Inspection on 17/12/07 for Rathside Rest Home

This inspection was carried out on 17th December 2007.

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

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

Rathside Rest Home 05/12/08

Rathside Rest Home 20/03/07

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Rathside Rest Home Gainsborough Lane Scawby North Lincolnshire DN20 9BY Lead Inspector Mrs Jane Lyons Key Unannounced Inspection 17th December 2007 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 Rathside Rest Home DS0000068229.V357334.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. Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rathside Rest Home Address Gainsborough Lane Scawby North Lincolnshire DN20 9BY 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) 01652 652139 01652 652139 Mr Sukhuinder Marjara Position Vacant Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th March 2007 Brief Description of the Service: Rathside is well established home, which provides residential care support for up to thirty service users in the category of older people. It is situated on the outskirts of Scawby a small village three miles from the town of Brigg and close to local amenities. The accommodation is over two floors, and there is a passenger lift available to the first floor. There are 26 single rooms in the home, and 2 shared rooms; 22 of the bedrooms have en- suite facilities. A garden room was provided to the front of the building in 2005, which has significantly improved the range of communal areas the home provides. There were three further sitting rooms and a dining room in the home. The home has a good range of bath and shower facilities. The front garden has been improved with a large paved area with plenty of seating and shade; a ramp with rails has been provided for access from the garden room. There is a pleasant, well maintained rear garden and ample parking space to the side of the home. It is a privately owned home, and the proprietor is Mr S Marjara. The home has recruited a new manager, Mrs Anna Golightly. Weekly fees are: £336.39 - £338.61 The home operates a system whereby the fees include a third party contribution. Additional charges are made for the following: toiletries, newspapers/ magazines, hairdressing and chiropody. Information about the home can be found in the statement of purpose and service user guide, both these documents are available from the owner at the home. Rathside Rest Home DS0000068229.V357334.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 1 star. This means that the people who use this service experience adequate quality outcomes. The site visit took place over one day in December 2007. Surveys were posted out prior to inspection; three were returned from relatives, one returned from staff and three from service users. Some of their comments have been included in this report. Mrs Jane Lyons carried out the visit. During the site visit we spoke to the manager, the owner, the administrator, five care staff, the cook, a domestic, two General Practioners, seven residents and six relatives to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. We also looked around the home and looked at lots of records, for example; resident care plans and risk assessments, daily records, supervision schedules, menus, and other records relating to the running of the home. Information received by the Commission over the last few months was also considered in forming a judgement about the overall standards of care within the home. On the 14th of November two care managers from the local authority carried out a monitoring visit. A number of concerns were identified around care planning, health care support and recruitment; these were passed on to the management of the home and the commission following the visit. There was evidence from this site visit that the manager and owner had taken action in relation to the concerns raised and the majority of improvements had been made where necessary. What the service does well: The staff working at the home were caring towards the people who use the service and had good working relationships with them. A welcoming atmosphere was created for family and friends when they visited the home. The staff were very friendly and helped the people who live there in a dignified and respectful manner. The home has a good range of pleasant communal facilities which means people who use the service have a good choice in where they can spend their time. Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 6 The home has good systems in place to ensure the safety of all residents, visitors and staff. What has improved since the last inspection? What they could do better: Some of the sections of the care plans were good but others didn’t contain all the information needed and one was not completed quickly enough after admission. This could lead to service users not receiving all the care they required. Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 7 The systems for weighing people who use the service must be more consistent to ensure any changes are identified and appropriate support can be accessed. The way the home manages medication must be improved to ensure that it is stored and disposed of properly. They must make sure that recruitment processes protect service users. They must obtain references before employment of staff. The supervisory arrangements for the home must improve to provide all the care staff with the necessary guidance, leadership and support to ensure people living in the home are safe and well cared for. The home must provide specialist diabetic diet provision for those individuals who have an identified need to ensure their nutritional needs are met. The management must make sure that they follow the multi agency safeguarding procedures when they receive any allegations of abuse to ensure the correct procedures are followed to protect the people who use the service. 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. Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 8 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 Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4,4,5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service and their relatives are provided with sufficient information to help them decide if the home is right for them. In most instances, individuals are assessed prior to their admission to the home and only admitted if it is considered that their assessed needs can be met. EVIDENCE: The statement of purpose and service user guides have been updated in October 2007 and contained current information about the services, facilities and management at the home. Copies of these documents are found in the entrance hall and manager’s office. The home has a good selection of leaflets and information regarding local agencies such as advocacy services available in the entrance hall. There are Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 10 various notice boards situated in the hall areas, which provide people with a variety of information such as activities and results from the quality assurance programme. Four care files were examined. Three of the care files contained evidence that the service users needs had been assessed before they were admitted into the home, one file evidenced that the service users needs had been assessed on the day of admission. The manager confirmed that she had held discussions with family prior to admission however this information had not been recorded. The assessments were found to be detailed and were supported where appropriate with risk assessment. Letters were on file confirming that the home writes to potential residents following this assessment to confirm the home can meet their needs. These individuals have also received a contract/statement of terms and conditions from the home. The majority of people who use the service are currently privately funded; copies of assessments and care plans from placing authorities for those persons publicly funded were in place. There was better evidence that the manager was carrying out reassessment visits prior to discharge from hospital to ensure the home could continue to meet the individual’s needs. Most individuals spoken to by the inspector stated that they had been given the opportunity to visit the home before they moved in. The manager stated that a respite service was available to enable people to stay for a short while and try out the home. This was confirmed in discussion with a service user. People who use the service are not able to make a choice of staff gender when deciding whom they would like to deliver their care, however the manager confirmed that all potential new residents are informed that there are no male staff currently employed at the home. The home does not accept intermediate care placements so standard six is not applicable to this service. Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A lack of consistency in the formation of care plans and some risk assessments means that they do not always contain all assessed needs and do not always have clear tasks for staff. This puts service users at risk of not receiving the full care required. Improvements have been made to the management of medication in the home however some deficiencies in the storage of medicines could place service users at risk of receiving medication that may be unsafe. EVIDENCE: There was good evidence that in recent weeks the manager and senior staff had audited all the care plans and had made significant improvements to the layout of the files. Two files were now in place, one containing all current records and a file for recently archived information. The current file now Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 12 contained an index and all information was clearly sectioned and more easily accessible. Photographs had now been obtained for the majority of individuals. Six care files were examined during the visit and they contained assessments and information to enable plans of care to be produced. Staff completed personal profiles detailing interests, hobbies, likes and dislikes. One service user had been admitted for respite care support two weeks previously, although the home had completed a detailed assessment they had not completed any plan of care so staff had no guidance on how to meet the persons’ needs. Fortunately the service user was able to say what physical support she required, however it was important that the home produced an interim care plan with basic instructions for staff until a more comprehensive one could be formulated if the individual chose to stay for a longer time. Risk assessments had been completed for falls, safe evacuation and moving/ handling; there was no nutritional risk assessment in place and the staff must ensure that nutritional assessments are carried out on all new admissions to identify any specific needs and access relevant support. The other five care plans were more advanced and generally contained service users assessed needs, although a number of gaps were identified and the quality of the wording of a number of the plans could be improved. One service user had behaviour that could be challenging to others and although this was detailed in the evaluation records a plan of care had not been developed with clear guidance for staff on how to manage this behaviour. Another service user had a plan in place to support her diabetic needs however it did not detail the staff support in relation to episodes of hypo/hyperglycaemia. An individual had a skin infection; the area affected had not been identified on the plan and the staff guidance relating to cross infection measures were minimal. Two of the residents have identified needs associated with depression the staff guidance relating to support in this area did not detail the support required. Information about the resident’s social interests, likes and dislikes, spiritual needs and wishes regarding death and dying are all included within the individuals care plan. Individual choices and decisions about how care is to be given were also documented and people who use the service said that staff respect their wishes. A number of inconsistencies were found with the management of health risks; a number of the files contained all relevant risk assessments which had been regularly reviewed however two of the new admissions did not have nutritional risk assessments in place and one file contained numerous risk assessments to support areas such as confusion, cellulitis and difficulties with breathing which needed to be more clearly detailed in the care plans. All files contained up to date moving/ handling risk assessments and falls risk assessments where appropriate; new formats had been used for the moving/ handling and tissue viability risk assessments. Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 13 All plans had been evaluated regularly and it was noted that the standard of the daily recording had improved. Supplementary records to support pressure care and food/ fluid intake were in place for a number of individuals and had been better maintained. Issues were identified at the previous inspection visit around the staff not weighing residents regularly and not consistently recording the weights to ensure any significant weight loss/ gain could be followed up. Records evidenced that residents had been weighed regularly and specific staff had been delegated this role who were using only the imperial measurement for greater consistency. However some issues remain, in recent weeks a records show that a number of the residents have lost significant amounts of weight although the manager confirmed that the residents appear very well and that their appetites remain unchanged but she had referred all the individuals to the dietetic services. One of the individuals concerned had been regularly attending the diabetic clinic where her weight had been identified as stable. Advice was given to ensure the scales are recalibrated. Residents spoken to by the inspector said that when they had appointments for their healthcare needs these were always carried out in private. One individual said that the manager was very good at arranging appointments and made sure that the doctor visited if she had any problems. Relatives commented that they are kept informed of their relative’s wellbeing by the staff; they are regularly consulted (were appropriate) on their care and feel involved in their lives. There was better evidence that the home sought support from the health care professionals such as Community Psychiatric Nurses, dieticians, district nurses and falls co-ordinator when necessary. The inspector spoke to two General Practioners at the home during the visit who confirmed they had a number of patients currently residing at the home, they considered the current management of the home was much improved, the standards of communication were very good and that the residents were well looked after. Records of visits by external professionals were more detailed and well maintained. Medication systems were examined; policies and procedures had been further reviewed since the previous inspection visit. The home has recently changed pharmacy providers and is now using the services of “Riverside Practice”; the home is currently using two monitored dosage medication systems which the staff have received training on however when the pharmacy provider updates its systems in the near future the home will utilise a single administration system. The manager confirmed that she has audited the systems regularly however has only recently started to record her findings, records were in place for the audit carried out on the 28/11/07. There were no individuals selfRathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 14 medicating although systems were in place to support this. Medication records were correctly completed. Records of receipt and returns of medication were in place and up to date. Checks of the controlled drugs and register showed that these were up to date, accurate and well managed; disposal of used controlled medication patches requires review as staff were currently disposing of them in the general waste bins. Medication in the home was appropriately stored except for some creams which need to be stored securely in resident’s rooms or returned to the trolley. Also the home had recently acquired a new medication fridge, which had recorded temperatures over the previous 11 days which exceeded the maximum levels of 5 degrees C; the manager took action to reduce the temperature and confirmed she would ensure staff were aware of the correct temperature range for the medication storage. There was evidence that the manager had been proactive in ensuring individual’s medication had been reviewed by the G.P. and they had been informed if residents regularly refused their medication. Evidence from staff training records and staff discussion indicated that staff who administered medication to service users at the home had received accredited medication training. Resident and relative comments show they are generally very satisfied with the care and support offered by the staff. People who use the service confirmed to the inspector that they were always treated with dignity and respect and the staff used their preferred term of address, knocking on their doors before they entered. This was also observed to happen on the inspector’s tour of the premises. The standards of personal care were observed to be good; individuals appeared well dressed and groomed. Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service were provided with the opportunity to become involved in a range of different activities at the home and in the community. Visitors were made to feel welcome in the home. Although meal provision in the home is generally very good the lack of diabetic diet provision means those individuals’ nutritional needs are not being met. EVIDENCE: Information from the resident and relative surveys and discussions during the visit identified that there has been more satisfaction in recent months with the level of activities provided at the home. Records and a plan of activities held in the home were available. The home employs an activity organiser who works in the home for one and a half days per week, the manager confirmed that her hours will increase in the New Year to two and a half days per week; the activity co-ordinator is clearly a very popular member of staff and all the people who use the service spoken Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 16 with during the visit confirmed how much they enjoyed the activities, entertainment and trips out that she arranged for them. There was more evidence that staff provided support with activities at other times such as crafts, flower arranging, quizzes, word search puzzles, music and films. The home has recently forged closer links with one of the local villages and the residents now attend social functions held in the local village hall, many residents commented on how much they enjoyed the concert they had attended recently and were looking forward to the party after Christmas. A mini bus has now been provided for the residents at the home, they have shared access for its use with the two other homes owned by the provider. Many individuals said how much they enjoyed going out on the trips and how the bus had made this much easier. The home had held a Christmas party for all the people who use the service and relatives the previous week and from discussions with residents and staff it had been a huge success; everyone said how much they had enjoyed themselves, commenting on how nice it was to see the owner and his family involved in the event and how much they had enjoyed the food and dancing. Discussion with the people who use the service indicated that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or staff would take around the village. Lots of visitors were seen coming and going during the day, staff were observed making them welcome and there was clearly a good relationship between all parties. The atmosphere at the home was very calm and welcoming, all residents appeared very settled and comfortable in their surroundings. One relative commented that she found the staff very friendly and helpful, she considered her mother looked well presented and that other members of the family had visited the previous evening to celebrate her mother’s birthday. Other visitors commented on how much they had enjoyed the coffee and mince pies provided by the staff that morning. During the inspection one of the relatives visited with her pet dog, the manager confirmed that the resident really enjoyed these visits. People who use the service were encouraged to maintain their personal preferences and choices at the home. Individual’s bedrooms were personalised and there were a variety of communal spaces for individuals to enjoy. Individuals’ religious needs were identified on admission. Staff reported that people who use the service had the opportunity to access local churches or attend services held in the local community, the manager confirmed that she has contacted a local vicar to try and arrange for services to be held in the home again. Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 17 The home provided a varied menu for the people who use the service and choices were available at all meal times. Individuals had had input into the development of the menus, those spoken to by the inspector all said that the quality of the meals was ‘very good’. The lunch meal was observed during the site visit, this was well presented with good portion sizes and home baking was evident. Aids were provided to encourage service users to maintain independence where possible and staff assisted service users where required in a sensitive and discreet manner. The kitchen was clean and well organised; an Environmental Health Officer had carried out an inspection of the kitchen facilities recently and a number of requirements had been made; the kitchen staff confirmed all works had taken place and the inspector was scheduled to return. Comments from the surveys received from staff, residents and relatives indicate that overall there is a good level of satisfaction with the meals provided by the home. There was good evidence that specific food requests were being provided for individuals, staff told the inspector how much a Polish resident had enjoyed the pickles and cold meats provided by the owner. Discussions with the cook identified that the home was providing fortified diets for a number of residents however the home was not currently providing specific diabetic puddings and baking for the diabetic residents; this was passed on to the manager who confirmed she would address the issue. Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides an environment where people who use the service and relatives feel able to complain. Although the home takes robust action in response to allegations of abuse people who use the service may be at risk of not being protected from harm, as the management did not follow the multi agency safeguarding procedures. EVIDENCE: The home had appropriate policies and procedures for dealing with complaints and for the protection of vulnerable adults. The complaint procedure was made available to individuals in the information provided and was also displayed in the home. A “niggles book” and suggestion box had also been provided in the entrance hall. Information from the pre-inspection questionnaire and checks of the complaints records indicated that the home had not received any formal complaints since the last inspection. The commission had not received any complaints. There was good evidence that the management of the home have consulted more with people who use the service and their relatives to improve service provision; for example regular resident and relative meetings, interviews during formal visits by the owner and more opportunity for one- to Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 19 one discussions with the manager. There was evidence that the management have acted on suggestions made for example work is in progress to have the door bell connected to the nurse call system. One of the relative’s surveys detailed “I would first of all complain to the manager who is very good at sorting out concerns although I have had no serious concerns, if I had I would contact care management.” In the last twelve months three safeguarding referrals have been made to the local authority adult protection team. Following investigations all staff members concerned have been dismissed. The last referral was made in October however the owner of the home informed the local authority and the commission after the home had carried out an investigation and dismissed the staff member, which contravenes the multi agency safeguarding procedures. Although it is clear that the owner takes all issues raised very seriously and deals with them robustly multi agency safeguarding procedures must be followed to ensure appropriate action is taken by relevant agencies such as the police, commission and local authority to ensure a safe outcome. A strategy meeting was held in November with the local authority to review the action taken by the home into the incidents raised and how these were managed by the home. Staff had accessed safeguarding training from the adult protection co-ordinator at the local authority earlier in the year; the manager confirmed that she would arrange further training in the New Year for all newly employed staff. In the surveys returned and from discussions during the visit the staff showed a good knowledge of the procedures. Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Rathside provides individuals with a very safe, comfortable and homely place to live. EVIDENCE: The inspector made a tour of the premises of the home. The home was decorated very festively and many of the residents and relatives commented on how nice the decorations were, small Christmas trees had been provided in all the resident’s bedrooms. The home was exceptionally clean and tidy and free from any offensive smells. It was well decorated and maintained, the furniture and fittings were of very good quality. Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 21 Several bedrooms had recently been decorated and had new carpets and furniture added to them. The hall and downstairs corridor had also been redecorated. Individuals spoken to by the inspector were very happy with the environment provided for them at Rathside, many of their rooms had been decorated and furnished to their own tastes and preferences. The home had a clear maintenance and renewal plan and equipment used at the home had up to date maintenance and service records. There were several lounges in the home that the people who use the service could choose to socialise, or have some private time in. Many of the residents told the inspector how much they enjoyed sitting in the garden room, watching everyone coming and going. The toilets and bathrooms were all close to the communal and bedroom areas for the service users. The owner confirmed that the maintenance programme included replacing the carpet in the ground floor bathroom with linoleum. All of the rooms in the home had a call bell system in them. People who use the service confirmed to the inspector that when the call bell was activated the staff were always quick to respond. The kitchen facilities are now showing some signs of age, a number of the unit doors have been removed as they were broken. Consideration should be given to the provision of new facilities for this area. The gardens of the home were large and well maintained; individuals told the inspector they had a lot of pleasure from walking and sitting in the gardens when the weather was nice. The heating and lighting in the home were domestic in character. Regular random checks were made on the hot water outlets to maintain the health and safety of the service users. Hot water temperatures were maintained close to 43°C. The laundry area was tidy and well organised; the home is utilising new laundry products with good results. Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels were appropriately maintained so that individual’s needs could be met. With further training and appropriate management support improvements have been made to the staff groups over reliance on leadership and guidance however some gaps remain in their competence which places residents at risk of not receiving the care they need. Recruitment checks had not been completed in all cases to ensure staff were safe to work in the home. EVIDENCE: The staffing levels in place at the home were appropriate for the dependency levels of the residents accommodated at the time of the visit. The management had not maintained the use of the Residential Homes Forum staffing guidance which must be used to determine the minimum number of staff that are required for each shift at the home. Levels of four staff on the day shifts and three staff on night duty had been maintained. There was evidence that the home had utilised agency staff when necessary. The manager has implemented a rolling three-week rota which staff said worked very well. The home also employs domestic staff, a laundry assistant, cooks and kitchen assistants. Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 23 Surveys from people who use the service and discussions during the day confirmed that they considered there was always enough staff available to meet their needs. Information provided prior to the visit evidenced that the home has now dipped under the target figure of having 50 of care staff trained at NVQ level 2 and this has been largely due to staff turnover; currently the home has 8 out of 18(44 ). However seven members of staff have now enrolled on the course. The manager has completed a training overview plan for the next twelve months, which identifies mandatory, general and service specific courses. Records showed that the majority of staff were now up to date with practical and theoretical moving/ handling training; the manager was arranging a course for the new staff members. All kitchen staff held current basic food hygiene certificates. Fire safety training had been provided for staff in November with a further course arranged in April 2008.The manager holds a current appointed persons first aid certificate and four staff are scheduled to attend this course in April 2008. Training in safeguarding adults, dementia and diabetes had been arranged for January 2008.In recent months some staff had accessed training in areas such as care planning, nutrition, management of falls, bereavement and catheter care. Concerns had been raised in November following a visit to the home from a care management team from the local authority; discussions with staff during the visit evidenced that they were not confident and competent in identifying signs of hypoglycaemia (low sugar) with the residents who have diabetes. This concern was passed on to the manager who has arranged formal training from the diabetes specialist nurse in January. The staff were all given information to read about caring for people with diabetes, however at interview during this visit, staff still did not appear clear about recognising the signs of hypoglycaemia or appropriate action to take; nor were some staff aware of the nutritional needs of residents with diabetes. This was reported to the manager who confirmed that she would provide further training for the staff in this area. This said records evidenced that those individuals with diabetic needs had accessed regular support from the diabetic clinic/ district nurse and their conditions were very stable. At the last key inspection visit changes to the management structure highlighted the staff groups over reliance on leadership, guidance and support; there was good evidence from this inspection visit that with further training, recruitment of more experienced care staff and the new manager’s approach and support that the staff groups competence has improved in many areas however there is still some way to go. Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 24 The staff have all had meetings with the manager and administrator to complete individual learning plans; this information now needs to be fed into the home’s training plan. There was evidence that new staff had completed induction workbooks to comply with the Common Inductions Standards and an in- house induction programme for the home. Employment records were checked for ten staff members. At the visit from the local authority team in November concerns had been expressed at the number of files (8) which did not contain Criminal Record Bureau checks. At this inspection visit three of the files checked contained the CRB disclosure numbers, at the time the checks were obtained the providers had received guidance that the disclosure documents were to be destroyed to comply with data protection legislation. One member of staff works at all three homes owned by the provider, it was agreed with the provider that copies of the staff member’s recruitment documents would be held in all three homes. The home had recently obtained two further staff member’s checks. All newly employed staff members files demonstrated that the home had ensured a Pova First check was in place prior to the staff member commencing employment. There was evidence that these staff members were identified on the rota and seconded to an experienced member of staff; discussions with newly employed staff evidenced that they were always supervised when delivering care to people who use the service. Records showed that the manager held weekly supervision meetings with newly recruited staff. The registered provider had recently carried out an audit of the recruitment files for all staff working at the home; outstanding photographs for staff were being obtained. One of the staff files checked only contained one reference and there was evidence that the provider had identified this and had taken steps to obtain the outstanding reference. Staff interviewed by the inspector and returned staff questionnaires provided evidence that they were happy working at the home and with the support that they received to carry out their tasks. Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An experienced and qualified manager has been employed in the home. Improvements have been made to the management of the home to ensure that people who use the service have their health welfare and safety needs better protected. The service users were included in the quality monitoring processes and their views were considered and acted upon in the development of the service. EVIDENCE: The new manager, Mrs Golightly has been in post since June, she has considerable experience in caring for older people and has held previous home Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 26 management positions; she is qualified at NVQ level 4 and has completed the Registered Manager’s Award. Although the manager has a clear understanding of the work needed to be done to move the home forward she has experienced a number of difficulties in effectively delegating work to the senior staff due to issues around competence. Following the visit from the local authority in November the manager held a meeting with the owner and secured extra hours for senior staff to assist with auditing and developing the care plan files with some positive results. Discussions with the owner and manager during this inspection visit confirmed that they were looking to recruit further senior staff to support the management of the home. It was very clear from discussions with staff, health care professionals, people who use the service and their relatives that the appointment of the new manager has been very positive. Staff considered the manager to be very approachable, supportive and that she gave clear direction. Comments from people who use the service and relatives included “Things have greatly improved under the new manageress, more outings are now arranged and my mother’s tablets are given on time.” and “We are very pleased with care of our relative in the home, the manager always makes time to talk to us.” One of the visiting G.P.’s told the inspector “The new manager is a huge improvement, the residents are well looked after and the staff seem much happier.” Staff reported that moral was good; the atmosphere in the home during the visit was very calm and pleasant. There was good evidence that the management of the home have consulted more with residents and their families to look at ways of improving the service. Regular residents meetings have been held and suggestions for menu changes and trips out have been actioned. Regular meetings have been held with all staff groups. Since January surveys have been issued to people who use the service and their families on areas such as quality of care, meals, and activities. The results of the surveys have been analysed and action plans developed, there was evidence that the management team work through the action plans. Regular audits take place for housekeeping, the kitchen, the laundry and accidents. The registered provider has produced an annual development plan for the next twelve months. The home holds the Investors in People Award, which had recently been reaccredited. The home does not currently manage any resident’s personal allowances. Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 27 The manager has made progress with implementing the staff supervision programme. She has provided training to the senior carer on night duty who has responsibility for supervising the night staff, all the night staff have now received at least one session. The manager is currently providing training to senior staff on day duty so she can effectively delegate supervisory duties for some of the day staff. The manager has so far completed supervision sessions for two thirds of the day staff. Records evidenced that the supervision sessions with the staff are structured and cover all aspects of practice, philosophy of care in the home and any career or training/development needs of the individual. Examination of maintenance records identified that checks and certificates were in place for installations and equipment. The fire safety equipment, checks and risk assessment were all in place and up to date. Training records show that staff have attended safe working practice up dates. Information examined in the home corresponds to that provided in the pre- inspection questionnaire. The staff complete regular checks of the hot water temperatures to ensure the temperature is maintained close to 43ºC. Accident records were completed and in place; these are audited by the manager to review action taken to reduce reoccurrence. The home had not provided any individuals with bed rails. One of the people who use the service had been provided by the community health team with foam wedges to provide support whilst in bed. The home has provided two individuals with pressure mats, which alert staff that the individual may need support; the manager confirmed that this equipment worked well in reducing the risk of individuals falling during the night. Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 4 3 X 3 X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 2 X 3 Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12(1) and (2)15 Requirement Timescale for action 20/02/08 2. OP8 12(1)a and b 3. OP36 18(2) The registered person must ensure that the care plans for all service users are reviewed and updated identifying all current needs. Previous timescales 01/03/07 , 15/05/07, 01/07/07,15/11/07 not met. It is acknowledged that some progress has been made but this is not consistent. The registered person must 31/01/08 ensure that service user’s weights are accurately and consistently recorded. Previous timescales 15/03/07, 15/05/07, 01/07/07 and 01/11/07 not met. 15/02/08 The registered person must ensure that the staff supervision programme is re- implemented. Supervision records must be completed in ink and be dated and signed by the supervisor and staff member on completion of the session. All care staff to have accessed at least one session by: Previous timescales 20/03/07, 01/05/07,01/07/07 and 15/10/07 not met. DS0000068229.V357334.R01.S.doc Version 5.2 Rathside Rest Home Page 30 4. OP7 15 5. OP9 13(2) 6. OP15 12 (1) a and b 7. OP18 13(6) 8. OP29 19 9. OP31 8 The registered person must ensure there is a care plan in place for all service users accommodated at the home, including those having respite care, to ensure their care needs have been identified and can be met. The registered person must ensure that prescribed creams are stored securely, medication that requires refrigeration is stored at the correct temperature and controlled medication patches are disposed of appropriately so that safe administration, storage and disposal of medication is maintained in the home. The registered person must ensure that systems are in place to identify and meet service users specialist dietary requirements such as diabetic diets which will better ensure individuals nutritional needs are met. The registered person must ensure that the home follows the multi-agency safeguarding procedures following allegations of abuse to ensure the service users are protected from harm. The registered person must ensure that two written references are obtained prior to the employment of staff. This is to ensure that staff are fit to work in the home and to protect the welfare, health and safety of the service users. The outstanding reference must be in place by: The registered person must ensure that the new manager applies for registration with the Commission to ensure her fitness for the role. DS0000068229.V357334.R01.S.doc 31/01/08 31/01/08 25/01/08 18/12/07 31/01/08 20/02/08 Rathside Rest Home Version 5.2 Page 31 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 OP8 Good Practice Recommendations The registered person should ensure that nutritional risk assessments are carried out on all newly admitted service users so that an accurate base line assessment is made and risks to the health and welfare of service users are minimised. The registered person should have the weighing scales recalibrated to ensure they are accurate. The registered person should consider the provision of new kitchen facilities. The registered person should re-implement the Residential Staffing Forum dependency tool to ensure appropriate staffing levels in the home are being maintained. 50 of the care staff should have achieved an NVQ 2 by July 2008. The manager should continue to assess the competence and knowledge base of the staff to ensure they understand the conditions common to elderly persons and are therefore equipped to effectively manage the individual care needs of the service users in the home. 2. 3. 4. 5. 6. OP8 OP19 OP27 OP28 OP30 Rathside Rest Home DS0000068229.V357334.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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