Inspection on 15/06/06 for Ravenscroft

This inspection was carried out on 15th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Ravenscroft 30/10/07

Ravenscroft 15/05/07

Ravenscroft 28/10/05

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Ravenscroft Ravenscroft Hilperton Road Trowbridge Wiltshire BA14 7JQ Lead Inspector Karen Mandle Key Unannounced Inspection 15 June 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ravenscroft DS0000065178.V295833.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. Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ravenscroft Address Ravenscroft Hilperton Road Trowbridge Wiltshire BA14 7JQ 01225 752087 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) Ashbourne (Eton) Limited Mrs Susan Mary Davina Robins Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (45), Physical disability (1), Terminally ill (3) of places Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Room 27 is not registered for nursing care as overall ceiling height is too low. No more than 40 persons in receipt of nursing care at any one time. One named female service user under the age of 65 in the category (PD) Physical Disability Date of last inspection Brief Description of the Service: Ravenscroft Nursing Home is registered to provide nursing care for 40 older people and personal care for 6 older people. The home is an older building, which has been extended over the years offering a range of single rooms and shared rooms. Two communal rooms are situated on the ground floor linked by a conservatory, which is also combined as part of the dining room. The gardens are to the rear of the building, which are well maintained. The home is currently under going a refurbishment programme. Ravenscroft is situated on the outskirts of Trowbridge. The home is owned by Southern Cross Healthcare. The registered manager is Mrs Sue Robins. The fees range from £442.00 per week for nursing care to £650.00. Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit for this key inspection took place on the 5th June 2006 commencing at 9.30am. The Manager Mrs Sue Robins was available to assist the inspector. The inspector was able to freely tour the building, visit with many service users and observe staff interacting with service users and attending to their care needs. Prior to the site visit-taking place, the inspector sent service users surveys to the home to gain the opinions from the service users regarding the service provided by the home. The surveys received contained positive comments about the care provided. The care of 5 service users was cased tracked through the inspection process by reviewing care records, observing care and speaking where possible with the service users. Southern Cross took ownership of the home at the end of 2005; the company have since refurbished all the communal areas and some corridors, which were poor. The gardens to the rear of the building are very well maintained. Service users that were able to communicate with the inspector were complimentary of the care provided, as was a visitor the inspector spoke with. The Manager and the staff were open to the inspection process and where needed assisted the inspector. The home had met all the requirements from the previous inspection. No requirements were set following this inspection. One recommendation was set. The home was providing care for 24 service users at the time of the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Due to the change of ownership the care plan format has been changed. However the care plans reviewed were detailed identifying health and personal care needs with evidence of monthly reviews taking place and when health care needs change. The care records were of a good standard. The care records also provided evidence of how health care needs are monitored and appropriate health care professionals contacted when care needs of the service users changed. The nutritional needs of the service users are closely monitored, through nutritional risk assessments and dietary intake. It was also observed how well service users were continually encouraged with fluid intake by the staff. Service users with complex needs are encouraged to spend time out of bed, and to socialise with other service users in one of the communal Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 6 rooms. Service users are supported by the home to maintain links with family and friends. The current staffing levels meet the needs of the service users. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 An admission procedure is in place and a full pre admission assessment takes place for all prospective service users. The home is not registered to provide intermediate care. Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All prospective service users are fully assessed by the registered manager prior to admission to Ravenscroft Nursing Home to ensure that through the assessment process the home is able to meet the nursing care needs and social needs of the service user. Two- pre admission assessments were seen which provided information relating to long term health care needs and current health care needs. The manager will support the assessment where possible by obtaining information from care managers families. A record of the assessment is kept on the service users’ file and used towards implementing a care plan. Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 9 The home is not registered to provide intermediate care therefore Standard 6 is not applicable to this service. Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 Health care needs of the service users are closely monitored and appropriate action taken when health care needs change. The care records fully address all aspects of care. The care team fully support the dignity of the service users. Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Due to two recent changes of ownership of the home, the care plan format has also been changed twice. However the care staff had managed the change well with care plans fully up to date. Five care plans were reviewed as part of case tracking service users. The current format is clear and easy to follow. All care needs of the service users had been identified and care plans were in place to support care needs. Appropriate risk assessments such as, falls risk assessments and pressure damage assessments were in place, which were reviewed monthly. Evidence was seen of monthly reviews of the care plans taking place or when the care needs of the service users changed. The manager has recently implemented an internal 6 monthly care review system Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 11 for all service users, which the family or next of kin are invited too attend and where applicable care managers are involved. All service users are registered with a local GP. A record of the GP visits was seen in the care records. Health care needs are monitored and records were maintained when other health care professionals were contacted for support and advice. Service users who were able to communicate were complimentary of the care provided, as were two regular visitors to the home who the inspector spoke with. Service users with higher care needs were fully supported by the care staff to be up and dressed. These service users were observed spending part of the day in the communal rooms socialising and interacting with other service users. The service users were well groomed and personal care needs were being met. Several ladies were observed having their hair taken care of by the hairdresser in the salon. The medication procedure was seen which was assessed as safe. The medication records were complete and up to date. All medication was stored correctly. The qualified nurses are responsible for the administration of medications. The disposal of medication procedure was in line current legislation. Three service users confirmed with the inspector that all nursing and personal care was provided in the privacy of their bedroom or the bathroom. This was also observed taking place whilst the inspector toured the home. The care staff were observed and heard interacting with the service users in a friendly but respectful manner with service users being addressed by their preferred name as recorded in their care records. Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15 The activities programme provided meets the social care needs of the service users. Service users are supported to retain links with family and friends. Service users are provided with choice and control over their lives as far as possible within the framework of a nursing home. Service users were satisfied with the food provided and nutritional needs are well monitored. Quality in this outcome area is judged to be good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The activities co-ordinator is employed for 32 hours per week and provides a range of daily activities. Group activities take place most afternoons. For those service users who do not wish to take part in-group activities, one to one visits take place with the activities co-ordinator. On the morning of the inspection, a charity coffee morning was taking place. The manager and activities coordinator were also in the process of arranging an Italian themed evening for service users and families with an Italian meal and music planned. A notice of the weekly activities is displayed around the home. Service users are supported by the home to maintain links with family and friends. The visitor’s book showed visits taking place throughout the day. Two Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 13 service users accompanied each by a family member went out together at lunchtime to a local restaurant for a meal. The staff had recently been provided with much training in “Service users rights and choice”. A service user who was visited in her room confirmed it was her choice to spend most days in her room apart from Tuesdays, which she had agreed too as this is when her room is fully cleaned. Another service user was able to confirm that she could get up when she wished and always had breakfast in bed. A choice of two main meals is available at lunchtime. Service users are asked the day before which meal they would like. The lunchtime meal was observed which was well presented. Service users were generally complimentary of the food. The home provides two dining areas. All service users were seen having their main meal in one of the two dining rooms. The home has worked hard to improve meals times for service users, which now would be considered to be a more social occasion for service users. The care staff were observed supporting service users where needed on a one to one basis. The nutritional needs of the service users are monitored through a nutritional risk assessment, recording of dietary intake for those assessed at risk, and through monthly monitoring of weights. Service users were observed through out the day of the inspection being encouraged by the care staff to drink plenty of fluid’s as it was a hot day. The kitchen was seen which was clean and organised. Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 A complaints policy and procedure are in place. All staff had been fully informed and have been provided with training in “Abuse Awareness”. The manager and deputy are both fully informed of the local vulnerable adults procedure. Quality in this outcome area is judged to be good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: An organisational complaints policy and procedure is in place. The manager has a clear understanding of how to conduct a complaints investigation and how to record the outcome of the investigation. The complaints policy is openly displayed in the entrance hall to the home. All staff had recently received training in “Abuse Awareness”, one member of staff commented to the inspector how useful and informative the training had been. The manager is fully aware how to implement the local vulnerable adults procedure if an allegation of abuse was made or observed. Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Ravenscroft is a well maintained home. The recent refurbishment of the communal areas has greatly improved the living environment for service users. The home is clean throughout and infection control measures are in place. Quality in this outcome area is judged to be good. This judgment has been made using available evidence including a site visit. EVIDENCE: Ravenscroft is a large older building, which has been extended overtime. The ground floor communal areas and corridors have recently been refurbished with new carpeting and all areas are now freshly painted. The communal rooms now appear light and spacious. The majority of service users were seen spending the day in one of the communal rooms. The re-decoration of these communal areas had greatly improved the living environment for service users, providing a clean and homely living space. Three service users were complimentary of the communal areas. The home is generally well maintained throughout. Many of the bedrooms were visited which were personalised and Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 16 homely. A full-time maintenance person is employed. A large well maintained garden is to the rear of the home. The manager and housekeeping staff have worked hard to improve the standard of cleanliness throughout the home. The kitchenettes on each floor, which are used to prepare service users’ breakfast and hot drinks were viewed and found to be clean. The communal bathrooms were clean. Cleaning schedules for all areas of the home are in place. The main kitchen was seen and again this standard of hygiene in the kitchen had improved since the previous inspection. Infection control measures were in place, with clinical waste dealt with appropriately. However it is recommended as good practice that all staff receive infection control training. The laundry facility was clean and organised. Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29,and 30 The staff provided can meet the nursing and personal care needs of the service users. The procedures for the recruitment of staff are robust and provide the necessary safeguards to offer protection to the service users. All staff had been provided with mandatory training. Quality in this outcome area is judged to be good. This judgment has been made using available evidence including a site visit. EVIDENCE: The home was providing care for 24 service users at the time of the inspection. The staffing levels operating were for 30 service users in line with the Staffing Notice; therefore the home was complying well within the Staffing Notice. Two qualified nurses are on duty at all times day and night. The Manager Sue Robins who is also a qualified nurse works Monday to Friday supporting the two qualified nurses. This is considered to be a good ratio of qualified nurses to the amount of service users requiring nursing intervention. A team of 4 carers supported the qualified nurses. Domestic staff and kitchen staff were also on duty. The inspector spoke with 3 members of staff during the course of the inspection, all of whom spoke positively about working at the home. It was evident through observation and reviewing the care records of service users, that the care staff knew the care needs of the service users well. Two members of the care team expressed how they had benefited from recent training in “Abuse Awareness”. Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 18 Four employment files were reviewed all of which contained an application form, two references and appropriate police checks. All files contained proof of the persons’ identification. The same employees training files were seen which provided evidence of all mandatory training being provided. The manager supports NVQ training which many of the care staff and domestic staff had obtained or were in process of completing. Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 The Registered Manager provides good leadership to the home and fully understands her responsibilities. Quality assurance systems are in place. The financial procedures of the home safeguard the service users. The Staff are provided with supervision. Health and safety issues are addressed providing a safe environment for service users and staff. Quality in this outcome area is judged to be good. This judgment has been made using available evidence including a site visit. EVIDENCE: The registered Manager Mrs Sue Robins has been in post approximately three years. During this period Mrs Robins has had to deal with two changes of ownership to the home, which had created some difficulties for the Manager and the home. However the home now presents as a stable environment for service users, with the Manager providing good leadership to the staff. Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 20 Through conversation with the Manager it was evident she is confident within her role and fully understands the care needs of the service users. Service users personal money is held in a bank account with a record of all transactions kept in the home. The administrator and Manager make regular audits of the account ensuring that the service users personal money is safeguarded by the audit trail. Quality assurance systems are in place through the organisation and service users/relatives surveys had recently been sent out to appropriate people. The home also holds regular “Clients and Families” meetings which is an opportunity for any concerns or complaints to be raised between the management of the home and families of the service users. As required from the previous inspection staff had been provided with regular clinical supervision, which is documented. However the Manager informed the inspector further training will be given to ensure that the staff who are responsible for providing fully understand how supervision is conducted. The home is well maintained throughout with health and safety issues addressed. The fire record indicated that all appropriate testing of the fire alarm system was taking place and staff had received fire training. Accidents had been recorded as to how the accident had taken place and what action had been taken by the home following the accident. The Manager audits the accident record monthly to ensure that any reoccurring accidents have been identified and fully risk assessed. Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 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 X 3 X 3 3 X 3 Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action 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 OP26 Good Practice Recommendations All staff should be provided with infection control training. Ravenscroft DS0000065178.V295833.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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