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Inspection on 10/01/07 for Ravenscroft Nursing Home

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

This inspection was carried out on 10th January 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

What the care home does well

What has improved since the last inspection?

The position for a registered manager for this home is vacant, in the meantime the temporary arrangements have provided a safe system of management. The recent employment of a nurse to lead the clinical team has improved the teams moral and their confidence, this should improve the standard of care provided to residents.

What the care home could do better:

Each resident has a plan of care however these are not reviewed regularly or always updated when changes in needs are recognised. This poses a risk that peoples changing needs may not be met consistently. A requirement has been made in this report to ensure care plans are inclusive and regularly reviewed. The homes medication policies and procedures for dealing with medicines do not completely protect people who use this service. Very few residents are given the opportunity to self medicate, those spoken to said they had not been asked if they would like to do so and there were no documented assessments in relation to residents managing their own medicines. Nurses were observed to administer medication into pots and carry these on a tray to residents in different areas of the home. This poor practise was discussed by the inspector particularly with regard to the risk that incorrect medicines may be given and records may not accurately reflect the medicine given or not. These practices put services users potentially at risk. Residents and their relatives/friends know how to make a complaint but verbal complaints are not handled in accordance with the homes procedure. This may mean that required improvements in practise are not identified and some residents may not have all of their needs met.Some equipment such as mobile commode chairs looked damaged and worn and some were rusty as were some bath hoists. Soap bars were seen on some baths this poses a risk of cross contamination, as the warm damp surface is a perfect medium for bacterial growth. The homes recruitment practice does not fully protect residents from being placed at risk of harm or abuse. The personnel records held on behalf of 4 recently employed members of staff were inspected; the records were incomplete and did not all contain 2 written references, proof of identity or that gaps in employment had been explored.

CARE HOMES FOR OLDER PEOPLE Ravenscroft Nursing Home Ravenscroft Nursing Home Old Crapstone Road Yelverton Devon PL20 6BT Lead Inspector Fiona Cartlidge Unannounced Inspection 10th January 2007 09:50 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 Nursing Home DS0000029227.V327164.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 Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ravenscroft Nursing Home Address Ravenscroft Nursing Home Old Crapstone Road Yelverton Devon PL20 6BT 01822 853491 01822 853444 enquiries@ravenscroftcare.com 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) Timothy O`Carroll Mrs Karen Louise O`Carroll Vacancy Care Home 54 Category(ies) of Old age, not falling within any other category registration, with number (12), Physical disability (12), Physical disability of places over 65 years of age (40) Ravenscroft Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Old age, not falling within any other category (12) Physical disability over 65 years of age (40) Terminally ill (4) 2 Residents under the age of 65 years (named elsewhere) Physical disability (12) A maximum of 54 residents at any time Date of last inspection 28th June 2006 Brief Description of the Service: Ravenscroft is a care home providing nursing and/or personal care for a maximum of 54 residents of either gender with physical frailty, illness or disability. It is situated near Yelverton, West Devon, on the edge of Dartmoor National Park. The home is arranged on 3 floors within an older ‘Edwardian’ house and more modern extensions. A new purpose built wing was registered and opened in September 2005; all rooms in this wing have en-suite toilets and are attractively decorated and furnished. Further improvements to the existing environment are on going. The home is well equipped to meet the needs of those residents identified with moving and handling risks and disabilities that affect their capability to bathe. Specialist equipment such as mattresses are in place for those residents requiring them as were height adjustable beds. Level access is achieved via 3 passenger lifts. There are 3 lounges and a dining room. There are large grounds, with grass and paved areas, with level access from the house. Information about the home was found in the entrance hall and people can request a copy of the latest inspection reports from the administration office. Information given to the Commission by the provider indicates the current range of fees is from £287 to £699/week. Ravenscroft Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit took place over 7 hours 30 minutes and was unannounced. A partial tour of the home took place when some bedrooms and all communal areas were viewed. Four residents had their care case tracked - this means their records were examined in detail, and three of the four residents were spoken to in depth about the care and services they receive. The fourth resident being case tracked was spoken to briefly, their care was observed and their next of kin provided information about their care. Five other residents were spoken with during the visit, as were 3 members of staff and the registered provider. Personnel records of 4 members of staff and policies and procedures were also inspected. What the service does well: The home has a residents guide; this document sets out the aims and objectives of the home and provides comprehensive information about the service. This enables prospective residents to make an informed choice about the home. An assessment of care needs of a prospective resident takes place prior to admission to the home. Records seen included copies of assessments carried out through care management arrangements and hospital/community health care teams where applicable. This should mean that residents are assured their needs are able to be met within this care home. Staff in the home make referrals to specialist health care professionals when needed. Records detail visits by General practitioners and also telephone calls made to them about their patients. This should mean that the health care needs of residents are met. Some effort is made to meet the social, cultural, religious and recreational needs of residents. Residents are provided with a monthly newsletter, which indicated that in January residents would be given the opportunity of going to a pantomime, receiving communion, being provided with musical entertainment by an organist, guitarist and key board player. The people living in the home said they were happy with the visiting arrangements, visitors said they feel welcomed into the home and are able to visit their relative/friend in private or socially. Ravenscroft Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 6 Residents receive a wholesome appealing diet. The feedback about food was positive - all of the residents spoken to said how good it was. The environment was found to be largely odour free, those residents spoken to about their private accommodation said they like the décor in their own rooms. The furniture, furnishings and equipment in communal rooms appeared to be in good order. There are usually sufficient numbers of staff with appropriate skills and knowledge to meet the needs of residents in this home. Residents spoken to during the inspection said the staff were kind and able to meet their needs. Quotes from residents included: ‘the staff will do anything, no trouble what so ever’, ‘all the staff are nice’ ‘the staff are good and very kind’ ‘all the staff are so helpful, nothing is too much trouble’. What has improved since the last inspection? What they could do better: Each resident has a plan of care however these are not reviewed regularly or always updated when changes in needs are recognised. This poses a risk that peoples changing needs may not be met consistently. A requirement has been made in this report to ensure care plans are inclusive and regularly reviewed. The homes medication policies and procedures for dealing with medicines do not completely protect people who use this service. Very few residents are given the opportunity to self medicate, those spoken to said they had not been asked if they would like to do so and there were no documented assessments in relation to residents managing their own medicines. Nurses were observed to administer medication into pots and carry these on a tray to residents in different areas of the home. This poor practise was discussed by the inspector particularly with regard to the risk that incorrect medicines may be given and records may not accurately reflect the medicine given or not. These practices put services users potentially at risk. Residents and their relatives/friends know how to make a complaint but verbal complaints are not handled in accordance with the homes procedure. This may mean that required improvements in practise are not identified and some residents may not have all of their needs met. Ravenscroft Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 7 Some equipment such as mobile commode chairs looked damaged and worn and some were rusty as were some bath hoists. Soap bars were seen on some baths this poses a risk of cross contamination, as the warm damp surface is a perfect medium for bacterial growth. The homes recruitment practice does not fully protect residents from being placed at risk of harm or abuse. The personnel records held on behalf of 4 recently employed members of staff were inspected; the records were incomplete and did not all contain 2 written references, proof of identity or that gaps in employment had been explored. 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. Ravenscroft Nursing Home DS0000029227.V327164.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 Ravenscroft Nursing Home DS0000029227.V327164.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): 1,3,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with sufficient information about the service to enable them to make a decision about admission to the home. The admissions process is safe. This home does not provide intermediate care. EVIDENCE: The home has a residents guide, this document sets out the aims and objectives of the home and provides comprehensive information about the service. This booklet was available in the entrance of the home and each resident’s room. Four residents were spoken with about the information they received before entering the home; all of those spoken to said they felt they had received enough information. Ravenscroft Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 10 An assessment of care needs of a prospective resident takes place prior to admission to the home. Records seen included copies of assessments carried out through care management arrangements and hospital/community health care teams where applicable. The clinical lead for the home explained that she visits prospective residents prior to their admission, but records did not provide evidence that the assessments performed are consistent or inclusive. A full assessment of need is performed by staff employed by the home following the residents’ admission and this information and that from the preadmission care management/health assessments informs the homes care planning process. Ravenscroft Nursing Home DS0000029227.V327164.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): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident has a plan of care however these are not reviewed on a monthly basis or always updated when changes in needs are recognised - this poses a risk that residents changing needs may not be met consistently. Staff in the home make appropriate referrals to specialist health care professionals when needed. The homes medication policies and procedures for dealing with medicines do not completely protect people who use this service. Residents are treated with respect and their right to privacy is usually upheld. EVIDENCE: Residents individualised files included care plans, manual handling assessments, and tissue viability assessments. Two of the four care plans examined were not well completed in that they missed important information Ravenscroft Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 12 that would impact on residents care; staff would not be consistently aware of residents needs, for example: residents care plans missed wound care information, information on residents social history and interests. Daily records of care provided were informative but information on them was not always used to plan identified needs. One resident was found to be at risk of falls but there was no documented plan for staff to follow to minimise this identified risk. A resident who was reported to settle and sleep well at night had a documented plan for the use of bed rails but the need for these was not clear, records showed that bed rails may well have compromised the residents safety as it was reported that their legs had been found caught between the rails, despite this the plan had not been reviewed. Reviews of documents have not been completed in detail on a regular or on going basis so do not capture changes in residents care needs. Daily reports highlighted care being given that was not detailed in care plans. The lack of consistent well-maintained records poses a risk to residents because the staff may not have the information they need to care for the full range of residents needs. The records provided evidence that staff in the home make referrals to specialist health care professionals. Records detail visits by General practitioners and also telephone calls made to them about their patients. When speaking to staff who had been employed at the home for some time they were clearly aware of residents overall care needs such as what they eat, if they needed assistance with washing and dressing; residents consistently said that they felt cared for and that staff treated them with kindness and respect, taking into account their privacy. During the visit the inspector noted that some staff did not always routinely knock on the doors to residents private accommodation before entering. Very few residents are given the opportunity to self medicate, those spoken to said they had not been asked if they would like to do so and there were no documented assessments in relation to this. No residents were self-medicating at the time of this inspection. Nurses were observed to administer medication into pots and carry these on a tray to residents in different areas of the home. During discussions with the trained staff it was evident this is common practise. This poor practise was discussed by the inspector particularly with regard to the risk that incorrect medicines may be given and records may not accurately reflect the medicine given or not. These practices put residents potentially at risk. The procurement, receipt and returns of medicines was well managed, documents were in place. The storage facilities for medicines were good at the home. However, how the medicine was stored was poorly managed. Over stocking and poor rotation of medicines is costly, could mean that medicines pass their best before date and showed the system is disorganized. A tour of the building confirmed that Ravenscroft Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 13 prescribed creams, lotions, and products were being used on Residents for whom they were not prescribed. This may result in residents having prescribed products that are not right for them and may result in reaction with other medication or may mean that residents may not have the product available should it be required. The controlled drugs register was well maintained. Medications requiring storage in a fridge was done safely. Ravenscroft Nursing Home DS0000029227.V327164.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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some effort is made to meet the social, cultural, religious and recreational needs of residents. Residents are able to maintain contact with family and friends. Residents receive a wholesome appealing diet. Residents are usually helped to exercise choice and control over their lives. EVIDENCE: During the site visit, some residents were seen sitting in the lounges; in one lounge a television was on, but none of the residents seemed to be aware of or interested in the programme. Other residents were seen spending time in their rooms, reading, listening to music, and watching television. In the afternoon an entertainer was seen chatting with residents. Residents are provided with a monthly newsletter it indicated that in January residents would be given the opportunity of going to a pantomime, receiving communion, being provided with musical entertainment by an organist, guitarist and key board player. In Ravenscroft Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 15 addition the newsletter advertised chiropodists visits and on the day of the visit the homes physiotherapist was seen visiting residents. The feedback about food was positive, all of the residents spoken to said how good it was; during the inspection lunch was served, residents were offered ham egg and chips or curry. Some residents ate lunch in the lounge/dining rooms; some residents ate their lunch in their own accommodation. Observation took place at lunch time in the 1st floor lounge/dining room, where residents required assistance, this was provided whilst they sat in their lounge chairs by staff on a 1:1 basis in a relaxed fashion. Five residents required assistance but only 2 staff were available to give this, this meant that residents were not all provided their meals at the same time, rather ‘one after the other’. Records seen provided evidence that it is not usual practice for residents to undergo nutritional screening and have a nutritional care plan, but resident’s weights are regularly monitored. The people living in the home said they were happy with the visiting arrangements, visitors said they feel welcomed into the home and are able to visit their relative/friend in private or socially. Ravenscroft Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents and their relatives/friends know how to make a complaint but verbal complaints are not handled in accordance with the homes procedure. People feel safe living in this home. EVIDENCE: The complaints procedure was found to be included in the document ‘residents guide’, which was situated in the entrance hall and in resident’s rooms. Three people who had their care case tracked said they were aware of how to make a complaint but all confirmed they had nothing to complain about. These residents said they feel safe living in the home. The Provider said they had not received any complaints since the last inspection and their were no records of any complaints. A relative of a resident told the commission that they have made several verbal complaints to the nursing staff about the care provided to their relative, but they did not feel these had been taken seriously or acted upon. The Relative/complainant confirmed that these complaints would now be put in writing to both the Registered provider and copied to the Commission. Ravenscroft Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 17 The policies and procedures seen, included information about adult protection and whistle blowing. Records indicate that 12 staff received training in September on the protection of vulnerable adults and 16 in October 2006. Despite receiving this training one member of staff spoken to was unaware of which external agencies would need to know about allegations or incidence of abuse. Ravenscroft Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is safe and adequately maintained and the home is clean and hygienic. EVIDENCE: A partial tour of the home took place, not every bedroom was seen, but those that were looked homely and there was evidence that residents have been able to bring personal belongings with them in to the home. Those residents spoken to about their private accommodation said they like the décor in their own rooms. The furniture, furnishings and equipment in communal rooms appeared to be in good order. Ravenscroft Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 19 Passenger lifts provide access to less mobile residents between 3 floors; the home has increased in size, the newer extensions have been built for their purpose and are suitable for people with diverse physical needs. All bedrooms in the new extension have en suite facilities. Some equipment such as mobile commode chairs looked damaged and worn and some were rusty as were some bath hoists. Soap bars were seen on some baths this poses a risk of cross contamination, as the warm damp surface is a perfect medium for bacterial growth. The environment was found to be largely odour free and hand wash facilities and disposable gloves were generally available through out the home. Ravenscroft Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are usually sufficient numbers of staff with appropriate skills and knowledge to meet the needs of residents in this home. The homes recruitment practice does not fully protect residents from being placed at risk of harm or abuse. EVIDENCE: The personnel records held on behalf of 4 recently employed members of staff were inspected; the records were incomplete and did not all show 2 written references, proof of identity or that gaps in employment had been explored. Each file did contain a completed application form but references from the latest employers had not been recorded for 2 of the 4 records seen. Training records seen indicated that some members of staff had received some training in fire safety, moving and handling and protection of vulnerable adults since the last inspection (June 2006). A notice seen advertised First Aid training to be held for 12 staff later in the month of January 2007. Individual records seen for 4 staff members showed that other training received in 2006 included: Confidentiality, Infection control, Epilepsy, Conflict, Diabetes, Ravenscroft Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 21 Diversity, Oral hygiene and Dealing with challenging behaviours. Care staff have either achieved National Vocational Qualifications (NVQ’s) in care or have been enrolled to undertake them. Residents spoken to during the inspection said the staff were kind and able to meet their needs. Quotes received were ‘the staff will do anything, no trouble what so ever’, ‘all the staff are nice’ ‘the staff are good and very kind’ ‘all the staff are so helpful, nothing is too much trouble’. The staff spoken to on the day of the inspection said they sometimes felt there were insufficient staff available. At the time of the inspection there were 33 residents with varying needs. Staff said that the number of staff depended on the number of residents and that the time taken to meet individual needs was not factored, some residents with high needs were taking up much of the staffs time. On the day of the inspection the clinical lead nurse was on duty between 09:00hrs and 17:00hrs, a Registered nurse was on duty between 07:30hrs and 14:30hrs as were 4 Care Assistants another Registered Nurse came on duty at 14:hrs until 20:30hrs supported by 2 carers working the same hours and a carer from an agency, with another carer working the morning and afternoon/ evening – a 13 hour shift which they confirmed was very tiring. Night staff work an 11 hour shift and comprise of 1 Registered nurse supported by 2 carers. Residents spoken to said the staff work very hard; they confirmed that it sometimes takes up to five minutes for staff to respond when they ring their call bells. This was confirmed during the site visit through observation of practice and discussions with the provider. The day care staff are supported by administrative, maintenance, catering and domestic staff. Ravenscroft Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The position for a registered manager for this home is vacant, in the meantime the temporary arrangements have provided a safe system of management. Personal money handled by the home on behalf of residents is not secure. The registered provider shows a responsible attitude toward promoting and protecting the health, safety and welfare of residents and staff. EVIDENCE: There has been no registered manager at the home in recent months. The Providers have been managing the home in this time and have made sure safe systems are in place to help protect residents. The Providers have now employed a lead nurse who is a registered nurse with experience of working in Ravenscroft Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 23 care homes. Staff spoken to said she was supportive and it made a real difference having a nurse in charge of care issues at the home. Discussions with the Providers and Lead Nurse confirmed that they are aware of what needs to change and improve in the home. The Lead nurse was clear that training and supervision needed to be a priority but in the last few months has been working with staff to understand the routines of the home and to get to know the residents and staff. The Lead nurse was also clear about how care would be planned and delivered in the future. Some formal systems of communication are in place, the minutes of meetings held between the senior management team i.e. the provider, clinical nurse lead and administrator were seen, as were meetings between the providers and catering team. The care staff meet 3 times a day at handovers, observation of this showed only small amounts of information about residents needs are discussed and little time is available because of shift patterns for more useful interaction at these times. There was little documentary evidence of quality assurance or quality monitoring systems. The provider confirmed that a questionnaire has been devised but this has not been sent to all residents or their representatives, those that have been returned have yet to be collated or reported on. The provider said there have not been any formal meetings held between themselves or the residents/representatives. Measurement of customer satisfaction remains informal; letters of gratitude and positive outcomes for people using the service were seen. The provider confirmed that an annual internal audit for quality assurance is due to be introduced. The inspector examined the records of money held on behalf of residents in the home; it was not possible to check the records against actual balances because the money is held in a pooled bank account (Ravenscroft business account 2). The provider demonstrated a responsible attitude towards health and safety of the environment all fire doors that were open were being held by ‘safe’ hold open devices and notices were displayed throughout the home. The home employs its own maintenance person and records of checks and services by visiting professionals were seen on equipment around the home. Risks to residents’ safety and well being are individually assessed and documented but it is not always clear who has agreed the action plan or what action is to be taken. The inspector found the risk assessment for 1 resident indicated the need for bedrails however records indicated this person settles and sleeps well but had been found with their legs trapped between the rails, there appeared to be no re-assessment of the apparent minimal risk, nor a plan to prevent reoccurrence of the incident. Ravenscroft Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 3 Ravenscroft Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Residents care plans must be inclusive and regularly reviewed and updated when a change in need requiring a change in their care occurs. Not met on due date: 01/08/06 The registered person must make suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This requirement relates to the pre potting of medications for administration and records being completed some time before or after the administration. This poses a risk that residents do not receive the correct medication or that records do not provide an accurate picture. Prescribed substances for topical application must be administered for those people they are prescribed only. To ensure that all residents have opportunities for stimulation through leisure and recreational DS0000029227.V327164.R01.S.doc Timescale for action 01/03/07 2. OP9 13(2) 01/03/07 3. OP12 12(2)(3) 01/03/07 Ravenscroft Nursing Home Version 5.2 Page 26 activities in and outside the home which suit their needs, preferences and capabilities their interests must be recorded. Not fully met on due date: 01/09/06 4 OP16 22(3) The registered person must ensure that any complaint made under the complaints procedure is fully investigated. Not met on due date 01/09/06 The registered person must not employ a person to work at the care home unless the person is fit to work at the care home. All references and gaps in employment must be explored and previous employers references must be taken up. Not met on due date: 01/09/06 The registered person must appoint an individual to manage the care home because there is no registered manager in respect of this care home. The registered person must establish and maintain a system for reviewing at appropriate intervals and improving the quality of care including nursing at the home and make a report of the quality review available for residents and or their representatives and the Commission. Not met on due date: 01/11/06 The registered person must not pay money belonging to any resident into a bank account unless – the account is in the name of the resident to which the money belongs and the account is not used by the registered person in connection DS0000029227.V327164.R01.S.doc 01/03/07 4. OP29 19 01/03/07 5. OP31 8 30/04/07 6. OP33 24 01/03/07 7 OP35 20 01/03/07 Ravenscroft Nursing Home Version 5.2 Page 27 with carrying on or management of the home. 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 To prevent the risk of cross contamination Soap bars should not be stored in communal bathing rooms. To enable adequate cleaning of equipment to maintain them in a hygienic state - rusty and damaged commode chairs and hoists should be repaired/replaced. Staffing numbers should reflect the assessed needs of the residents as well as their number and the size and layout of the home. 2 OP27 Ravenscroft Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Ravenscroft Nursing Home DS0000029227.V327164.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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