Inspection on 18/12/08 for Rathmore

This inspection was carried out on 18th December 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rathmore 15/12/06

Rathmore 10/02/06

Rathmore 03/10/05

Rathmore 07/01/05

Rathmore 04/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rathmore 3 St Annes Road East St Annes Lancashire FY8 1TA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Denise Upton     Date: 1 8 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Rathmore 3 St Annes Road East St Annes Lancashire FY8 1TA 01253729410 01253729410 rathmore@talktalk.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Mary Jane Jarvis Type of registration: Number of places registered: Mrs Mary Jane Jarvis care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care Home only - Code PC To Service Users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP The maximum number of Service Users who can be accommodated is: 8 Date of last inspection Brief description of the care home The Rathmore Care Home is registered to provide personal care for up to 8 older people who do not require nursing accommodation. The home is a smaller family type establishment with the experienced proprietor providing the majority of care supplemented by a small nucleus of staff that have been employed at the home for a substantial period of time. In consequence, residents individual needs and preferences are well known and therefore more easily addressed with high quality care delivered in an informal setting. The home is conveniently situated close to the main shopping area of the Town and in close proximity to community amenities and resources. The home Care Homes for Older People Page 4 of 33 Over 65 8 0 Brief description of the care home consists of communal accommodation on the ground floor of the building and single occupancy bedroom accommodation is located on the first and second floors. Stair lifts are provided for ease of access throughout the building. Three individual bedrooms are provided with an en-suite facility and communal bathrooms and toilets are located close to the lounge and dining room and resident bedroom accommodation. Participation in community activity is encouraged either independently or with the assistance of staff and visitors are made welcome at any time of the residents choice. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The visit was unannounced and look at all of the national minimum standards, plus a standard relating to staff supervision. At the time of the visit there were six people resident at the home. We spoke with the homeowner, her husband and individual discussion took place with two members of staff and the hairdresser who was visiting. In addition, discussion also took place with three residents and a telephone conversation took place with a relative who wanted to add her very positive comments about the home. Care Homes for Older People Page 6 of 33 Information was also gained from the Annual Quality Assurance Assessment (AQAA) completed by the owner. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also provides some numerical information. CSCI survey forms inviting feedback were received from three members of staff, three residents and a relative. A relative also made some comments on a resident survey. A number of records were viewed and a partial tour of the building took place that included communal areas of the home, bathrooms and toilets and some individual bedroom accommodation. Time was also spent observing staff and the people living at the home as they went about their daily activities. Details of current fees and what is included in the fees is available from the home. The last key inspection at The Rathmore took place on 15th November 2006 and an Annual Service Review was undertaken on 29th January 2008. The report relating to the service review is held at the CSCI office and would be made available on request. What the care home does well: What has improved since the last inspection? The written information recorded regarding the pre admission assessment outcome are now more detailed and provide a good account of the prospective residents strengths and needs. Likewise, care plans that tell staff what a resident can do independently, and what help is required, are also more detailed in order to advise and direct staff in providing an appropriate level of care for the individual resident. The homeowners of The Rathmore continue to make improvements to the building resulting in a well maintained, homely and comfortable home. Recently new stair lifts have been provided to assist resident access the upper floors with ease. Additional shelter has been provided in the outside area for residents that like to access the garden area and the home has an ongoing maintenance and redecoration programme. Care Homes for Older People Page 8 of 33 As recommended in the last key inspection report, a record is now maintained of the regular random testing of hot water outlets in resident accommodation. This helps to protect residents from accidental scalding or alternatively from water being delivered from hot water outlets that is too cool. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre admission assessment process helps to ensure that people are only admitted to the home if their needs and requirements could be met. Evidence: Residents are only admitted to The Rathmore following a comprehensive assessment of their current needs and requirements prior to the individual moving into the home. This is to make sure that people are only admitted to the home if their needs could be met. Since the last inspection, a new pre inspection assessment form has been introduced that provided good detail in order to develop the initial plan of care. The records of two people living at the home were viewed including a recently admitted resident. This showed that relatives are involved in the pre admission assessment as appropriate for the individual. This helps to make sure that as much information as possible is gained in order for the homeowner to make an informed Care Homes for Older People Page 11 of 33 Evidence: judgement as to whether the level of care and support required can be provided. A relative spoken with also confirmed that she had been fully involved in her mothers pre admission assessment and the development of the initial care plan. This same person went on to add that the homeowner and staff, Always consults with family to make sure that mum gets what she wants. The Rathmore also provides short term and respite care, with some people living outside the local area, coming to stay at the home on a regular basis. This sometimes occurs when the main carer is on holiday or in need of a break from their care duties. However one gentleman has decided to spend his second successive Christmas at The Rathmore as he now finds family Christmass too exhausting and prefers the quieter pace of Christmas at the home. Whilst it was very apparent that the needs and requirements of people living at the home were being well met, there is a requirement that any person that has been assessed for possible admission to a care home must receive written information following the pre admission assessment. This should confirm the outcome of the pre admission assessment and that the prospective residents current needs and requirements could be met at the home or alternatively that they could not be met. This should be provided prior to admission. There was no evidence that this had occurred. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care needs are well met and privacy and dignity respected. Staff training ensures that in the main, medication is handled appropriately. Evidence: There is a consistent approach to care planning and the regular review of care plans to make sure that the written information is current and accurate. The care plans of two residents were viewed. With regard to one person, the care plan said that the resident must be assisted at all times by two staff when raising from a chair. Staff were seen to be doing this throughout the course of the inspection. The resident had been provided with a personal buzzer so she could alert staff when any assistance was needed. There was also a formal risk assessment in place regarding this matter. Residents spoken with were consistent in their praise for the care and support provided at the home. One resident told us that, The best is always there and went on to add that, I am well looked after by the staff. I am well and happy with good care for my every need. A relative simply described the care her mother received as Care Homes for Older People Page 13 of 33 Evidence: Excellent. The hairdresser spoken with described residents as being very well looked after at the home and that The Rathmore was very much a home from home with staff caring and lovely with the ladies. It was clear that staff had a good understanding of the needs of people who lived at the home and were seen to be patient, kind and respectful when speaking with residents. Through discussion with residents and a member of the care staff team, it was confirmed that the health care needs of residents are fully met. One lady told us that the homeowners husband always escorted her to hospital appointments and that staff were spot on if any medical input was required. Records showed that clients had been enabled to access chiropody services, dental services, hearing aid and optical services. Other medical services are accessed as required for each individual resident. Staff with responsibility for the administration of medication have all received appropriate medication training to make sure they are competent. The home has a policy and procedures for the administration of medication that staff are expected to follow. Residents that wish to do so are enabled to self administer their own prescribed medication following the outcome of a successful formal risk assessment. One resident had chosen to self medicate and an appropriate risk assessment was in place. This should be regularly reviewed to make sure that the information remains current. Since the last inspection along side the individual drug administration record, details have been provided as guidance to staff with regard to what each drug is prescribed for. The staff member spoken with said that she had found this helpful in understanding the importance of any particular drug and why it was necessary. Patient information leaflets are also available for staff to read. In the main, medication is well managed at the home however in respect of one resident, a PRM medication (a medication to be taken only when required) was prescribed in November 2008. This medication was not included on the drug administration record. The resident had required an occasional dose of this medication but there was no record of when this had been given. It is essential that all prescribed medication be entered on the drug administration record. If a hand written entry is required this should be the exact replica of the pharmacist label and signed and dated by the person making the entry. The hand written entry should then be checked and countersigned by a second person to confirm accuracy of the recording. This would help to keep residents safe and provide evidence that their prescribed medication had been given as directed. Residents spoken with felt that their privacy and dignity was respected and that staff Care Homes for Older People Page 14 of 33 Evidence: were sensitive and mindful of residents feelings, with one resident saying that staff were very good, very caring and respond immediately. A carer also gave a good account of how she respected residents privacy and dignity when assistance with personal care was required. All staff receive training in respect of maintaining privacy and dignity during induction training and National Vocational Qualification (NVQ) training, a qualification that all staff working at the home has achieved. i Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are arranged according to peoples preferences and staff support family and friendship links. Residents benefit from a varied diet and enjoy the meals provided. Evidence: Daily routines are kept flexible to take into account individual preferences. One resident has chosen to spend her waking day in her bedroom including mealtimes and this is supported. The relative of one resident told us how the homeowner had consulted with her to make sure that her relative was provided with a range of specific activities suited to her needs and interests. The homeowner had helped to find suitable equipment and materials to ensure that these interests could be pursued and the relative said that staff had been patient and helpful in making these activities worthwhile and meaningful for the resident. This same person went on to say, There are sufficient activities to meet the needs of most people in The Rathmore. In my mothers case she enjoys her own company and likes to help with drying pots and some light washing up. The staff allow her to do this and it enables her to feel useful and active. She has been encouraged with activities such as sewing, knitting and colouring books. Birthdays are celebrated with small parties for each resident. At Christmas there is an open house for residents and families. Care Homes for Older People Page 16 of 33 Evidence: Individuals spoken with expressed their satisfaction with the flexibility to do as they wished, when they wished or simply do nothing at all. This could included activities such as watching television, reading, social or shopping trips out in the car with staff, accessing community activities, outings with family, craft activities, painting or any other activity of their choice. Because of the small, long standing staff group, the wants, needs and wishes of each resident are well known. Some residents enjoy a chat with staff at various times of the day either individually or with one or two other people. This is sometimes valued far more by residents than formal planned activities that they may not wish to participate in. A Christmas party is planned for residents, relatives and friends. This includes the relatives of people that has once lived at the home. Some relatives have attended functions at The Rathmore for several years after they have lost their loved one but they are always made very welcome and enjoy the event. The relative of one resident has been invited to spend Christmas day at the home and enjoy Christmas lunch with her mum. The resident said she was very much looking forward to this. A morning and evening newspaper is delivered each day along with several weekly publications. Alternatively people can arrange for their own newspaper to be delivered if they so wish. People living at the home are supported to attend religious services of their choice or alternatively watch religious services on the television. Visitors are made welcome at any time of the residents choice and there is a good and comfortable relationship between relatives and staff. One relative spoken with said that not only do staff support the residents very well but also support the relatives as well. This had been greatly appreciated. People living at the home are supported to make decisions about their day-to-day lives, such as when to go to bed, when to get up and how to spend their time. Residents are involved in choosing the decoration for their own bedroom and encouraged to personalise this personal space with their own important things. One lady brought her own bed from home, another lady has her own recliner chair in her bedroom and another resident chose to bring a chair from home to place in the lounge. This shows that peoples views and opinions are valued and autonomy is encouraged. Individuals are supported to manage their own financial affairs for as long as they are able and wish to do so. For some people however, a family member takes on this responsibility. Details of advocacy services are also made available for residents and their family to access if and when they choose. Care Homes for Older People Page 17 of 33 Evidence: People living at The Rathmore are very happy with the meals provided. Comment on CSCI surveys included, Always good fresh food and The food is always home cooked, healthy and to individual taste. My mother has a poor appetite but every effort is made to ensure she eats and enjoys her food. She is encouraged to eat. A resident spoken with told us she was very satisfied with the food served and that the food is very good, wide choice of good home cooking like I use to make at home. The main meal is served at lunchtime and residents enjoy a glass of sherry before this meal. Although most residents enjoy the planned lunchtime meal, an alternative of the residents choice is always made available if preferred. Some residents enjoy breakfast in bed and drinks and snacks are served at regular intervals throughout the day and on request. The food preferences of each resident are well known and the specific dietary needs of one person who has diabetes are accommodated. There is a rotating menu that is changed periodically but this is kept flexible to take into account what residents feel like eating on a particular day. Recently the home has achieved the Fylde Borough Councils Taste for Life award. This was a course specifically for people working in care homes and focused on information and guidance about the nutritional needs and requirements of older people. The homeowner commented that this had been very useful and some changes had been made to the planned menu to take account of the information provided. There are further planned seminars arranged for the coming year. This all helps to ensure that residents at The Rathmore are provided with a well balanced and nutritious diet suited to their needs and taste. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home and their relatives are able to raise any concerns, with policies and procedures and staff training in place that helps to ensure that any concerns are dealt with appropriately. Evidence: There have been no complaints since the last inspection. A complaint policy is in place and this is made available to those living at the home. Information is clearly provided for people living at The Rathmore in the event of them, or their relatives wanting to make a complaint about the home or its staff. Responses in the CSCI surveys completed by people living at the home confirmed that residents knew who to speak with if they were unhappy and how to raise any concerns. One person had written, I have never had a need to address any issues but feel able to do so should the need arise. I know I would be listened to. Other residents spoken with all said that they would speak with the homeowner if they had a concern but one lady said that she never had anything to complain about. The surveys completed by staff also showed that staff knew what to do if anyone had concerns about the home. Information within the Annual Quality Assurance Assessment (AQAA) completed by the owner of the home, states that it is recognised that complaints are not necessary negative. Because of the close relationship between the residents, relatives and staff, complaints are very rare as there is frequent dialogue between all Care Homes for Older People Page 19 of 33 Evidence: concerned to resolve any issues immediately. The home has policies and procedures in place regarding abuse and the protection of people living at the home. Staff spoken with said they had easy access to documents, which included guidance for staff should they be concerned about the work performance of another member of staff. All staff undertake training regarding the protection of vulnerable people and issues regarding protection and vulnerability. This is provided initially through nationally recognised induction training for care staff and more advanced National Vocational Qualification (NVQ) training programmes. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Rathmore is comfortable, clean and well maintained, providing a pleasant and homely place to live. Evidence: The Rathmore care home is close to the town centre and local shops and amenities. Observation of communal areas of the home and some individual bedroom accommodation showed that the building appeared well maintained, homely and comfortable. All bedrooms are for single occupancy and a minority provide an en-suite facility. Decoration and refurbishment of the home is on-going. Bedroom decoration reflects the interests of the occupant and people are encouraged to personalise their bedroom by bringing their own personal items, such as pictures and ornaments. Residents are also able to bring larger items from home if they so wish and if their individual bedroom will accommodate it, such as their own bed or favourite chair. Communal areas consist of a lounge to the front of the building and a separate dining room at the rear. All bedroom accommodation is located on the first and second floor of the building that is served by new stair lifts. Bedroom doors are provided with an appropriate lock with the occupant retaining the key if they so wish to ensure privacy Care Homes for Older People Page 21 of 33 Evidence: and dignity. A locked facility is also provided for the safe storage of personal items. Appropriate aids including grab rails and an assisted bath are provided. Since the last inspection, a thermostatic device has been fitted to the only bedroom that was without this safety feature on the hand wash basin. This helps to prevent the possibility of accidental scalding through very hot water being delivered from the hot water tap. A bathroom on the second floor of the building is also without this safety feature. This was removed when the two residents that are accommodated on this floor complained that the water from the hot water outlet was not sufficiently hot. Whilst this still continues to satisfy residents choice, as recommended in the last key inspection report, formal risk assessments should be undertaken in respect of the individual residents accommodated and the bathroom environment. This is especially important if other residents are accommodated on this floor who may only be visiting for a short period of time. Whilst the lack of a thermostatic device may pose no risk at present to the permanent residents accommodated on this floor, this may not be the case in respect of respite care residents who may also be accommodated in this area. It is essential in order to minimise any risk that formal risk assessments are in place that are regularly reviewed with significant outcomes identified on the individual care plan. This also applies to any other resident that may be accommodated on this floor or other residents who may occasionally use this bathroom independently. The outside area to the front of the home is provided with seating and tables to enable residents to sit out in the warmer weather. Since the last inspection more shelter has been provided in this area to help protect residents who wish to sit outside. The Rathmoor care home continues to be clean, pleasant and hygienic. This was also confirmed by residents spoken with and comments on the CSCI surveys received. One person said, The home is always fresh, clean and there are never any unclean smells. All residents always wear their own clothes. There is never any confusion over belongings, clothing is always clean. A resident told us, Floors well hoovered and well dusted. There are a variety of policies and procedures in place for the control of infection and safe handling of waste products. Laundry facilities are located in the basement area of the home and do not intrude on residents. All laundry is washed at an appropriate temperature. The AQAA confirmed that the majority of staff have received infection control training meaning that they know how to reduce the risk of infection within the home. Care Homes for Older People Page 22 of 33 Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are very well supported by a consistent, qualified and caring staff team. Evidence: The homeowner, residents and staff spoken with and comments on the CSCI surveys all confirmed that there are always sufficient staff on duty to ensure that needs and requirements of people living at the home are met. The residents spoken with said that staff are always available when they need them and this includes during the night time period. The staff team has remained stable and no agency staff are used, this means that people know who is going to be helping them and helps to ensure consistency of care. Because The Rathmore is a small home with a small staff group, residents and staff get to know each other very well and there is a very comfortable relationship. This helps people living at the home feel safe and secure. Feedback, about the staff from relatives and those living at the home was extremely positive. One resident described staff as spot on, they are very good, very helpful and respond immediately. A relative told us that she could not fault the staff in any way, The Rathmore management and staff should be recognised and acknowledged for the high standard of care they deliver to service users. They are an example that should Care Homes for Older People Page 24 of 33 Evidence: be followed by more care homes and rest homes. There have been no staff changes since the last inspection. This means that people living at the home are supported by staff who know them well. This was clear when watching staff going about their duties and when listening to their communication with the people living at the home. All care staff at The Rathmore care home have achieved at minimum a National Vocational Qualification (NVQ) Level 2 in care. This is a nationally recognised qualification for care staff and well exceeds the minimum standard expected. This is to be commended and shows that all staff at the home have the skills, knowledge and understanding to provide a good standard of care. There have again been no new staff appointments since the last key inspection. As already highlighted in this report, the staff group at the Rathmore have all worked together for a considerable period of time and work very well together. However, The Rathmore continues to have a have a structured recruitment and selection policy that includes obtaining references and a Criminal Records Bureau (CRB) disclosure before any prospective member of staff could take up their appointment at the home. This helps to protect residents and to make sure that only suitable people are employed. The homeowner confirmed that any newly appointed staff would be provided with the Skills for Care induction training programme soon after commencement of employment to ensure that they had the basic skills to provide an appropriate level of care. During the course of the visit, the homeowner explained that recently, there had been only limited external staff training and the training matrix needed to be updated. However The Rathmore has a very experienced staff team and all staff have previously attended a variety of courses to fulfil their training needs. One member of staff has more recently attended a training course about diabetes and the home owner and a member of staff attended the Taste for Life course. There is a good programme of mandatory health and safety training that all staff have completed. These training courses all help to give staff knowledge and skills for their work and help the people living at the home to receive a good standard of care. It is recommended that the staff training matrix be brought up to date to ensure that a clear and accurate record is maintained of all training undertaken and to highlight when refresher training is due. It was also evidenced that a variety of booklets are available in the home covering a wide range of topics such as medical conditions, end of life care and keeping people safe. Staff can access these at any time and the members of staff spoken with also stated that the homeowner always provides guidance about specific conditions that is Care Homes for Older People Page 25 of 33 Evidence: discussed with the staff team. Staff spoken with and those who completed a CSCI survey all spoke very positively of the help given by the homeowner. One person told us, We always spend half an hour before shift being updated and everything important. Another member of staff told us, There is always support here if you need it for anything and we are given training. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and staff are well supported in their work. Policies, procedures, good practise and staff training promote the health and safety of people living at the home. Evidence: The homeowner is a qualified nurse, has completed the Registered Managers Award and is very experienced in managing a care home for older people. The Registered Managers Award is the qualification recommended for somebody managing a care home and shows that the homeowner is qualified to manage the care home well. The homeowner provides strong leadership and staff, residents and relatives spoke very highly of her. One person told us, Mary (homeowner) and ***** (the homeowners husband) are very kind and caring people, they are always here to help look after the residents, they not only care and support for the residents but their familys too when needed. They Care Homes for Older People Page 27 of 33 Evidence: support staff also with any personal problems. Another member of staff also commented, All I would like to say, after 20 years of working in care homes, this is the most caring one I have come across. Nothing is too much trouble. The staff and residents are all very well looked after. Mary and **** are lovely people, I could not find better anywhere. Its like home from home and I love to come to work. I have learnt so much while I have been here. Because The Rathmore is a small home with an excellent relationship between residents, staff and relatives, feedback about the home is often informal and ongoing during general discussion. This clearly suits the people living there and their family. However surveys are provided especially to short stay residents but very few are actually returned. People prefer the verbal approach to giving feedback as to whether the home is meeting residents needs and expectations. One resident survey that had been returned was viewed and this gave very positive comments about this residents visit to the home. There are occasional formal staff meetings but most information sharing in done informally on a daily basis. Time is set aside for this during the working day. This clearly suits the needs of staff and the management team and any issues are discussed very quickly ensuring that staff always have accurate and up to date information. The Rathmore care home has gained the Investor in People award. This is a national quality standard which sets a level of good practise for improving performance, with effective management being the key. This is only awarded when a high standard has been achieved. All residents are encouraged to remain financially independent or are assisted in this task by a family member or advocate. In consequence, the home does not normally hold any monies or valuables in safekeeping for residents or support residents to manage their personal allowance. If an item is purchased on behalf of a resident, the homeowner pays for the purchase and then issues a monthly account. However very recently, the homeowner has become partly involved in assisting a resident. Whilst this assistance is clearly of benefit to the person concerned, it is recommended that in any instance when transactions take place this is clearly recorded and signed and dated. This would help to protect both the resident and homeowners and provide a clear record of any financial involvement regarding personal allowances. Staff supervision was discussed with the homeowner. There was evidence of very recent formal staff supervision having taken place in respect of two members of the care staff team. The supervision notes provided good information. Although staff feel Care Homes for Older People Page 28 of 33 Evidence: very well supported and informal supervision is ongoing on a daily basis, it was clear that formal staff supervision has not been taking place as often as recommended. Staff should have opportunity to meet regularly and in private with the homeowner to discuss their practises in the home and career development needs. Formal staff supervision, at least six times a year, is seen as good practise. This meeting does not have to be lengthy but would provide opportunity for individual discussion including practical issues relating to working at the home. Records relating to health and safety were seen. These included records of fridge/freezer temperatures monitoring and random monthly water temperatures testing. Records also showed that equipment such as stair lifts and fire equipment are regularly serviced and that electrical installation and electrical equipment are also checked. Fire drills take place at regular intervals. The homeowner and a member of staff spoken with confirmed that mandatory health and safety training is provided that includes, manual handling, food hygiene, fire safety, infection control and first aid. All these checks, along side the training staff receive help to protect people living at the home, staff and visitors. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Following the pre admission 31/01/2009 assessment, the prospective resident must be informed in writing of the outcome of the assessment. This would confirm to the prospective resident that their current needs and requirements could be met at the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 All prescribed medication should be entered on the drug administration record. All medication administered should be recorded on the drug administration record. Formal risk assessments should be in place in respect of all individual residents who use or have access to the 2nd floor bathroom that is not provided with a thermostatic device to control the temperature of the hot water delivered. This would help to minimise risks. The single member of staff that has not received infection control training should do so, to help prevent the possibility of cross infection. 2 25 3 26 Care Homes for Older People Page 31 of 33 4 28 The staff training matrix should be brought up to date to provide a clear and accurate record and to highlight when refresher training is due. It is recommended that when ever a resident is assisted in financial matters, a record is maintained. This would help to protect both parties. Formal staff supervision should take place at least six times a year. This would provide opportunity for private discussion about work practises and career development needs. 5 35 6 36 Care Homes for Older People Page 32 of 33 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!