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Inspection on 21/04/06 for Ravenscourt Nursing Home

Also see our care home review for Ravenscourt Nursing Home for more information

This inspection was carried out on 21st April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Health care needs are well met with pressure care and wound care as well as diabetic care appropriately documented. Referrals to other health professionals such as the dietician, hearing aid clinic, optician, dentist, tissue viability nurse (care of skin/pressure areas) and chiropodist was observed to be documented in service users records. There is an activities co-ordinator who is employed to provide one to one activities and group activities. Health and safety documentation was found to be easily accessible and in order with the appropriate tests undertaken as necessary.

What has improved since the last inspection?

Since the last inspection a member of staff has been added to the evening/night shift and also the early morning shift. This gives the night staff more support at times when service users want to go to bed and before the morning shift commence duties, when some service users want to get up. This is seen as good practice with the home striving to meet the needs of service users.There have been no complaints for some time. This evidences that communication within the home has improved reducing the need for relatives or service users to make complaints. The completion of nursing documentation has improved. This enables anyone reading the documentation to see the care the home has provided. The home also held a staff meeting to discuss the completion of some nursing records on the 12/4/06. Each member of staff now has a record of the training they have undertaken held in their file. Supervision sessions are taking place as well as annual appraisals. The entrance hall has had the floor levelled and new carpeting fitted making the hallway very welcoming. The home was clean and free from odours. A random selection of bedrooms were inspected. These were found to be clean. At the last inspection there was concern about the bedding in the home, at this inspection the bedding was found to be clean and fresh with beds well made. Linen and clothing at the last inspection was observed to be stained and not laundered appropriately. This has been addressed by the home and a new destainer has been provided. The environmental health officer visited the home to inspect the main kitchen and work practices these were found to be appropriate and no requirements were made from their visit. Infection control and storage of clinical waste awaiting collection has improved throughout the home.

What the care home could do better:

There have been good improvements in the completion of nursing documentation, with a monitoring system now in place. At this inspection a random selection of care plans inspected found that only one service user`s file had not been updated in certain areas. The manager will be raise this with the nurse responsible for the service users file. Although all staff now have a record of the training they have completed, there is no training and development plan for each staff member. This was a requirement at the last inspection and will therefore be re-stated in this inspection with a reduced timescale given for compliance. Although the inspector was able to see from documents that 5 supervision sessions had taken place, the rest of the records were said to be in the care ofa senior nurse, these were locked away and the manager did not have access to these. It is recommended that a supervision chart is drawn up for a `rolling` year for all staff. Both the supervisor and the supervisee should sign and date this chart to show when a formal supervision session has taken place. When inspecting staff employment files it was observed that some induction programmes were not held in the files. One file for a nurse did not have a copy of the updated `PIN` number expiry date. The home must ensure that this staff members `PIN` number is current enabling her to practice as a nurse. The staff files were untidy with loose papers slotted into them. The staff files require attention to ensure that all documentation held is appropriate and retrievable.

CARE HOMES FOR OLDER PEOPLE Ravenscourt Nursing Home 111-113 Station Lane Hornchurch Essex RM12 6HT Lead Inspector Ms Rhona Crosse Unannounced Inspection 21st April 2006 09:30 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 Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 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. Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ravenscourt Nursing Home Address 111-113 Station Lane Hornchurch Essex RM12 6HT 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) 01708 454 715 01708 458 469 Lukka Care Homes Ltd Jean-Claude Seevathean Care Home 70 Category(ies) of Dementia - over 65 years of age (36), Old age, registration, with number not falling within any other category (34) of places Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th September 2005 Brief Description of the Service: Ravenscourt is a purpose built care home. The building has been improved and extended by the current owners of the home, Lukka Care Homes Ltd. The home accommodates 70 older people requiring nursing care. All accommodation is in single bedrooms, the majority have a lavatory and wash hand basin of their own. Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced therefore the home did not know the inspector was coming. As part of the inspection process specific service users’ nursing records and associated documentation were tracked to check that their care needs were being met. Service users and visiting relatives were spoken with to find out how they view the service the home provides. All stated they were happy with the care and the service the home provided. The fees for the service range from £520.00 - £575.00 per week. The manager was at the home at the time of inspection. Currently there is no deputy manager, the home is recruiting for this post. Since the last inspection the home has progressed well in achieving all but one of the requirements set at the last inspection (there were 23 made). The standard of care and documentation has greatly improved as well as the communication within the home. What the service does well: What has improved since the last inspection? Since the last inspection a member of staff has been added to the evening/night shift and also the early morning shift. This gives the night staff more support at times when service users want to go to bed and before the morning shift commence duties, when some service users want to get up. This is seen as good practice with the home striving to meet the needs of service users. Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 6 There have been no complaints for some time. This evidences that communication within the home has improved reducing the need for relatives or service users to make complaints. The completion of nursing documentation has improved. This enables anyone reading the documentation to see the care the home has provided. The home also held a staff meeting to discuss the completion of some nursing records on the 12/4/06. Each member of staff now has a record of the training they have undertaken held in their file. Supervision sessions are taking place as well as annual appraisals. The entrance hall has had the floor levelled and new carpeting fitted making the hallway very welcoming. The home was clean and free from odours. A random selection of bedrooms were inspected. These were found to be clean. At the last inspection there was concern about the bedding in the home, at this inspection the bedding was found to be clean and fresh with beds well made. Linen and clothing at the last inspection was observed to be stained and not laundered appropriately. This has been addressed by the home and a new destainer has been provided. The environmental health officer visited the home to inspect the main kitchen and work practices these were found to be appropriate and no requirements were made from their visit. Infection control and storage of clinical waste awaiting collection has improved throughout the home. What they could do better: There have been good improvements in the completion of nursing documentation, with a monitoring system now in place. At this inspection a random selection of care plans inspected found that only one service user’s file had not been updated in certain areas. The manager will be raise this with the nurse responsible for the service users file. Although all staff now have a record of the training they have completed, there is no training and development plan for each staff member. This was a requirement at the last inspection and will therefore be re-stated in this inspection with a reduced timescale given for compliance. Although the inspector was able to see from documents that 5 supervision sessions had taken place, the rest of the records were said to be in the care of Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 7 a senior nurse, these were locked away and the manager did not have access to these. It is recommended that a supervision chart is drawn up for a ‘rolling’ year for all staff. Both the supervisor and the supervisee should sign and date this chart to show when a formal supervision session has taken place. When inspecting staff employment files it was observed that some induction programmes were not held in the files. One file for a nurse did not have a copy of the updated ‘PIN’ number expiry date. The home must ensure that this staff members ‘PIN’ number is current enabling her to practice as a nurse. The staff files were untidy with loose papers slotted into them. The staff files require attention to ensure that all documentation held is appropriate and retrievable. 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. Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 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 Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 The home does not provide the service standard 6 applies The quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. These standards were met with information to support the admission process of each service user ensuring that the home can meet their individual needs prior to admission. EVIDENCE: The home has a Statement of Purpose and a Service Users Guide which have been updated this year. Service users files inspected at random showed that for service users placed by social services, a social services contract was held on file. For service users placed privately, a contract and terms and conditions provided by the Lukka Care Homes Ltd was held on file. Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 10 All the files held a pre admission assessments as well as a social services assessment as necessary. No service users are admitted to the home without an appropriate assessment carried out prior to admission by the home. Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome areas of Standards 7 and 9 is ‘adequate’ the outcome areas have some strengths but there are other areas of particular weakness that require improvement. Greater care is required to standard 7 (care plans) and standard 9 (medication records) to ensure that they are updated and correct at all times so that the ongoing care of all service users is appropriate. The quality in the outcome area is good for standards 8 and 10. This judgement has been made using the available evidence including a visit to this service. Standard 8 was well documented showing that health care needs are being met this ensures the welfare of service users is met. Standard 10 shows service users are treated with dignity and respect. EVIDENCE: Care plans inspected at random showed an improvement in the updating of care plans in general. Only one service user’s file had not been updated in some areas. The pain control had been increased in January 2006 but the care plan did not reflect this although these changes were documented in the daily Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 12 records and the medication administration records so staff were aware of the change in the service uses needs. A visit and subsequent report made by the pharmacist on the 7/10/05 who provides the medication for the home showed no errors of recording, administration or storage at that time. An inspection of the medication administration records and the medication held by the home at this inspection showed that for two service users medication was not signed as being administered. The medication was for Paracetamol on the 18/4/06 at 22.00 hours and Lactulose on the 19/4/06 at 22.00 hours. For two different types of medication received into the home on the 5/4/06 the quantity of medication received was not recorded on the medication administration record. Other medication received at the same time had been recorded appropriately. All controlled drugs held were correct, corresponding with the documentation held. Health care needs were well documented with weight loss referred to the dietician, changes in blood sugar levels referred to the specialist diabetic nurse for advice and pressure care and wounds referred to the tissue viability nurse as necessary. GP referrals, diagnosis and advice was also well documented. Staff were observed to take service users privacy and dignity into consideration when dealing with any personal care at the time of the inspection. In discussion with relatives they also confirmed this. One relative stated “Mum is in bed and quite frail, when they are to deal with mum for any personal care and we are visiting they always ask us politely if we would mind leaving the room until they have attended to her, mum is so well cared for here, they are hoping to be able to get her to sit up again soon”. Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15 The quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Service users are able to make a choice in daily living as far as their abilities allow, this enhances their well being and fulfilment. EVIDENCE: Activities take place on a daily basis and the activities co-ordinator undertakes one to one activities as well as group activities. At the time of the unannounced inspection a birthday party with entertainment was to take place that afternoon. The inspector joined the celebrations for a short time. Service users appeared to enjoy the singing and joined in and got up and danced with staff. Not all service users wanted to join in with the entertainment and one service user retired to his bedroom. Activities are discussed as part of the admission process and the programme of activities is displayed on the notice board. Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 14 There is a 4 week menu with a variety of meals identified. Alternatives are always provided and service users are asked for their choice of meals, a record is kept of these choices. On the day of inspection the main meal of the day was fried fish, chips and peas or steamed fish with mashed potatoes and peas. One service user had requested to have turkey and this was provided. In discussion with the cook she stated that at the weekend several service users had requested to have salads again and these were provided. The home caters for 11 diabetic diets and several pureed diets. There are no other specialist diets catered for due to cultural or medical needs. Dietary needs are discussed as part of the admission process. Staff were observed to be seated whilst assisting service users to eat at lunch time. A service user stated ‘I like the food here there is nothing I do not like, if you want something different they do it for you’. There are no set visiting times and relatives and friends are free to visit at any time. There is a quiet/visitors lounge upstairs and relatives or visitors can use this lounge if they do not choose to use the service users bedroom. Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 The quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Due to improved communication the service users needs are being met, therefore the amount of complaints received has fallen. Staff training in adult protection is provided ensuring procedures are in place for the wellbeing and safety of service users. EVIDENCE: There has been one complaint since the last inspection this was investigated by Havering Social Services as they are the local authority funding the service user. A review of care was undertaken and the problem has since been resolved. The home has a policy and procedure for dealing with complaints and this information is identified in the Statement of Purpose and the Service Users Guide. The home also make reference to the Commission for Social Care Inspection and identifies the contact number and address. In discussion with relatives visiting at the time of the inspection they stated: ‘I have no complaints my mother is being well looked after, she had a terrible time in hospital and caught infection after infection. Here they take good care Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 16 of her helping her to eat and drink, she looks clean and is as comfortable as they can make her here in bed’. ‘They are kind and gentle when they care for mum and the staff are always willing to help, you could not ask for more I have no complaints’. ‘It’s early days mum has just been admitted recently but I hope things will continue as they are, I have no concerns’. ‘This home was recommended to us, mum used to live locally and her GP recommended it you can’t get a better reference than that can you, I have no complaints’. One relative spoken to as part of the inspection process was unhappy about the care his wife was having and questioned whether her meals were provided appropriately and whether she was supported at meal times. Also that a referral had been made to the hearing aid clinic but no information had been provided to him since then. The inspector stated that a check would be made of the documentation for his wife. The care plan recorded that the service users meals are always to be cut up for her and that she may need assistance from time to time. Recently she has been refusing food and the assistance at meal times has increased. This was confirmed in discussions with staff. The referral had been made to the hearing aid clinic this was confirmed in documentation written on the GP visits report sheet (this had been written by the service user’s GP). Before the relative left the home this information was passed back to him by the inspector, showing that the home was taking the appropriate action. The home has policies and procedures for the protection of vulnerable adults including a whistle blowing policy. These policies and procedures are available for staff to refer to at any time. Staff training in adult protection has taken place and staff are aware of their role and responsibilities to report any poor practice and allegations of abuse. Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 The quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Ongoing refurbishment ensures that service users surroundings are kept to an acceptable level enhancing their living standards. EVIDENCE: The home has a programme of ongoing refurbishment. Since the last inspection a bathroom and several bedrooms have been decorated. A service user has asked that the colour of the walls be changed in her bedroom, the home is now going to redecorate this room. Lighting in the hallways has been upgraded throughout the home. Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 18 The lounges are the next main areas that are to be decorated. The woodwork along corridors and in some bedrooms particularly skirting boards need painting. Since the last inspection the main entrance hallway has had a new carpet fitted to it and is now homely and welcoming. All the hallways have had new light fittings provided. A bathroom has been decorated and several bedrooms have also been decorated. One service user has requested a change in colour for her bedroom this is to be decorated again. Bedrooms are very individual and some are filled with personal possession and small pieces of furniture making them very homely. Service users were observed to spend time in their bedrooms as they wished with no restrictions placed on access. One service user had gone to his room to rest in the afternoon as he did not want to join in the entertainment that was going on in the lounge. Service users who require specialist equipment have had this provided. Aids and adaptations are provided in W.C.’s and bathrooms. Specialist mattresses and chair cushions to relieve pressure are provided. Hoist to aid the lifting of frail service users are provided. 10 new ‘profiling’ beds have been purchased and are in use since the last inspection. Further beds are to be purchased. There are sufficient bathrooms and shower facilities for service users. These were found to be clean and free from odours. All en-suites were clean. Liquid soap and paper towels were available in all areas. The home was clean and free from odours. A carpet was shampooed at the time of the inspection due to staining in one of the service users bedrooms. Clinical waste was appropriately stored awaiting collection. There were several items of furniture awaiting disposal or repair including some walking frames and wheelchairs. Some of these items were in the courtyard garden that is not used by service users, others were in a corridor not used by service users leading to staff rooms. However these items should be removed and disposed of or returned or stored more appropriately. Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Staff training needs to be monitored more closely to ensure that staff improve their skills to enable them to provide appropriate care. The home must ensure that nursing staff ‘PIN’ numbers are current, protecting the service users in their care. EVIDENCE: Staffing levels are appropriate for the size of the home. Since the last inspection there has been an increase in staffing prior to service users going to bed and also in the morning before the day shift comes on duty. This is to aid the night staff get service users to bed (20.00 hours to midnight) and assist in the busy time in the morning (06.30 to 07.30) before the morning shift come on duty when several service users wish to get up. Since the last inspection each member of staff has a list of training they have achieved. It was a requirement at the last inspection that all staff have a training and development plan drawn up, this has not been achieved and will therefore be re stated as a requirement with a shorter timescale for compliance given. Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 20 Staff files inspected at random showed that these files need to be sectioned appropriately to be able to find the information easily and ensure that all information required by legislation is held. The staff files need to be reviewed. Staff files inspected at random showed that all inspected had an application form and 2 written references were received, CRB disclosure forms had been received for staff. Terms and conditions were also held on file. The ‘PIN’ number for one member of staff ran out in February 2006. No further information was held on file to state the ‘PIN’ number had been extended. As nursing staff have to have an up to date ‘PIN’ number to enable them to carryout any nursing tasks, the home must urgently check that the ‘PIN’ number of this member of staff is current. The home must fax this information to the Commission. It is recommended that each nurses ‘PIN’ number expiry date forms part of the information on the staff members training profile to ensure that these are kept updated as necessary. Staff files held the training certificates achieved. It was stated by the manager that approximately 80 of the staff have either achieved or are currently undertaking NVQ level 2 training. Other courses undertaken and observed in staff files showed that MRSA, scabies, adult protection, abuse awareness, wound classification, medication administration, gastroscopy care, skin care, dealing with dementia, fire training, palliative care, care planning and manual handling and health and safety had been achieved. Recently completed training has been: poor nutrition and the importance of protein in the diet carried out on the 13/3/06 (10 staff attended). Manual handling updates took place on the 14/3/06 (9 staff attended). Manual handling took place again on the 5/4/06 and (15 staff attended). The acting deputy commenced the registered manager award in November 2005. Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 The quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The majority of these standards are mostly met this evidences that the home is operating for the benefit of service users. EVIDENCE: The home is managed by a suitably qualified manager. The manager has recently completed the Registered Managers Award and undertakes training to ensure skills are kept up to date. Since the deputy manager left the home the manager has been more involved in the running of the home and this has shown benefits to service users. Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 22 Record keeping has improved the home can therefore quantify the nursing needs and care needs provided to service users. A quality assurance questionnaire was sent to service users and relatives. A low response was returned. The information returned showed that in general the home was considered by relatives to be operating to a good standard. The quality assurance questionnaire should also be sent to visiting health professional to get their views on the operation of the home. Questions raised during this questionnaire have been dealt with such as the evening tea menu being more varied. In discussion with a relative they stated ‘we are pleased with the changes to the tea menu there is more selection now, a milk pudding is provided at tea time and this makes a difference’. The home must look at it’s quality assurance systems and improve these as the quality assurance systems and the information gained from this will form part of the new inspection process. Regulation 26 visit reports carried out to check the operation of the home is satisfactory and these are sent to the Commission. Service users money held in safe keeping and spent on their behalf was inspected. All records are computer generated with an ongoing balance. The record is printed off and held on file. Service users and relatives are able to have a copy if they choose. Receipts are kept for all expenditures made and the money is held in individual wallets. The money held and the receipts kept for any expenditure were correct. The home has access to £1,000 petty cash therefore any service user who’s funds have run low is still able to have hairdressing, chiropody or any other purchase made on their behalf until their personal allowance is topped up by their relatives. This is seen as good practice. Service uses have the same rights as anyone living in the community the Statement of Purpose makes reference to service users being able to exercise their rights in full whilst living in the home. Staff are given formal written supervision sessions. The inspector observed that 5 staff have had recent supervision. The manager did not have access to other supervision records as these were locked away as they are in the care of one of the nurses who was not on duty. It is recommended that the manager create a supervision chart for a rolling year and the supervisor and supervisee both sign and date the chart when supervision has taken place. By doing this the manager will be able to see at a glance who still requires supervision (6 supervision sessions must be undertaken in any one rolling year). Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 23 Copies of performance reviews were observed to be being undertaken and were held on staff files. Health and safety information was easily retrievable. Fire drills are taking place as required, the last one took place on the 18/4/06 and 18 staff were present. The annual service of fire extinguishers is due this month. The fire alarm system was serviced and the emergency lighting system tested on the 5/1/06. The Gas safety certificate was dated the 16/3/06. Mobile hoists and bath hoists were serviced on the 21/11/05 and are due again on the 20/5/06. The 5 year electrical safety certificate is dated 2/3/04 and is current until 2009. The maintenance of the passenger lift took place on the 29/3/06. The homes insurance certificate is current and the renewal date is June 2006. The kitchen was inspected. The food stores had been decorated since the last inspection and new food containers had also been provided for dry foods. There was sufficient food stock for the service users accommodated. Fresh vegetables and fruit are provided. The fridge and freezer temperatures are taken daily and a record is kept of these. Food in the freezers and fridges were dated and labelled. New fly screens have been provided and were in place. The kitchen was clean and tidy. The environmental heath officer visited on the 7/4/06 to inspect the kitchen there were no requirements made from this visit. Service users records tracked as part of the inspection process showed that only one of these service users had had an accident. The information was well documented and corresponded with the daily records. Other accidents reviewed as part of the inspection process showed that despite the size of the home there were a lower number of accidents than anticipated. There are monitoring process for accidents and a monthly log is kept of these. Induction programmes could not be found for 3 of the 5 staff files inspected. The home must ensure that all staff receive a written induction programme and that they sign and date this to evidence this has been achieved and a copy is held on file. Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 3 2 Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 25 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. 2 Standard OP7 OP9 Regulation 15(1) & (2) 13(2) Requirement Care plans must be updated as changes occur. All medication should be appropriately recorded, after administration and any medication received by the home must have the quantity received recorded to enable a clear audit trail. Remove old furniture, walking frames and wheelchairs from around the building and from the court yard garden. Either dispose of, return or repair these items or store more appropriately. Decorate the woodwork in the hallways and the skirting boards service users bedrooms. Ensure that all nurses ‘PIN’ numbers are current. Provide a copy of the up to date ‘PIN’ number for the nurse identified All staff must have a written training plan to identify their new training needs. This is an unmet requirement from the last inspection. Timescale for action 30/06/06 30/04/06 3 OP19 23(2)(l) & (n) 30/05/06 4 5 OP19 OP29 23(2)(b) 18(1)(a) 30/07/06 30/05/06 6 OP30 18(1)(c) (i) 30/08/06 Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 26 7 8 OP33 OP38 24(1) (a) & (b) 18(1)(a) Review and improve the quality assurance system for the home. Ensure that all staff complete and induction programme when they commence duties. 30/08/06 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP29 OP37 Good Practice Recommendations Draw up a supervision chart identifying when supervision sessions have taken place. Both the supervisor and the supervisee should sign and date this chart. Review the way staff files for recruitment and selection are kept. Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ravenscourt Nursing Home DS0000015600.V290387.R01.S.doc Version 5.1 Page 28 - 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. 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