Inspection on 26/04/07 for Ravenscourt Nursing Home

This inspection was carried out on 26th April 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ravenscourt Nursing Home 29/07/08

Ravenscourt Nursing Home 21/04/06

Ravenscourt Nursing Home 16/09/05

Ravenscourt Nursing Home 25/05/05

Ravenscourt Nursing Home 19/01/05

Ravenscourt Nursing Home 09/09/04

Ravenscourt Nursing Home 21/01/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Ravenscourt Nursing Home 111-113 Station Lane Hornchurch Essex RM12 6HT Lead Inspector Ms Gwen Lording Key Unannounced Inspection 26th April 2007 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 DS0000015600.V337175.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. DS0000015600.V337175.R01.S.doc Version 5.2 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 DS0000015600.V337175.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st April 2006 Brief Description of the Service: Ravenscourt Nursing Home is a purpose built care home registered to provide nursing care for up to 70 people over the age of 65 years, of whom 36 have dementia type illnesses. The home is owned and operated by Lukka Care Homes Ltd. All accommodation is in single bedrooms and the majority have en suite facilities. There is a passenger lift to all floors. The home is situated in a residential area of Hornchurch in the London Borough of Havering and is close to shops and public transport – buses and underground. On the day of the inspection the range of fees for the home was between £520.00 and £575.00 per week. A copy of the Statement of Purpose and Service User Guide to the home is made available to both residents and their families. Copies of the most recent inspection report are available on request. DS0000015600.V337175.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken by the lead inspector, Gwen Lording. It started at 9.30am and took place over seven hours. The registered manager was on leave, however, the deputy manager was available throughout the visit to aid the inspection process. This was a key inspection in the inspection programme for 2007/ 2008. Discussion took place with the deputy manager, several members of nursing and care staff; activity co-ordinator; kitchen and laundry staff; maintenance staff and the home’s administrator. Nursing and care staff were asked about the care residents receive, and were also observed carrying out their duties. The inspector spoke to a number of residents and relatives. Where possible residents were asked to give their views on the service and their experience of living in the home. A tour of the premises, including the laundry and main kitchen, was undertaken and all areas were clean and tidy with no offensive odours. A random sample of residents’ files were case tracked, together with the examination of other staff and home records. This included medication administration, staff rotas, training schedules, activity programmes, maintenance records, menus, complaints, fire safety, accident/ incident records and staff recruitment procedures and files. Information was also taken from a pre-inspection questionnaire, which was completed and returned by the manager. As part of the inspection the views of several community health care professionals who provide a service to the home, were sought and are commented on in this report. The inspector had a discussion with the deputy manager and people living in the home about how they wished to be referred to during the inspection and in the report. They expressed a preference to be referred to as resident. This is reflected accordingly in the report. The inspector would like to thank the residents and staff for their input during the inspection. What the service does well: As part of the inspection contact by phone was made with community health care professionals who visit the home, this included tissue viability nursing service and speech and language therapy team. They commented positively on their involvement with the home; expressed no concerns about the care being DS0000015600.V337175.R01.S.doc Version 5.2 Page 6 provided; and that any advice given was well received and actioned accordingly. The manager and staff make every effort to sort out problems or concerns and makes sure that residents and their relatives feel confident that their concerns and complaints are listened to and acted upon. Visiting times are flexible and people are made to feel welcome in the home so that residents are able to maintain contact with their family and friends. What has improved since the last inspection? What they could do better: The home’s Statement of Purpose says that the home will respond appropriately to residents spiritual values and respect their religious, ethnic and cultural diversity. One of the stated aims of the home is to also provide care in a flexible manner, which respects the right of residents to make informed choices and retain maximum flexibility in the routines of the daily life of the home. To achieve this care plans need more development around identifying and reflecting individuals cultural, religious and social care needs. The care plan should aim to enable the resident to be able to take as full as part as possible in their daily living routines and so allow them as much independence as possible. Consideration must be given to the environment on the dementia unit to best utilise the layout and design to meet the specialist needs of people living with dementia. For example, through the use of décor, visual clues such as colour, signage and the use of familiar things from a person’s previous setting, such as photographs. All staff working in the home and in particular on the dementia unit must undertake comprehensive training in caring for people living with dementia, so as to equip them with the relevant skills and knowledge. The registered persons, together with the staff team, should consider how the service could be further developed, so as to achieve good and excellent quality DS0000015600.V337175.R01.S.doc Version 5.2 Page 7 outcomes, as set out in the Commission’s Key Lines of Regulatory Assessment (KLORA’S) 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. DS0000015600.V337175.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 DS0000015600.V337175.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): Standards 3 & 4 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. A pre-admission assessment is undertaken for all prospective residents and care plans are drawn up from the information in this assessment. However, the religion, ethnicity and social/ cultural needs of individual residents must be identified so that staff understand and are able to meet such needs. The home does not offer intermediate care. EVIDENCE: Individual records are kept for each resident. A total of eight files were examined, four on each floor. All records inspected have assessment information recorded and the information had been used to continue assessment following admission to the home and develop written care plans. The records showed that residents and their relatives/ representatives are involved in the process. Where appropriate, information provided by the placing authority was also included. DS0000015600.V337175.R01.S.doc Version 5.2 Page 10 All records examined had full assessment information recorded around the physical nursing care needs of the residents. However, at the initial preadmission assessment the religion, ethnicity and social/ cultural needs are identified to a limited degree, and this area does need expanding so that staff understand and are able to meet such individual needs. The inspector was satisfied that the physical nursing care needs of residents were being adequately met and understood but very little information was recorded as to the specialist care needs of those residents with dementia. More detail needs to be obtained around a person’s existing abilities, such as making a cup of tea, washing up and other ordinary activities of daily life. This should then enable the staff to provide the right level of care to assist the resident to continue to live as full a life as possible, and for as long as possible. The staff on the dementia unit have not received adequate and appropriate training to meet and understand the needs of people living with dementia. Such training would equip staff with the relevant skills and knowledge required to ensure good quality care provision for people admitted to the home, and ensure that their specialist needs will be met. The deputy manager advised that training in dementia care has been identified as a future training need for all staff. The deputy manager was provided with a copy of the Commission’s ‘Policy and Guidance on Provision of Fees Information by Care Homes’. This sets out what information care home providers need to include in the Service User Guide regarding fees and terms and conditions, and is in a format that is easy to understand. DS0000015600.V337175.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): Standards 7, 8, 9, 10 & 11 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents’ health and personal care needs are set out in individual care plans. The care plans are generally detailed but need to be more specific with regards to the recording of outcomes for residents around the cultural, religious and social care needs of the individual; and the specialist needs of those people living with dementia. There are clear medication policies and procedures to follow. However, there are some inconsistencies in the management of medication, which may result in unsafe practices. All residents could be assured that at the time of their death, staff would treat them and their family with care, sensitivity and respect. DS0000015600.V337175.R01.S.doc Version 5.2 Page 12 EVIDENCE: Individual care plans were available for each resident and a total of eight residents were case tracked, four on each floor, and their care plans and related documentation inspected. The records for these residents were found to be generally detailed, but need to be more specific with regard to the recording of outcomes around the cultural, religious and social care needs of residents. For example residents religion is recorded but there was no evidence on the care plans as to the impact of a person’s religion on the method and type of care provided. Staff need to have knowledge of what a person’s religion means in terms of care and activities. There was also limited information on meeting the specialist care needs of people living with dementia. The quality of care, which is experienced by someone with dementia, can be improved by the way staff use and understand care plans. For example the care plan of one resident with dementia stated, “To minimise confusion staff must wear their name badges”. However, very few members of staff were wearing name badges on the day of the visit. A comprehensive care plan can only enhance the care experience of a resident living with dementia. Care plans tended to plan care in terms of risk, dependency or disability. The assumption that people with dementia cannot do much can lead to dependence of care staff to do tasks that the individual could actually be doing themselves. It is therefore essential that comprehensive care plans be developed, with the assistance of relatives/ friends of the resident, to ensure that staff provide the correct level of care. The documentation/ health records relating to wound management; management of diabetes; catheter care and the two most recently admitted residents, were examined. The records for these residents were found to be detailed and being adequately maintained. There was evidence that care plans were being reviewed at least monthly. Risk assessments are routinely undertaken on admission for all residents around nutrition, manual handling, continence, falls and pressure sore prevention; and reviewed on a regular basis. Records are maintained of nutrition, including weight gain or loss with appropriate action being taken where necessary. Records indicated that residents are seen by other health professionals such as tissue viability nurse and diabetic nurse specialists; speech and language therapist; optical, dental and chiropody services. As part of the inspection the inspector made contact by phone with community health care professionals who visit the home, this included the tissue viability nursing service and the speech and language therapy team. They commented positively on their involvement in the home; had no concerns about the care being provided and that any advice given was well received and actioned accordingly. DS0000015600.V337175.R01.S.doc Version 5.2 Page 13 A number of monitoring charts were examined including blood sugar monitoring, turning charts and fluid intake/ output monitoring charts. The majority of these were found to be in good order. However, a small number of fluid charts had significant gaps in the recording of fluid intake. For example, at 12.00 hours on the day of the inspection the last recorded entry on some charts was 08.00 hours. If the recording of fluid intake is indicated for a resident then this must be considered to be a clinical record and must be monitored by nursing staff accordingly. It is essential that all monitoring charts are maintained accurately and up to date. Discussion with staff suggested that residents were receiving fluids but that staff were failing to record this on each occasion or being completed retrospectively. The inspector observed these individuals being given fluids during the inspection. Care plans contained some information on end of life wishes and the importance of developing these further was discussed with staff. However from discussions with staff, it was apparent that staff dealt with a person’s dying and death in a sensitive and understanding manner, both for the individual and relatives. The inspector was informed that the manager has expressed an interest in implementing the Liverpool Care Pathway (LCP) for the Dying Patient. This transfers the hospice model of care into other settings and has been used effectively in care homes. There are policies and procedures for the handling and recording of medicines. An audit was undertaken of the management of medicines within the home and a random sample of Medication Administration Records (MAR) charts were examined. The following issues were discussed with the deputy manager, and the respective nurses in charge of the units: • All hand written entries on MAR charts must be signed and dated by the person making the entry. The entry must also include the source of the information. It was noted that insulin in current use was being stored in the medicine fridge. In accordance with directions and the product licence, some insulin preparations in current use must be stored at room temperature. This was confirmed by the inspector and the deputy manager reading the ‘pharmaceutical information’ regarding storage as included with the product. • Staff talked about and were observed to treat residents in a respectful and sensitive manner. They were seen to be very gentle when undertaking moving and handling tasks and offered explanation and reassurance throughout the activity. DS0000015600.V337175.R01.S.doc Version 5.2 Page 14 Several residents were asked about the care they receive in the home. Comments included: “ All the staff are kind and very friendly”. Another said: “ I have all I need, I am looked after well”. The inspector also spoke to the visiting relatives of two residents. Both were very happy with the care. One said: “My husband has been in this home for a number of years. I have no concerns about his care and I am always made to feel welcome”. Another relative had visited three homes when choosing a home for her mother to be cared for. She had decided on Ravenscourt because she “liked the atmosphere, very relaxed and friendly”. DS0000015600.V337175.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): Standards 12, 13, 14 & 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. There is a varied programme of activities available and residents are given the opportunity to take part in a variety of activities which meet their recreational interests and needs. However, there are limited opportunities for residents on the dementia unit to be independent or exercise individual choices and wishes. The meals in the home are well presented and there is always a choice of meal. Residents on the dementia unit may benefit from the use of, for example picture menus, finger foods, small nutritious snacks and more flexible eating times to maintain independence, exercise choice around food and eating and still provide a healthy balanced diet. Visiting times are flexible and people are made to feel welcome in the home so that residents are able to maintain contact with their family and friends as they wish. EVIDENCE: The home employs a full time activity co-ordinator who works five days a week, and includes weekends. There is a regular programme of planned activities for all residents and regular visits by professional entertainers. There are a variety of large and small group activities, which are usually held in one DS0000015600.V337175.R01.S.doc Version 5.2 Page 16 of the main lounges. The activity co-ordinator takes into account the needs, preferences, expectations and capabilities of all residents by arranging activities suited to individual’s interests. There is an established annual Summer and Christmas Fair; which relatives and friends are encouraged and welcomed to attend. In particular on the dementia unit (Hollyoak) she arranges 1:1 sessions such as hand massage, manicures, and sitting and engaging with individuals. The inspector was able to observe meals being served to those residents living with dementia on the first floor (Hollyoak). Meals are served in the large lounge/ dining room or residents may choose to eat in their rooms. On the day of the visit the majority of residents remained in their lounge chairs and ate off small tables placed in front of them, though it is not clear if this is through choice. Many of the residents needed either supervision by staff or assistance with eating and staff were on hand to assist individuals when necessary. Staff were observed to be offering assistance appropriately and residents were not being rushed. Menus were inspected and found to be balanced and a choice is offered each day. The meals were well presented but it appeared that it was the staff that decided what somebody would eat. Service users living with dementia may benefit from the use of, for example pictorial menus, finger foods, small nutritious snacks, smaller portions and more flexible eating times to maintain independence and exercise choice around food and eating. This area does need to be developed through the provision of pictorial menus or other methods such as making available to residents before the actual mealtime, small portions of the meals so that they can see, smell or touch the food and thereby make a more informed choice. The taking of meals should be an enjoyable experience for all residents, and the manager’s attention is drawn to the Commission’s recent report Highlight of the day that is about food and nutrition within care homes. A visit was made to the kitchen and the inspector was able to discuss the storage and preparation of food with the cook. She was fully aware of those residents requiring special diets, for example diabetic diet. She demonstrated a good knowledge and understanding of the importance of well balanced and well presented meals. Fresh fruit is provided each day and available on request. The majority of bedroom doors on the first floor (Hollyoak) were being routinely locked when the resident had vacated them. Though this was not evidenced on the ground floor (Bower House). The inspector was informed that this was where a relative had requested the door to be locked for a particular reason for example, other confused residents entering the room and interfering with or removing personal possessions. On inspecting records there was no evidence of a relative’s request. It is not acceptable to routinely lock DS0000015600.V337175.R01.S.doc Version 5.2 Page 17 bedroom doors, unless this has been agreed with the resident and/or their representative, since this restricts residents’ ability to return to their room without assistance from staff to unlock the door. If there is such a request from a relative, staff must explain to relatives that such a request has significant implications for the individual resident since it restricts any access they may wish to have to their own room during the day. There was inconsistent use of appropriate signage on bedroom doors, for example some had pictures and names or other identifying methods, whilst some individuals names had been hand written directly on the wooden surface of the door in felt tip or ball point pen. There must be appropriate signage on bedrooms doors or other identifying methods, unless the individual resident or their relatives indicate otherwise. Visiting times are flexible and visitors commented that staff “make them feel welcome, at any time”. Residents are able to receive visitors in their own rooms or in the lounges. DS0000015600.V337175.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): Standards 16 & 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The manager and staff make every effort to sort out problems or concerns. Residents and their relatives/ representatives can be confident that their complaints and concerns will be listened to and acted upon. Staff working in the home have received training in safeguarding adults to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a written complaints policy/ procedure and the complaints log inspected indicated the number of complaints and issues of concern received, and included details of investigation, action taken to resolve them and the outcome for the complainant. No complaints have been received by the Commission since the last inspection. Those residents and relatives spoken to were aware of how to complain and to whom. There is an in house training programme for all staff in safeguarding adults and recognising and reporting abuse. All staff working in the home have received this training and this is included in induction training for all new staff. Those DS0000015600.V337175.R01.S.doc Version 5.2 Page 19 staff spoken to during the inspection were aware of the action to be taken if they had concerns about the safety and welfare of residents. DS0000015600.V337175.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): Standards 19, 20, 21, 22, 23, 24, 25 & 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home is clean, generally well maintained, decorated and furnished to a satisfactory standard. However, the environment on the first floor – dementia unit, must be improved so as to meet the specialist needs of people living with dementia. The signage, décor and use of communal areas are not appropriate, some residents do not have unrestricted access to their bedrooms and this restricts their choice and independence. EVIDENCE: The building was toured by the inspector, accompanied by the deputy manager, at the start of the visit, and all areas were visited again later during the day. DS0000015600.V337175.R01.S.doc Version 5.2 Page 21 Some bedrooms were seen either by invitation of the resident, whilst others were seen because the doors were open or being cleaned. All of the bedrooms seen were personalised and were reflective of the occupant’s interests, culture and religion. There is a call alarm system fitted to each bedroom, and is located within easy reach of each resident’s bed. There were no offensive odours and the home was clean and tidy. The standard of the décor, furnishings and fittings are generally being maintained to a good standard with the exception of the first floor – dementia unit, which is detailed later in this report. There is an ongoing programme of refurbishment and re-decoration. Two maintenance personnel are employed and there is an effective system in place for staff to report items requiring attention or repair. The external grounds are being well maintained. Since that last inspection the main lounge on Bower House has been decorated and the carpet has been replaced in the communal areas. There is an ongoing programme for the decoration of bedrooms. An additional ten profiling beds have been purchased. The laundry area was visited and this was found to be clean, with soiled articles, clothing and foul linen being stored appropriately, pending washing. The laundress was aware of health and safety regulations with regard to handling and storage of chemicals. Personal Protective Equipment (PPE) such as clothing, gloves, masks and goggles were available and in use. Hand washing facilities are prominently sited and staff were observed to be practising an adequate standard of hand hygiene. First Floor – Dementia Unit (Hollyoak) On the dementia unit most residents bedrooms were being routinely locked. Staff stated that some doors were locked because relatives complained that other residents were going into these rooms. Therefore some residents were unable to enter their bedrooms when they wished. It is not acceptable to lock bedrooms if residents are unable to manage a key as this restricts residents’ choices and access to their own rooms. (See also Daily Life and Social Activities) The signage and décor were not appropriate to the needs of residents living with dementia and this needs to be developed. Toilets had some signage and the doors had been painted a different colour. However, this had not been continued through to bathroom and en suite toilets to aid identification. Assisted bathrooms and toilets were also being used as storage rooms for DS0000015600.V337175.R01.S.doc Version 5.2 Page 22 wheelchairs and other sundry items of equipment and therefore not available or accessible to residents wishing to use them. As the ability of people living with dementia to communicate with words decreases, the use of non-verbal cues and the environment are important in enabling them to cope better with daily life and aids to orientation. The home is registered to accommodate people with dementia. Therefore the general environment on this floor must reflect good practice guidance on dementia care within care homes. Consideration must be given to utilising the existing design and layout of this unit to meet the specialist needs of people living with dementia. For example, through the use of visual cues such as colour and signage. Staff must be aware of the factors such as noise. On the day of the inspection the majority of residents on the dementia unit were sat in the lounge with the television on and the sound turned down to a very low level. The television was situated in such a place that not all residents would be able to see the television or hear it, even if they wished to do so. There were no appropriate pictures in the corridors, lounges or dining room. The manager must give consideration to ensuring that there are items of interest for residents throughout the home. These can also be used as points of discussion with residents living with dementia. As well as a large lounge/ dining room there is a small lounge/ quiet room off the main corridor. Staff stated that this is rarely used and on the day of the visit was being used to store staff outdoor coats and bags. This is a communal facility for residents but is not being used to its full capacity or is being used for other purposes. The registered providers must review the use of all communal facilities in the home to utilise them to the best advantage of residents and to make them accessible and safe. The physical environment has an enormous impact on how the strengths and skills of people living with dementia are supported or not. Changes mentioned above, if implemented, can help to support people living with dementia, and help to maximise independence and minimise confusion. The nurses’ station is located in one corner of the lounge/ dining room and occupies quite a large area. There are two notice boards, one is situated on the wall adjacent to the nurses’ station, and the other is situated on the wall in the dining area. Both have residents’ armchairs situated directly underneath. The notice boards contain a variety of written information. On the day of the visit this included information for relatives; restrictive/ prohibitive instructions to staff; a list of resident birthdays as well as their respective dates of birth. On the wall directly above the lounge chair of one resident was a poster promoting adequate hand washing to promote effective infection control. Whilst it is DS0000015600.V337175.R01.S.doc Version 5.2 Page 23 acknowledged that staff may need information pertaining to employment issues and clinical practice, it is not appropriate for this to impinge on residents communal areas. DS0000015600.V337175.R01.S.doc Version 5.2 Page 24 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): Standards 27, 28, 29 & 30 People using the service experience adequate quality outcomes in this are. We have made this judgement using a range of evidence including a visit to this service. The home employs staff in sufficient numbers to meet the personal and nursing care needs of the residents. However; nursing and care staff on the first floor dementia unit, are not sufficiently trained or skilled to understand and effectively meet the needs of people living with dementia. EVIDENCE: The staffing levels of qualified nurses and care staff on both floors were sufficient to meet the nursing and personal care needs of all residents. Staff were being effectively deployed to ensure that residents choosing, or needing to remain in their bedrooms were being cared for appropriately. In addition to qualified nurses and care staff Ravenscourt employs an activity co-ordinator, catering, laundry, domestic, maintenance and administrative staff. The home has a relatively stable workforce and there is no use of agency staff. This is clearly to the benefit of residents since it provides consistency of care, which is very important to all residents. Only a limited number of staff working in the home have received training in dementia awareness. This must be considered to be a priority training need for DS0000015600.V337175.R01.S.doc Version 5.2 Page 25 all nursing and care staff, particularly on the first floor dementia unit. All staff must receive comprehensive and certificated training in caring for people living with dementia, so as to equip them with the relevant skills and knowledge to ensure good quality care provision to residents. A record is maintained of staff training and records showed that staff have undertaken training in essential areas such as fire training, manual handling, food and hygiene, and safe guarding adults. Other training included wound care, first aid, basic life support and nutrition. Approximately 66 of care staff are qualified to National Vocational Qualification (NVQ) level 2 or above. From viewing staff records and talking to staff, it was evident that staff receive regular supervision, which includes observational and peer supervision, but such supervision needs to ensure that staff practices on the dementia unit are always in line with current good practice, the home’s policies/ procedures and Statement of Purpose. Lukka Care Homes Ltd., as an organisation, employs a workforce from diverse cultures and backgrounds. It was apparent at the time of the inspection that the ethnicity of the staff team was different to that of the people living in the home. It is important therefore that the manager ensures that staff working in the home receive the necessary training in equality issues and valuing diversity, so that the needs of all the residents can be understood and appropriately met, wherever possible. A random sample of staff personnel files were inspected and these were found to be in good order with necessary references, Criminal Record Bureau (CRB) disclosures, and application forms duly completed. DS0000015600.V337175.R01.S.doc Version 5.2 Page 26 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): Standards 31, 32, 33, 35, 36 & 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The manager is a very experienced and well-qualified person and generally residents benefit from his expertise. However, residents on the dementia unit are not experiencing the same benefits due to the current practices of restricting choice and the promotion of independence. All people using this service can be satisfied that their financial interests will be safeguarded. Generally the health safety and welfare of the majority of residents are promoted and protected but again this is not being experienced by the residents on the dementia unit due to the current practices. DS0000015600.V337175.R01.S.doc Version 5.2 Page 27 EVIDENCE: The home’s Statement of Purpose sets out the aims and objectives of the service in that: • Choice – We aim to help service users exercise the opportunity to select from a wide range of options in all aspects of their lives. • Security – retaining maximum flexibility in the routines of the daily life of the home. • Aims and Objectives – We aim to provide a care service in a flexible, attentive, non-discriminatory manner, respecting the independence, privacy and right of residents to make informed choices and take risks. • Summary – The first floor specialises in the care of elders with dementia with nursing needs. On the day of the inspection there was little evidence on the dementia unit that the above aims of the home were being experienced by the residents on this unit. It is essential therefore that the manager ensures that the aims and objectives of Ravenscourt Nursing Home are extended to, and experienced by, all of the residents at the home. Robust and effective systems must be developed for the service to be able to demonstrate that it is meeting the needs of all residents and in accordance with the home’s Statement of Purpose. The registered manager is an experienced, well-qualified person and holds a registered nursing qualification. He has been the manager of the home for a number of years. Whilst the manager was not on duty on the day of the inspection it has been evident from previous discussions with him that the service is planned to be resident focused. Along with the deputy manager he aims to work in partnership with the family of residents and professionals. The manager must review the methods of auditing the various systems and procedures including supervision. This will ensure that good practice guidelines are being operated throughout the home so that the service is person centred in respect of all residents. Regulation 26 visits are being undertaken regularly by the responsible individual and a copy of the report is sent to the Commission. However, these reports have not identified the current poor practice on the dementia unit and therefore need to be more robust and resident focused. A discussion took place with the deputy manager around the recently introduced Mental Capacity Act 2005, which became effective for those people who do not have family or friends from April 2007, and for everybody from October 2007. It is important that this is discussed with people living in the DS0000015600.V337175.R01.S.doc Version 5.2 Page 28 home, staff and relatives, and that the organisation ensures that staff undertake adequate and appropriate training in this important area. Currently the manager does not act as an appointed agent for any resident. The home has responsibility for the personal allowances of several residents. There is a computerised financial system in place, which is managed by the home’s administrator. A random sample of records were inspected and there was evidence to show that residents financial interests are safeguarded. Secure facilities are provided for the safekeeping of money and valuables held on residents behalf. A wide range of records were looked at including fire safety, water temperatures checks, accident/ incident reports, Portable Appliance Testing (PAT) and lift service/ maintenance. These records were found to be detailed, up to date and accurate. Fire risk assessments had been undertaken in line with the new fire regulations, which came into effect from October 2006. DS0000015600.V337175.R01.S.doc Version 5.2 Page 29 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 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 3 3 3 2 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 N/A 3 2 X 3 DS0000015600.V337175.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO 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 OP3 OP4 Regulation Requirement Timescale for action 31/08/07 2 OP4 3 OP7 OP11 4 OP8 5 OP9 14, 12, 18 The registered providers must ensure that staff individually and collectively have the required skills, experience and training to deliver the service and care which the home offers to provide on the dementia unit. 14 The registered providers must ensure that during the initial preadmission assessment the religious, social/ cultural needs of the resident must be identified. 12 & 15 The registered providers must ensure that care plans are more specific with regard to the recording of religious, cultural and social care needs of residents and how these are to be met, and include End of Life choices and decisions. 12 The registered providers must ensure that where a record of food/ fluid is indicated, that these recordings must be accurately maintained and up to date. 13 The registered providers must ensure that: DS0000015600.V337175.R01.S.doc 30/06/07 31/08/07 26/04/07 26/04/07 Version 5.2 Page 31 • All hand written entries on MAR charts must be signed and dated by the person making the entry, and include the source of the information. 6 OP14 OP24 12 7 OP19 OP20 OP24 23 8 OP27 OP30 18 9 OP31 OP32 OP33 OP36 9 & 24 Insulin in current use must be stored in accordance with the product licence. The registered providers must ensure that where relatives have requested that the door of a resident’s bedroom be locked, that the reasons for this are fully recorded and include who was involved in the decision. The registered providers must ensure that the existing layout and design on the dementia unit reflects good practice guidance on dementia care within care homes, to ensure that the specialist needs of the residents on this unit are met. The registered providers must ensure that all staff working on the dementia unit receive comprehensive and accredited training in caring for people living with dementia. The registered providers must ensure that there are robust and effective systems in place for monitoring practice and compliance with the home’s policies and procedures and in line with the home’s Statement of Purpose. • 30/06/07 30/09/07 30/09/07 30/09/07 DS0000015600.V337175.R01.S.doc Version 5.2 Page 32 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 OP15 Good Practice Recommendations Residents living with dementia may benefit from the use of, for example pictorial menus, finger foods, small nutritious snacks and more flexible eating times to maintain independence and exercise choice around food and eating. DS0000015600.V337175.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 DS0000015600.V337175.R01.S.doc Version 5.2 Page 34 - 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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