Inspection on 24/04/08 for Ravelston Grange Care Home

This inspection was carried out on 24th April 2008.

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

Ravelston Grange Care Home 25/07/06

Ravelston Grange Care Home 17/10/05

Ravelston Grange Care Home 26/05/05

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

CARE HOMES FOR OLDER PEOPLE Ravelston Grange Care Home 10 Denton Road Eastbourne East Sussex BN20 7SU Lead Inspector Kathy Flynn Unannounced Inspection 10:30 24th April 2008 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 Ravelston Grange Care Home DS0000062737.V363714.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. Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ravelston Grange Care Home Address 10 Denton Road Eastbourne East Sussex BN20 7SU 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) 01323 728528 01323 728528 office@cumberlandcourt.co.uk PJP Care Ltd Manager post vacant Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is twenty-four (24) Service users must be older people aged sixty-five (65) years or over on admission 25th July 2006 Date of last inspection Brief Description of the Service: Ravelston Grange is a Care Home registered for twenty-four older people. It is a three-storey building with a lift to the upper floors. The home is situated in The Meads, an attractive residential area of Eastbourne. The home is close to local shops, and a short drive away from the main town centre, shops, buses and the main railway station in Eastbourne. There is a homely, safe comfortable and friendly atmosphere provided by the home. There are fourteen single and five double bedrooms, which are individually furnished to reflect personal taste and preferences. Double rooms are offered to married couples or those who make a positive choice to share. At the current time these rooms are generally being used as single’s meaning that numbers of those accommodated generally peaks at around 19 persons. [17 people at the time of inspection] PJP CARE LTD [Mr P and Mrs. J Piercy] owns the home as part of a group of two homes for older people, the other home being in St Leonards-on-Sea. Information on the range of fees charged is within the homes current statement of purpose/service user guide and ranges from £359 to £443 per week. The higher rate of fee is based on room size and facilities. Charges for extras include personal items beyond the basic toiletries and activities provided by the home. Such items include newspapers, perfumes, chiropody, and hairdressing. Inspection reports are not routinely sent out to families and advocates after each publication although a copy is kept on display in the reception area of the home and can be obtained via the manager. A service user guide containing the most recent inspection report is sent to any interested person [or their representatives] looking to move into the home. Ravelston Grange Care Home DS0000062737.V363714.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 the people who use this service experience adequate quality outcomes. This unannounced inspection was carried out on the 24th April and took place over seven and half hours. The inspection included a tour of the home, a review of pre-admission assessments, care plans, staff records and training, medication records, activities, and menus. There were 18 residents at the home during the inspection. 17 of the residents were spoken with and two visitors to the home were happy to discuss the support provided. The manager, deputy manager, and the staff on duty discussed the care and support they provide at the home. The Annual Quality Assurance Assessment (AQAA) was completed by the manager, within the required timescale, and identified areas where improvements are planned for the benefit of residents. The reader should aware that the Care Standards Act 2000 and the Care Homes Regulations 2001 use the term ‘service user’ to describe those living in care home settings. However for the purposes of this report those living at Ravelston Grange will be referred to as ‘residents’. What the service does well: Ravelston Grange offers residents a homely place to live, the environment is clean and residents are able to personalise their rooms with their own possessions if they wish. Communication between residents, relatives and staff was relaxed and friendly, and residents appeared comfortable during the inspection. Residents spoken with said the staff ‘are very good’ and they provide the help they need. Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A pre-admission assessment is completed for all but emergency admissions to the home, prior to the offer of a place. EVIDENCE: The service users guide has been reviewed and updated to reflect the change of manager at the Ravelston Grange. An examination of care plans showed that pre-admission assessments had been completed for two of the three viewed. One resident had been admitted from hospital as an emergency through social services, for respite care and the manager advised that an assessment had been completed on the day of admission, to enable them to offer appropriate support. Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 9 The manager confirmed that he is aware of the importance of ensuring that sufficient information is available regarding prospective residents, to ensure that the home can meet their needs. Emergency admissions are only taken in exceptional situations, and only if sufficient information about their social and medical needs is provided. Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 10 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. The care planning system does not provide staff with enough information for them to meet the residents needs, which may put residents at risk. Medication training is provided for staff to protect residents, however the homes practice regarding some medicines is unsafe and may put residents at risk. EVIDENCE: Five care plans were examined and were found to provide staff with very limited information regarding the needs of residents. Two of the care plans consisted of basic information on admission, with no evidence of ongoing assessment of their individual needs, staff therefore were unable to show that they could provide the support required. The other care plans viewed did not contain appropriate risk assessments, residents weights were not recorded, and the care plans were not reviewed Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 11 and updated when the residents needs changed. Some residents have a history of falls and continue to be at risk. Falls have been recorded in the accident book, but there was no evidence that this information was used to review the plan of care and produce an action plan to prevent falls. One resident had been in hospital in January 2008, there was no information regarding her needs on returning to the home, the care plan had not been updated and information about her post-operative care had not been developed for staff to follow. Staff have recorded in the care plans that they have been reviewed, with the comment of ‘no change’. If there is insufficient information for staff to plan the residents individual care and support needs, then a review is ineffective and inappropriate. Records are kept of visits from GP’s and District Nurses, and staff advised that residents can see other health professionals if they need to. However this is difficult to assess because there is very little information about residents needs. Discussions with the manager and deputy concerning the care plans identified that the deputy is responsible for ensuring they are up to date, but there has been no additional time allocated for her to do this. The manager advised that he will be reviewing the care planning system urgently and is hoping to introduce a system of staff training, which will enable other members of the staff team to take responsibility for some care plans. A requirement has been made with regard to care plans. Medication training is arranged for staff, the deputy advised that updates are provided as required and the training pharmacist audits the homes medications regularly. Staff spoken with said they had attended the training and felt able to administer the medicines, and the District Nurse (DN) visits the home daily to administer insulin for those residents who are insulin dependent. Medicine Administration Records Charts (MAR) were examined and found to be appropriate for all but one of the charts. The information kept of the controlled drug for a resident was insufficient, there was no record of when medicines were received and no indication of how many tablets were in the medicine trolley. Changes in care homes responsibility regarding the safe storage and recording of controlled drugs was discussed with the manager and deputy. They had no previous knowledge of these, and the manager advised that he will be dealing with this immediately. A requirement has been made with regard to medication. Communication between residents, staff and visitor was relaxed and friendly, and staff were noted to treat residents with respect when offering support and encouragement. Residents spoke very positively about the home and the staff saying they are ‘very good’ and ‘the home is comfortable’. Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 12 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. Activities are available for residents to join if they wish. The food is good, offering choices and meeting residents specific dietary needs. EVIDENCE: The manager advised that a programme of activities has been developed for residents to participate if they wish. On the day of the inspection there were no activities and the staff explained that the residents chose to sit and read or watch TV. Residents are encouraged to live an independent life in the home, making choices about all aspects of their day-to-day lives. Residents spoken with said they could choose how they spend their time, and they were sitting in the lounge or their own rooms depending on what they wanted to do. One said she preferred to stay in her room and watch TV, while most like to sit in the lounge and talk to other residents. Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 13 There is open visiting at the home and links with the local community have been developed, with special events organised during the year for relatives and friends to attend. The manager advised that they would be organising a fete when they weather improves, which will take place in the rear garden. There is a four week menu, which has been developed with the involvement of residents, offering choices for each meal. The cook and staff said they can have what they want, it is their home, and residents said there is always a choice and they can change their minds if they decide to have something else. The food looked appealing, staff were able to demonstrate an understanding of the residents preferences and choices were available for lunch and supper. Appropriate meals are available for individual who have specific dietary needs. Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes complaints policy provides residents and visitors with details of who they can raise any concerns with. Staff have attended training in the protection of vulnerable adults, and the manager is arranging further training to update staff. EVIDENCE: The manager advised that residents and visitors are encouraged to discuss any concerns they have about the services provided by the home, and details of the complaints policy is included in the Service Users Guide. The manager confirmed that there have been no complaints since the last inspection. Staff spoken with have attended training for the protection of vulnerable adults and were able to demonstrate an understanding of abuse, and what action they would take if they had any concerns. The manager is arranging further training for staff to ensure they are up to date with current practice. Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 15 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Ravelston Grange offers residents a comfortable and homely environment. The homes policies for infection control and the training provided for staff protects residents. EVIDENCE: The home is a large detached building that has been extended and converted, keeping some of its original features, and is situated in a residential area of the Meads. All rooms are used as single rooms and some have ensuite facilities. Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 16 There is a large lounge on the ground floor that looks out onto an attractive garden to the rear. The dining room is attached to the lounge and offers residents individual and group seating areas for meals. A shaft lift enables residents to safely access all parts of the home, and residents are supported to use walking aids to enable them to be independent. Wheelchairs are available for staff to use to assist residents if required. Infection control policies are in place and staff follow them when using gloves and aprons. The use of gloves at meal times was discussed with the manager, in particular staff using the same gloves when giving out meals and assisting residents to the dining area. He advised that staff would be reminded of the policy. Training in the control of infection has been provided for staff, although this may have been up to two years ago. An update is required and the manager is arranging this. Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 17 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. Staff training is not up to date which may affect the staff members ability to meet the individual needs of residents. EVIDENCE: The manager and deputy advised that there are sufficient staff working at the home to meet the residents needs. However lack of time was the main reason given for the failure of the home to make sure care plans are being completed and up to date, which is linked to staffing levels. A requirement has been recorded regarding staffing levels. All new staff are required to complete induction training in line with Skills for Care, however there have been no new members of staff for some time. The home meets the minimum requirement of 50 staff with NVQ level 2 or its equivalent. The manager confirmed that there are opportunities for staff to do this training. Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 18 Robust recruitment procedures are used with two references and POVA checks prior to employees starting work at the home. CRB checks may be completed when the staff are working through their induction training, and the manager confirmed that staff do not work with residents without supervision until all the checks have been completed. Training provision at the home was discussed in detail, the manager advised that he is developing a training programme to ensure all staff are up to date with all the mandatory training. Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management processes encourage residents and staff to be involved in development of the services at the home. Staff training is not up to date, which may put residents health and safety at risk. EVIDENCE: The manager of Ravelston Grange has been in place since November 2007, he has experience of providing care and support for older people, and is applying to register with the Commission. Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 20 He is aware of the improvements that are needed to ensure the home meets the National Minimum Standard for Older People, and confirmed that he will be working with the provider and the staff to make the improvements. A quality assurance and monitoring system is in place, however the system used should be reviewed so that it can identify the concerns raised during the inspection including care plans, staff training, staff supervision and medicines. A requirement has been made regarding this. Staff spoken with said that supervision has not been provided for some months, the manager is aware of this and is planning to develop a programme for all staff at the home. The manager confirmed that the home does not take responsibility for residents finances. Some residents cash is kept in the office, records are kept of payments and withdrawals. Signatures of residents and staff who complete the records would make the system clearer. Staff training in manual handling and infection control is not up to date, which may put the health and safety of resident at risk. The manager confirmed he is addressing the training issues. Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 22 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 15 (1)(2) Requirement Timescale for action 07/07/08 2. OP9 13 (2) 3. OP27 18 (1)(a) 4. OP33 24 (1) That the Registered Person must ensure that Care-Plan’s set out in detail the specific action to be taken by care-staff to meet all needs, as well as promote independence and strengths. That all needs are recorded such as preferred routines. That monthly review of plans indicates actual changes. That the plan shows involvement by the individual resident concerned. Appropriate systems are to be 26/05/08 developed and introduced, in line with current guidance, regarding the receipt, storage and administration of medication, to protect residents. Staffing levels to be reviewed 26/05/08 and appropriate changes made to ensure staff are able to carry out their responsibilities and protect residents. The quality assurance and 07/07/08 monitoring system to be reviewed to ensure that it identifies areas for improvement and enables appropriate support DS0000062737.V363714.R01.S.doc Version 5.2 Ravelston Grange Care Home Page 23 and protection for residents to be provided. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ravelston Grange Care Home DS0000062737.V363714.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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