are available on request and through the Commission for Social Care Inspection website. Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 13 A new resident was case tracked and it was established that residents have appropriate contracts in place, which specify the fees charged, rooms occupied, trial visits and other relevant information. There was evidence that the service undertakes an appropriate assessment before the resident is offered a place in the home to ensure that their needs can be met. These are used to form the basis of the individual plans of care, which provides staff with the information as to how the resident is to be cared for. There was some evidence that residents and or their relatives are able to visit the home before deciding whether they would like to live there, this was confirmed by staff and the comments received from relatives. The service does not provide intermediate care. Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents have basic individual plans of care, which fail to demonstrate that their needs are consistently and proactively met. EVIDENCE: Residents have an individual plan of care, which is based on their original assessment of need. These provide some instruction to staff about how the resident is to be cared for in their health, personal and social care needs. However these are currently very basic and do not provide the level of detail that is required to ensure that the care is person centred or that the management of care is proactive. However there is observational evidence that staff understand and are responsive to the individual needs of residents. Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 15 Daily records are also basic and do not show how the residents are supported to make choices in their daily lives or give an accurate reflection of daily events. There are basic risk assessment for the prevention of falls, these currently provide a statement as to whether the resident has had previously had falls and what walking aids they are currently using. However there are no documented controls in place to prevent a reoccurrence. There are basic risk assessments in place for the risk of falls from the bed for some residents and there was evidence that bed rails were provided to prevent this. However there were no risk assessments in place for the associated risks including potential restraint and entrapment. There was evidence that individual plans of care are reviewed on a regular basis and that residents are assessed as to their ability and wishes to be involved in the care planning process. The individual plans of care evidence that residents have access to appropriate health care services such as Hospital facilities, General Practitioners, Dentists, Audiologists, Podiatrists, Community Psychiatric Nursing Services and District Nursing Services. There was some verbal evidence from staff that residents have access to the continence services but the care plans failed to evidence this and provided only basic information about how continence was managed. Residents in receipt of the District Nursing Service have appropriate assessments for the risks associated with pressure and these records are retained within the home. There was evidence that these residents also have access to appropriate pressure relieving equipment. However those who do not receive input form the District Nursing Service do not have recognised risk assessments in place for the management of pressure. The individual plans of care do evidence that residents are assessed for the risks of malnutrition. There is some evidence that they are weighed on a fairly regular basis, which would enable those at significant risk to be referred to the District Nursing Service and the dietician. However the service does not have the facilities to weigh residents who are confined to bed and alternative means of assessment should be used. Individual plans of care evidenced appropriate Movement and Handling assessments, which are regularly reviewed. Movement and Handling practices were observed and the staff seen to practice appropriate techniques. The service does now have a hoist to enable the safe movement of the nonambulant residents. Staff receive annual training in the Movement and Handling practices. Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 16 Medication systems were reviewed and seen to be in good order. Medication Administration Records were well maintained and seen to be an accurate record of medication administered. A spot check was conducted and there was an appropriate audit trail to enable the remaining medication to be checked against the amount dispensed and the remaining quantity, which demonstrated that the correct amount had been administered. The service has now obtained an appropriate drugs trolley that is kept locked and is secured to the wall, when not in use. Controlled medication has traditionally been stored in a locked facility within a locked cupboard within the office which is also locked however it is now recommended that all care homes have specific facilities for the storage of controlled medication. Staff files evidenced that staff have received training in the Safe Administration of Medication. There was evidence that staff relate well to residents and that they are mindful of the resident’s privacy. Staff were seen to address residents by their preferred name and knock on residents door before entering. Residents appeared well presented and one residents spoken to was able to confirm that the staff were nice to her and that she was treated well. The individual plans of care evidenced that residents and their relatives’ wishes regarding terminal care and death were recorded and there was some evidence of compliance with the new Guidelines on Decisions Relating to Cardiopulmonary Resuscitation. Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities and meals are both managed well, are creative and provide daily variation and interest for people living in the home. EVIDENCE: The individual plans of care evidence that residents are consulted about their preferences regarding times of rising and retiring to bed and there was evidence that routines are flexible within the home. Residents are able to have their meals at preferred times, choose whether to participate in activities and to mobilise freely around the home. Individual plans of care contained information about the residents past lives which are used by staff to communicate with residents about their previous lives. There was some evidence in the individual plans of care about the activities that residents had participated in however this was not up to date. There was clear evidence of regular group and one to one activities going on throughout the day including armchair exercise, card games sing along Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 18 sessions and appropriate music throughout the day. Residents were seen to enjoy the activities and were also able to confirm that they could choose not to join in if they wished to do so. Activities were seen to be appropriate for the gender of residents such as crafts, knitting and reminiscence sessions. There was also evening entertainment in the form of an Easter Party comprising a competition for the best-decorated Easter bonnet, a buffet supper and invitations to relatives and friends. Since the last inspection a member of staff has taken responsibility for the coordination of activities and a programmes of entertainment is displayed in the main entrance this indicates that there is generally at least three organised activities a day. This staff member is currently exploring other options and associated equipment to further develop the variety of activities provided. Residents were able to confirm that they were able to receive their chosen relatives and that their visitors were made welcome in the home. Visitors were seen to come and go at varied times, one visitor was able to confirm that she came regularly and was made welcome at varying times. Individual plans of care evidenced that residents are supported to maintain their faith though the provision of Holy Communion and the support of visiting clergy appropriate to the needs of the resident. All existing residents are white European and in the main have the English language as their first language. As such the celebrations and activities are appropriate for the existing residents. Menus indicated that the food offered is varied and traditionally English. However there is usually a choice of two set meals including a vegetarian dish. Resident’s preferences are known to staff, even though they are not recorded in consistent detail within the individual plans of care. Special diets are accommodated such as reduced sugar for diabetics and soft diets. Food is appropriately pureed if required and staff offer sensitive and discrete assistance. Three meals are provided a day with a least one hot meal and there are appropriate drinks and snacks provided in between meals. One resident was able to confirm that the food was good and that portion sizes were adequate. Since the last inspection the Commission have received one concern that the service had run out of supplies such as bread, squash and milk and three relating to the quality of the food purchased. It was established through discussion with staff that the arrangements for the ordering and supply of provisions has been changed and that it is only on rare occasions that additional supplies were required at short notice form local supermarkets. The Meat is supplied by a local butcher and other items are supplied by a recognised catering supplier. The service employs a cook for six days of the week, in general the food is home cooked and the management are mindful of the need to keep the provision of processed food to a minimum. There Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 19 appeared to be adequate supplies of food on the premises during the inspection. Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a robust complaints procedure and good staff awareness, however incidents that have Safeguarding Adults implications have not been followed up in a robust way and therefore have the potential to put residents at risk. EVIDENCE: The service has a robust complaints procedure, which is included in the Statement of Purpose and Service Users Guide. The policy is not currently displayed in the home, however most people indicated that they knew how to complain and staff were able to confirm that the Statement of Purpose and Service Users Guide were always provided to residents and their relatives at the time of admission and staff explained the procedure to them. Discussion with the Responsible Individual indicated that management were open to comments, concerns and complaints and that they viewed these as opportunities to improve the service. Since the last key inspection the Commission has received eight concerns about this service, four of these were referred back to the provider for investigation. The complaints file contained evidence that complaints are handled appropriately, including an investigation and response to the Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 21 complainant. The concerns raised covered a wide range of issues including the management of personal care, staffing, the environment and the management complaints. The content of these has been reviewed and used to inform this current inspection. The Commission for Social Care Inspection conducted a random inspection in February 2007, in response to an anonymous allegation that 13 of the Care Home Regulations 2001 had been contravened. As a result 4 requirements were made and compliance has been reviewed during this current inspection. There have been two Safeguarding Adults allegations since the last Key inspection and there is evidence that staff have worked with appropriate health professionals and the police to ensure the protection of residents. However there is no evidence to demonstrate that Safeguarding Adults issues were referred to the Adult Care Team for further advice and action as specified in the Local Authority Guidelines. One of the residents has returned to the home following a period of hospitalisation with ongoing support form the Community Psychiatric Nursing Services, the individual plans of care contained only basic information regarding observation and monitoring of the residents whereabouts. There was no evidence that a formal risk assessment had been conducted to reduce or manage the potential risks associated with challenging or inappropriate behaviour. Staff spoken to were able to confirm recent training in the Safeguarding of Adults, and further training is planned. The management were able to confirm that they have received a copy of the new Local Authority Guidelines. One resident was able to confirm that they felt safe living at Rathgar. Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements to the standard of the environment are ongoing however there are significant shortfalls that need to be addressed to ensure the residents dignity and safety. EVIDENCE: The premises are suitable for their stated purpose, comprising a spacious detached residential property close to the town centre and local transport links. It provides suitable wheel chair access to the front of the building and following a Requirement made at the previous inspection a portable ramp has been provided to ensure that residents have access to the courtyard and Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 23 arrangements are in place to improve wheel chair access to the garden at the rear of the property. There is also a passenger lift to the upper floors. The communal areas are appropriately furnished and well maintained, comprising quiet seating areas in the hallway and the conservatory. There is a separate dining room and a large lounge. However there are no radiator guards fitted to the radiators in either the communal or private areas. The Responsible Individual confirmed that there were no risk assessments in place to reduce and manage the risks associated with exposed radiators. She also confirmed that heating temperature was controlled at source and that there were individual thermostats to control all of the radiators. The implication of this would be that in the event of severe cold weather the heating could not be turned up to maintain temperatures within the home without increasing the risks to residents from the exposed radiators. The service has a plan of decoration and refurbishment, which includes the development of resident’s personal accommodation. Three rooms were viewed, two of these were twin rooms with washbasins and appropriate screening was provided. The Responsible Individual confirmed that prospective residents are shown rooms before they decide to move into Rathgar and that they are clear that the room on offer is shared accommodation. However the management are mindful of the individual residents needs and do offer single rooms to residents as they become available. Three wheelchairs were stored in one of the twin rooms, it was established that only one of the residents required the use of a wheel chair to access the communal areas and the others were there for storage purposes. One of the rooms was for single occupation, the carpet in this room is considerably worn and stained and should be replaced at the earliest opportunity. In addition the ensuite currently not in use was being used for the storage of a vacuum cleaner and the lavatory had no seat or lid. Rooms evidenced that residents are able to bring their personal items into the home, residents have access to call bells and a random check indicated that they were in good working order. A Requirement was made following the last inspection regarding an item of furniture that was broken. This has since been removed and replaced, however the standard of furnishings and fittings in the rooms viewed was, although safe, in a poor state. The surfaces of bedside cabinets and chests of drawers had either lost or had damaged varnish meaning that it is difficult to maintain cleanliness and the appearance was unappealing. The management confirmed that they have plans to replace some of the more dilapidated furniture in the near future. Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 24 However the bedding appeared to be comfortable was clean and well maintained. There was a slight odour of urine in one of the bedrooms, the carpet had recently been replaced and the bedding was clean and dry. Through discussion with staff it was established that the carers do the laundry and that although the service has invested in new industrial laundry facilities that the machines were sometimes overloaded meaning that the laundry may not always be free from odour. The laundry room was viewed and seen to be functional, staff confirmed that the equipment was in good working order. However the washing powder was easily accessible to anyone who entered and the door was not locked. The powder contains information on the container that indicates that it may be hazardous if ingested or applied to the eyes. This was immediately raised with the Responsible Individual who arranged for the door to be locked and a notice applied to ensure that the room was locked when unattended by staff. A cleaner is employed for five days a week; the home appeared to be clean and hygienic throughout. There is evidence that staff receive training in Infection Control procedures. Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Recruitment procedures are not sufficiently robust to ensure that residents are fully protected. EVIDENCE: The staff duty rota indicates that staffing levels are generally adequate. The Responsible Individual is present in the home during the week and the Acting Manager is also available at this time. There are at least three carers on duty throughout the day time shifts and two throughout the night, care staff are supported by a cook and cleaner. However staffing levels are reduced at the weekend as the Responsible Individual and Acting Manager are not present and there is neither a cook nor cleaner on duty on a Sunday. The staff duty rota also indicates that when new staff start working in the home that they are included in the basic numbers. This combination of factors has the ability to compromise the care and supervision that residents receive on a Sunday. The staff group are generally reflective of the culture and ethnicity of the residents living at Rathgar, there are a small number of staff from overseas Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 26 and the management confirmed that when appropriate there are systems in place to support them with the development of the English language. A random inspection was conducted on the 14th February 2007 to follow up concerns raised about staff working without appropriate clearances and training. A Requirement was made regarding recruitment practices and the failure to obtain Criminal Records Bureau Clearances and povafist checks before staff commence employment. The Responsible Individual has stated that she has not received this report and associated Requirements. The report had therefore been reissued. Two staff files were reviewed and appropriate references were in place. However one of the staff files evidenced that the staff member had recently commenced working in the home without the necessary checks. This Requirement is therefore restated. Staff files indicated that staff have received appropriate mandatory training, including induction, Infection Control, Safe Administration of Medication, First Aid, Fire Safety, Health and Safety, Basic Food Hygiene and Movement and Handling and training in the Safeguarding of Adults. Staff have recently received training specific to the health care needs of the residents such as the management of diabetes, incontinence, tissue viability and dementia awareness. Further training is scheduled for the management of death and dying and the Safeguarding of Adults. Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 27 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 poor. This judgement has been made using available evidence including a visit to this service. The management of the service in not proactive, which means that the service is not consistently managed to ensure the health and safety of residents. EVIDENCE: The Responsible Individual has appointed a new acting manager who has been in post for three and a half years and promoted to the post of acting manager six months ago. Both she and the Responsible Individual confirmed that it was their intention that she is to seek registration with the Commission, in the near future. The Annual Quality Assurance Assessment indicates that the Acting Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 28 Manager is currently doing her National Vocational Qualification in Care level 4 and the Registered Managers Award. There have been eight concerns raised about this service since the last Key inspection two of these relate to the attitude of the acting manager and the response to complaints made to the service. The Commission have received no complaints about this service since the current acting manager took on her management role. There was one recent complaint held within the service complaints file and this has been dealt with appropriately. There is evidence that the service seeks the views of residents and their relatives on a regular basis. This includes regular meetings and also formal surveys. There was evidence that the information received is used to improve the service and has resulted in more frequent and stimulation activities for residents and some improvements to the laundry. The results are displayed in the entrance. The service holds small amounts of money for two residents, this is stored appropriately within a secure facility and is kept within individual envelopes. The amount contained is recorded on the envelope. A spot check was conducted and one of the amounts was found to be in excess, of that recorded on the envelope. There was a note to say that some money had been spent on tights, but there was no receipt. Additionally concerns were raised at the random inspection dated 14/02/07 about £40;00 that had been missing form an unnamed resident. The resident had been refunded the money by the Responsible Individual. The Responsible Individual confirmed that the police had been notified but was unaware of any outcome. The Responsible Individual was unclear whether Safeguarding Adults procedures had been followed and the expectation that a referral to the povalist held by the Secretary of State should be made in the event that it was identified that theft by a staff member had occurred. Staff have now received training in the Safeguarding Adults and further training is scheduled. Records that are stored in the resident’s rooms to manage personal care issues need to be recorded filed and stored appropriately. One of the files viewed had records that were undated, were written on the back of other forms and were not secured or filed in any order. There were 2 folders one of these had been superseded and should have been archived, the pages within were loose and stuck together due to water damage and talcum powder, having been stored underneath the washbasin. The accident records were reviewed for the previous year and it was found that there were a significantly high number of incidents where residents had tripped, slipped or fallen. The records failed to evidence that residents were routinely followed up at significant times after the event to ensure that they were free from injury or pain or that significant people were informed of the Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 29 incident. This is consistent with some of the comments made by relatives in that they are not consistently informed of accidents or injuries to their relative. There was no evidence that the number of incidents had been collated to identify which residents were most at risk, causes, locations and times. The Responsible Individual was advised to review risk management practices to ensure that they are consistent with current best practice guidelines issued by the Health and Safety Executive and the National Institute for Health and Clinical Excellence. In addition to seek further advice from the falls prevention officer at the local hospital, including possible referral of residents at high risk to the local falls clinic. A random inspection was conducted on the 14th February 2007 and four requirements were made. There is evidence of compliance with two of the requirements. However staff files evidenced non-compliance with the Requirement regarding staff recruitment. Non-compliance with Regulations is an offence under the Care Home Regulations 2001 and non-compliance with Requirements is an offence under the Care Standards act 2000. The Responsible Individual contends that the report dated 14/02/07 was not received; in these circumstances the Commission would consider it to be a demonstration of the Fitness of the Responsible Individual to alert the Commission to this fact. In addition the Inspector who conducted the inspection dated the 14/02/07, provided comprehensive verbal feedback to the Responsible Individual regarding requirement to obtain appropriate Criminal Records Bureau Clearances prior to the commencement of employment of new staff in the home, to ensure that residents are protected from potential abuse. Following the random inspection dated 14/02/07 a Requirement was made regarding the location of the freezer within the cellar. The concerns included the damp floor in the cellar, the electrical safety, the possible contamination of food and the restricted head height. The floor of the cellar continues to be damp and the freezer is elevated on bricks to remove it from the moisture. There continues to be a raised wooden pathway to provide some protection from the damp it has caused a decrease in the already restricted head height and increased the potential for injury. These concerns have been raised with the local Environmental Health Officer who has agreed to conduct their own investigation. Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 30 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 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 1 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 X 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 1 X 2 1 Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 31 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 OP7 Regulation 13.4 Requirement Timescale for action 01/06/08 2 OP7 13.4, 13.7& 13.8 3 OP8 12.1 4 OP18 13.6 5 OP18 13.4 & 13.6 Risk assessments for falls must be further developed to ensure that they have suitable controls in place that are based on current best practice to reduce and manage the risks to individual residents Risk assessments for falls from 01/06/08 the bed must be further developed to ensure that they are based on current best practice and include the risks of entrapment and potential restraint. To reduce and manage the risks to individual residents. All residents must have a 01/06/08 recognised formal assessment of their risks of pressure. To promote the individual residents health and well being Incidents that have Safeguarding 01/06/08 Adults implications must be referred to the appropriate authorities and followed up to establish an outcome to ensure that residents are protected from abuse. Appropriate risk assessments 01/06/08 must be developed to ensure DS0000066316.V361192.R01.S.doc Version 5.2 Page 32 Rathgar Residential Care Home 6 OP19 13.4 7 OP19 13.4 8 OP26 13.3 9 OP26 13.4 10 OP27 18.1 11 OP29 13.4 (C), 13.6 & 19.5 (7)(b) 12 OP35 13.6 &17.2 that residents who exhibit challenging behaviour or have been involved in Safeguarding Adults incidents to ensue that they and other residents are protected from abuse. Individual risk assessments must be conducted regarding the exposed radiator surfaces to ensure that residents are protected from the associated hazards. Bathroom facilities must be reviewed to ensure that they have appropriate fixtures and fittings e.g. lavatory seats. To protect the safety and dignity of residents Laundry procedures must be reviewed to ensure that they comply with Infection Control guidelines and protect residents from the risks of infection. Substances hazardous to health must be stored appropriately to ensure the health and safety of residents. Staffing levels must be reviewed to ensure that they comply with the guidance issued by the Department of Health at all times including Sundays when staff may be deployed to other duties or when new staff are on duty. To ensure the protection, health and safety of residents New staff must not commence employment within the home without appropriate i.e. povafirst or a Criminal Records Bureau Clearance. To ensure that residents are protected form abuse. The management of residents money must be reviewed to ensure that accurate records are maintained of money received, expenditure, including receipts DS0000066316.V361192.R01.S.doc 01/06/08 01/06/08 01/06/08 01/06/08 01/06/08 01/05/08 01/06/08 Rathgar Residential Care Home Version 5.2 Page 33 and a balance bought forward. To ensure that residents are protected from financial abuse. Accurate records must be accurately maintained and kept in good order and be appropriately stored in line with the Data Protection Act. To ensure the protection of residents. A review of accident records must be conducted to identify high risk factors such as incident type, residents, locations and times of incidents to reduce and manage the risks to individuals. 13 OP37 17 01/06/08 14 OP38 13.4 01/06/08 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 OP7 Good Practice Recommendations Individual plans of care should be further developed to ensure that they are person centred and that they contain detailed instruction to staff about how the residents needs and wishes to be cared for. Staff should receive training in record keeping and person centred care planning. Daily records should be reviewed to ensure that they are a detailed and accurate record and comply with the Mental Capacity Act 2005. Accident recording systems should be further developed to ensure that a record is made to demonstrate that residents are followed up at significant periods after an accident. Accident recording systems should be further developed to ensure that a record is made to ensure that resident’s relatives are notified when accidents and incidents occur. Guidance should be obtained from the local falls clinic and or falls prevention coordinator. Staff should receive training in the development of risk DS0000066316.V361192.R01.S.doc Version 5.2 Page 34 2 3 4 OP7 OP7 OP7 5 6 7 OP7 OP7 OP7 Rathgar Residential Care Home 8 OP8 9 OP8 10 11 12 13 14 OP9 OP16 OP19 OP19 OP31 assessments and risk management. Residents individual plans of care should be further developed to include information about referrals to specialists such as the continence advisor and a detailed care plan be developed to reflect the guidance issued. All residents should be weighed according to their individual need, where this is not possible with traditional scales the Malnutrition Universal Screening Tool should be used to monitor the well being of residents. The storage of controlled medication facilities should be reviewed to ensure that it complies with the guidance issued by the British Royal Pharmaceutical Society. The complaints policy should be displayed in a prominent and secure location to ensure that residents and their relatives have access to information. The furnishings and fittings in resident’s bedrooms should be reviewed to ensure that it is of an acceptable standard and fit for purpose. Resident’s private accommodation should not be used for the storage of equipment unless it is necessary to the individual resident. Registration with the Commission for Social Care Inspection should be sought for the acting manager. Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Rathgar Residential Care Home DS0000066316.V361192.R01.S.doc Version 5.2 Page 36 - 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. 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