Inspection on 29/07/08 for Ravenscourt Nursing Home

This inspection was carried out on 29th July 2008.

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

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 26/04/07

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Ravenscourt Nursing Home 111-113 Station Lane Hornchurch Essex RM12 6HT Lead Inspector Ms Gwen Lording Unannounced Inspection 29th July 2008 07:15 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.V369044.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. Ravenscourt Nursing Home DS0000015600.V369044.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 max.j.c@hotmail.co.uk Lukka Care Homes Ltd Jean-Claude Seevathean Care Home 70 Category(ies) of Dementia (70), Old age, not falling within any registration, with number other category (70) of places Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 70 26th April 2007 Date of last inspection Brief Description of the Service: Ravenscourt Nursing Home is a purpose built care home registered to provide nursing care for up to 70 older people, of whom some 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 £565.00 and £625.00 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. Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. This was an unannounced inspection which started at 07:15am and took place over seven hours. The inspection was undertaken by the lead inspector, Gwen Lording. The registered manager was available throughout the visit to aid the inspection process. This was a key inspection in the inspection programme for 2008/2009. Since the last key inspection we undertook a random visit to the home in October 2007 to discuss what action had been taken to address requirements made at the previous inspection. We also did a thematic inspection in May 2008 to look at how well this service makes sure people are protected from abuse. A thematic inspection is a short, focused inspection that looks in detail at a specific theme. We did this thematic inspection with an ‘expert by experience’ who spoke to people using this service. An ‘expert by experience’ is a person who either has a shared experience of using services or understands how people in this type of service communicate. Overall, that inspection showed that people who use the service are safeguarded from harm and abuse. Discussions took place with the manager, deputy manager; kitchen and laundry staff, and the home’s administrator. We spoke to a number of residents and several relatives; and where possible residents were asked to give their views on the service and their experience of living in the home. Night and day nursing and care staff were asked about the care that residents receive and were also observed carrying out their duties. A tour of the premises, including laundry and main kitchen was undertaken. The files of several residents on each unit were case tracked, together with examination of other staff and home records. This included medication administration, staff training maintenance records and complaints. We did not look at staff recruitment, safeguarding and complaints on this visit, as these areas were the focus of the previous thematic inspection in May, which specifically looked at safeguarding. A separate report will be published on safeguarding, but the findings of that visit have been incorporated in the overall quality rating of this inspection Information was taken from an Annual Quality Assurance Assessment (AQAA); which was completed by the manager and returned to us prior to the inspection. This is a self-assessment process which all providers are required to complete once a year. Additional information relevant to this inspection was also obtained from Regulation 26 monitoring reports and Regulation 37, notification of events. Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 6 Surveys were sent out prior to the inspection for completion by staff, residents where possible and relatives. As part of the inspection process the views of funding authorities that place residents in the home were sought and are commented on in this report. We have been told previously by the manager that the majority of people living in this home prefer to be called ‘residents’. This is reflected accordingly in this report. We would like to thank the residents, relatives and staff for their input during the inspection. What the service does well: What has improved since the last inspection? All the requirements made at the last key inspection have been met. There has been a significant improvement in the standard of care plans and other health related records. Care plans specific to meeting the specialist needs of people living with dementia had been developed. The routines of daily living on the dementia unit are now more flexible and staff are being proactive in their approach in supporting residents to remain independent and express their wishes and needs. Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 7 The physical environment on the first floor has improved considerably to meet the specialist needs of people living with dementia. These changes have helped support residents and assisted in maximising their independence and minimising their confusion. The majority of staff have now received training in caring for people with dementia. In discussion with staff it was apparent that this training had not only increased their knowledge and understanding but also their confidence. The service is now more resident focused and the manager has developed a strong and supportive staff team. He has a clear understanding of what further improvements are needed and the key areas, which need development. All staff spoken to demonstrated a commitment to ensure that they work as a team for the benefit of the residents and to provide a high standard of care. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ravenscourt Nursing Home DS0000015600.V369044.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 Ravenscourt Nursing Home DS0000015600.V369044.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 & 5 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. A pre-admission assessment is undertaken for all prospective residents. Care plans are drawn up from the information in this assessment ensuring that the needs of the residents are identified, understood and met. The home does not offer intermediate care. EVIDENCE: At the last key inspection a requirement was made for individual’s religious, social and cultural needs to be identified during the pre-admission assessment. Individual records are kept for each resident and a number of files were examined on both units. Assessments were found to be more detailed around these specific identified areas of need. All contained a comprehensive preadmission assessment from which a care plan had been compiled with input Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 10 from the resident where possible, family members where appropriate, and health and social care professionals. Pre-assessment visits to the home by family/ friends and where possible the prospective resident are encouraged. This gives people an opportunity to talk to staff, residents, and visiting relatives and assess the home’s facilities. A relative commented: “I was given a lot of information about the home when we visited so I could decide if it was the right place for my wife”. Ravenscourt Nursing Home DS0000015600.V369044.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 good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Residents’ health and personal care needs are set out in individual care plans and provide staff with the information they need to satisfactorily identify and meet residents’ needs. There are clear medication policies and procedures for staff to follow, so as to ensure that residents are safeguarded with regard to their medication. All residents could be assured that at the time of their death, staff would treat them and their family with care, sensitivity and respect. EVIDENCE: A significant improvement was noted in the standard of care plans and health related documentation since the last key inspection. Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 12 New care planning documentation has recently been introduced. Standardised care plans are generated from a computer however; there was a good level of detail and personalisation in the care plans seen. Of note since the last inspection was the development of care plans specific to meeting the needs of those people living with dementia, and improvements in recording of outcomes for residents around their cultural, religious and social care needs. Religious preferences are clearly recorded and residents are enabled to participate in Church and other religious activities as desired. Individual care plans were available for each resident and a total of eight residents were case tracked, four on each unit, and their care plans and related documentation inspected. It was not possible to talk to some residents in a meaningful way due to their level of dementia. However, it was evident from viewing care plans and talking to staff and residents that individual health care needs were being met. Care plans showed evidence that nutritional screening is being undertaken on admission and that a record is maintained of nutrition, including weight gain or loss. Where concerns are indicated there is evidence that appropriate action is taken, with an initial referral to the GP and then to a dietician or nutritionist. Residents are routinely weighed on a monthly basis, or more frequently if a significant risk or concern is identified. However, it was noted that such observations are being recorded in a number of different sources and then transferred to the individuals care plan. It is recommended that weights are recorded in one source only, so as to avoid any error/ discrepancy when transferring information, and for ease of access. The documentation/health records relating to wound management; management of diabetes; and catheter care were examined. Professional advice and input are sought as required from Tissue Viability Nurse (TVN); Diabetic Nurse Specialist; Speech and Language Therapist and Continence Nurse Advisor. There was evidence that residents are able to access GP, dental care, chiropody services, optician and other specialist medical services as necessary. A number of monitoring charts were examined including blood sugar monitoring, turning charts and fluid intake/output monitoring charts. These were found to be in good order and being adequately maintained. Whilst care plans were being regularly reviewed, the manager must ensure that reviews are undertaken in a meaningful way and do not become a routine exercise with ‘no change’ being automatically recorded each month. Staff also need to ensure that daily recordings are more in line with the outcomes identified in care plans, and also that the implications of the Mental Capacity Act are taken into account in both the care planning and the daily recordings. Risk assessments are routinely undertaken on admission for all residents around nutrition, manual handling, continence, falls and pressure sore prevention. Risk assessments are being reviewed and updated accordingly. In Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 13 discussions with staff they demonstrated a good understanding of the residents’ needs and also of the identified risks associated with each individual, such as risk of falling, or indicators which may lead to behaviours which challenged. An audit was undertaken for the handling and recording of medicines within the home, and a sample of Medication Administration Record (MAR) charts were examined on both units. Discussion with staff and the review of medication records show that nursing staff are following policies and procedures, so as to ensure that residents are safeguarded with regard to their medication. The pharmacy that supplies a service to the home undertakes quarterly monitoring visits. Since the last inspection there has been some development around recording end of life care needs and wishes. Whilst some files showed evidence of end of life care needs and wishes, not all residents have an end of life care plan. However, the manager has identified in the AQAA that this is an area for further development over the next twelve months. The manager has also been proactive in ensuring that key staff receive training in palliative care and the use of syringe drivers; and works in partnership with the Palliative Care Team of the local hospice. This has improved the way staff are able to meet the needs of residents in their last stages of life and ensure that people die in their preferred place of care. Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 14 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 good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. This judgement has been made using available evidence including a visit to this service. The routines of daily living on the dementia unit are now more flexible to suit individual’s preferences and capabilities. Staff are more proactive in their attitude and practice in promoting opportunities for residents to remain independent, exercise individual choice and express their wishes and needs. EVIDENCE: The inspection started at 07.15am. The day staff commence duty at 8am. The atmosphere was relaxed, with adequate night nursing and care staff on each unit. There was a good staff presence in the lounges were some residents were having drinks. It had been a very warm night and obvious attention had been paid by the night staff to residents comfort during this warm spell of weather. For example, fans in bedrooms and communal areas; lighter bed clothing and nightwear and plenty of cold drinks available and being offered. In addition staff recognised and respected the individual preferences of one Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 15 resident who indicated that she felt cold. Staff moved the resident to another part of the lounge, away from a fan and got a cardigan for her to wear. We were able to observe that the routines of daily living were very flexible to suit the preferences and capacities of residents, especially around getting up in the morning and having breakfast. At the beginning of the visit it was evident that residents are not routinely got up in the mornings for the convenience of the staff or rigid home routine. For example we observed that some residents were up and dressed, whilst others appeared comfortably asleep in their bedrooms. One resident we spoke to told us: “I like to get up early about six o’clock. The staff know this and I always get a nice early morning cup of tea”. Another resident told us: I like to take my time getting up and have my breakfast later on in the morning”. Whilst viewing the care plan of another resident we noted it was recorded: ‘Prefers to have her shower at night with the assistance of a female carer’. We observed members of staff allowing time for residents to express their wishes and supporting individuals to make choices in their daily lives. All staff are very aware that Ravenscourt is the home of the residents and try to make this as pleasant as possible. At the last key inspection it was noted that the majority of bedroom doors on the first floor were being routinely locked during the day when the residents had vacated the room. This had significant implications for individual residents since it restricted any access that they may wish to have to their own room during the day. The manager and staff have addressed this concern, and we were pleased to note that at this inspection the majority of rooms were left unlocked, unless the individual had expressed otherwise. The home employs a full time activity co-ordinator who works five days a week, including some weekends. There has been a review of the general activities programme, in consultation with residents where possible and their relatives. The activity co-ordinator has given a great deal of consideration and time in planning and undertaking activities in the home. Care staff were also observed to be involved in 1:1 activities with residents on the dementia unit. Staff generally interacted well with residents and demonstrated a good understanding of the differing needs of people living with dementia. It was apparent that the training staff have undertaken in caring for people with dementia was to the benefit of residents. This was evidenced through talking to staff and the many positive interactions we observed during the visit. We observed breakfast being served on the ground floor and lunch being served on the first floor. Meals are served in the large lounge/ dining rooms or residents may choose to eat in their rooms. On both floors tables were routinely laid with tablecloths, placemats, napkins, cutlery, glasses and condiments. The settings were very congenial and there was a nice relaxed atmosphere throughout the meal. Daily newspapers were available for Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 16 residents to read. Both meals were well presented and generally residents who required assistance were being given this in a positive, sensitive and encouraging manner. The AQAA informed us that that the home is progressing the development of pictorial menus on the dementia unit to further encourage and assist residents in making choices at meal times. We were also informed that menus are being reviewed in consultation with residents and more finger foods are being introduced to maintain independence for some residents around food and eating. Relatives and friends are encouraged to visit, and are able to use the small servery kitchens to make drinks. Also visitors can choose to have a meal with their relative, and certainly there was evidence that one visitor does this on a regular basis. The home tries hard to facilitate relatives/ friends to keep in touch with residents, if for any reason they are able to visit, via e-mail and telephone. One relative commented: “I always receive a warm welcome and am offered a drink”. A visit was made to the kitchen and the inspector was able to discuss the storage / preparation of food and menus with the cook. She was able to demonstrate a good knowledge and understanding of the importance of well balanced and well presented meals, and the special dietary needs of some residents. Fresh fruit is provided daily and is available on request. A cooked breakfast is provided each day and on the day of the visit twelve residents had chosen one variety or other from this option. Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 17 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 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The home welcomes complaints, concerns, suggestions and compliments about all aspects of the service, and uses these positively to improve service provision. The organisation and the staff team make every effort to sort out any problems and concerns. All the staff working in the home have received training in safeguarding vulnerable adults to ensure that there is a proper response to any suspicion or allegation of abuse. People using the service can be assured that they will be protected from abuse, neglect and self-harm through staff awareness, knowledge and ongoing training. EVIDENCE: We did not look at these standards at this visit because they were the focus of an inspection around safeguarding which had been undertaken on the 8th May 2008. A separate report will be published around these standards. We did this thematic inspection with an ‘expert by experience’ who spoke to people using this service. A comment from the expert by experience was: “They (residents) all said that if they had any concerns they would speak to the manager, a member of staff, or a relative. Without Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 18 exception all said that they were not aware of any abusive situation at the home, and that they all felt safe”. Complaints and issues of concern are dealt with appropriately by the manager and the organisation. The manager works co-operatively and openly with regard to safeguarding adult concerns. Overall, the inspection showed that people who use the service are safeguarded from abuse and harm through the training, supervision and monitoring of staff. The attitude and practice of the service and that of the staff give ‘keeping people safe’ a high priority. This ensures that there is a proper response to any suspicion or allegation of abuse. The home has an open culture that allows residents to express their views and concerns in a safe and supported way. The judgement made above is also reflective of the separate focused inspection on safeguarding. Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 19 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, 24 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. There has been a notable improvement in the physical environment, particularly on the first floor. The living environment now appears more attractive, homely and reflects good practice guidance on dementia care within care homes. EVIDENCE: We did a tour of the premises, at the start of the visit and all areas were visited again later during the day. The inspection commenced at 07:15am and on arrival we found the home to be clean, tidy and there were no offensive odours. The home is registered to accommodate people with dementia. At the last key inspection a requirement was made for the physical environment on the first floor to be improved to meet the specialist needs of people living with Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 20 dementia. The manager has made considerable improvements since the last inspection. This includes: • • • • • • Lounge / dining room re-decorated Layout of the furniture in the lounges more homely and appropriate to the specific needs and lifestyle of people accommodated on this floor. New flooring in dining areas. Improved signage and décor in corridors, toilets and bathrooms Communal areas less cluttered Nurses station in main lounge – less intrusive on residents communal areas. The physical environment has an enormous impact upon on how the strengths and skills of people living with dementia are supported or not. These changes help to support people living with dementia, and assists in maximising their independence and minimising their confusion. Other improvements to the home generally since the last inspection include: • • • • • Purchase of a new hoist Rolling programme of replacing beds with profiling beds Purchase of low pressure relieving mattresses Re-decoration of lounge (ground floor) Improved the external areas of the home with flowerbeds and garden furniture to both the front and centre patio areas. Whilst the above improvements are acknowledged, other areas of the home are beginning to look ‘tired and worn’. This includes the rear downstairs corridor, main kitchen, surrounding corridor and staff changing room/ toilet. We were informed that new lighting has been installed in the kitchen and work is scheduled to commence on the ceiling and flooring. The home has an ongoing redecoration and refurbishment programme and this must continue to be progressed, with clear timescales for completion. We visited the laundry and this was found to be clean. The laundress reported that one of the washing machines has been out of order for some weeks. At the time of the visit soiled articles and clothing were being stored appropriately pending washing. The manager stated that they have ordered parts for the repair of the machine. Personal protective clothing and equipment were available and in use, with the exception of masks. This was discussed with the manager, who has agreed to obtain these. Hand washing facilities are prominently sited and staff were observed to be practising an adequate standard of hand hygiene. Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 21 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 good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Staffing levels are satisfactory and the effective deployment of staff ensures there are sufficient staff on duty to meet the assessed needs of the residents. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. EVIDENCE: We did not look at the home’s recruitment policy and procedures or staff employment files during this visit because these areas were the focus of an inspection around safeguarding which had been undertaken on the 8th May 2008. A separate report will be published around these standards. Overall, the inspection showed that the registered providers Lukka Care Homes Limited; have a robust recruitment and selection procedure in accordance with current legislation and good practice. All elements of recruitment are accurately recorded and all required documentation is obtained and verified prior to the commencement of employment. The judgement above reflects the outcome of the focused inspection on safeguarding. Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 22 We inspected staff rotas and the staffing levels and skill mix of qualified nurses and care staff, both night and day was sufficient to meet the assessed nursing and care needs of the residents. In addition to the registered manager there is a deputy manager who works supernumerary hours, across both floors. Care workers were being effectively deployed to ensure that residents choosing, or needing to remain in their bedrooms were being cared for appropriately. Effective team working was observed throughout the inspection. Staff were interacting well, both with each other and the residents. The home operates a key worker system, and in discussions with staff we found that they were very knowledgeable about the residents and their individual needs as identified in the care plans we case tracked. At the last key inspection only a very limited number of staff had received training in caring for people with dementia. A requirement was made for this training to be considered as a priority for all nursing and care staff, particularly on the first floor dementia unit. The majority of staff have now received training in this important area and further training has been booked. In discussion with staff it was apparent that this training had not only increased their knowledge and understanding but also their confidence. We looked at the current training records and saw that staff have received training in food hygiene, manual handling, infection control, health and safety and first aid. Other training undertaken included record keeping, catheterisation and wound care. Some staff have received training in the implications of the Mental Capacity Act 2005. On the day of the visit a training session for nursing staff was being undertaken by the pharmacist that provides a service to the home. Equality and diversity is identified throughout the AQAA as an essential part of staff development, training and practice within the home. It was evident that the skills and training deficits identified at the last key inspection have been proactively addressed and training is being given a high profile by the registered providers. The AQAA identified that approximately 75 of care staff are qualified to National Vocational Qualification (NVQ) level 2 or above and remaining staff are working towards this qualification. The home has an agreement with Thames Valley University to take student nurses on 12-week placement. The manager has undertaken the required mentoring course. In discussion with a student nurse who had been on placement in the home for eight weeks, she commented: “This is a management placement and has been a very positive learning experience” Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 23 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 good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The manager is a very experienced and well-qualified person and residents benefit as the home is run in their best interests. Monitoring visits are undertaken by the responsible person to monitor and report on the quality of service being provided in the home. EVIDENCE: The registered manager has been in post for a number of years and is ably supported by an experienced deputy manager. There have been significant improvements since the last key inspection. The service is now more resident focused and the manager has developed a strong and supportive staff team. He has a clear understanding of what further improvements are needed and Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 24 the key areas, which need development. The AQAA clearly identifies the plans for improvement over the next twelve months. In discussion with nurses, care staff and ancillary staff it was evident that they felt well supported by the manager. They demonstrated a commitment to ensure that they continued to work as a team for the benefit of the residents and to provide a high standard of care. From viewing staff records and talking to staff it was evident that there is a formal supervision process and staff receive regular supervision. This could include observational and peer supervision, as well as 1:1 sessions. A representative of the organisation undertakes monthly Regulation 26 monitoring visits to monitor and report on the quality of the service being provided to people living in the home. A copy of the report is made available to the Commission. Since the last key inspection the quality and content of the Regulation 26 reports has improved and are more resident focused and based on outcomes for people living in the home. Currently the manager does not act as an appointed agent for any resident. Residents financial affairs are managed by the individual resident or their relatives/ representatives. There is a computerised financial system in place, which is managed by the home’s administrator. Through discussion with the administrator and records inspected, there was evidence to show that resident’s financial interests are safeguarded. Secure facilities are provided for the safekeeping of any valuables or money held on behalf of residents. A wide range of records were looked at including fire safety, accident/ incident reports, emergency lighting, gas safety, water safety, emergency call system, and lift and hoist maintenance. These records were found to be in order and up to date. Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 26 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 OP19 Regulation 23 Requirement The registered persons must ensure that the refurbishment and renewal programme for the fabric and decoration of the premises is progressed in line with timescales for completion. However, priority must be given to the ground floor rear corridors and kitchen areas to which the timescale given applies. This will make sure that people live, and staff work, in a in a wellmaintained environment. Timescale for action 31/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations It is recommended that weights are recorded in one source only, so as to avoid any error/ discrepancy when transferring information, and for ease of access. Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Ravenscourt Nursing Home DS0000015600.V369044.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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