Random inspection report
Care homes for older people
Name: Address: Ravenscroft Nursing Home Old Crapstone Road Yelverton Devon PL20 6BT one star adequate service 22/10/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Anita Sutcliffe Date: 1 1 0 6 2 0 0 9 Information about the care home
Name of care home: Address: Ravenscroft Nursing Home Old Crapstone Road Yelverton Devon PL20 6BT 01822853491 01822853444 enquiries@ravenscroftcare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Susan Mason Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ravenscroft Homes Ltd care home 54 Number of places (if applicable): Under 65 Over 65 54 0 old age, not falling within any other category physical disability Conditions of registration: 0 54 The maximum number of service users who can be accommodated is 54 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability (Code PD) Date of last inspection Brief description of the care home 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
Care Homes for Older People Page 2 of 10 2 2 1 0 2 0 0 8 Brief description of the care home near Yelverton, West Devon, on the edge of Dartmoor National Park. The home is arranged on 3 floors within an older `Victorian house, plus a more modern extension and purpose built wing opened in September 2005. All rooms in the wing have en-suite toilets. Further improvements to the existing environment are on going. Level access is achieved via 3 passenger lifts. There are 2 lounges and 2 dining rooms. 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 indicates the current range of fees is from 306 to 650 pounds per week. The actual fee is dependant on the needs of the person and the room occupied. Additional fees are for hairdressing, chiropody, privately funded eye care, outings (with the cost informed in advance) transport for hospital appointments, visitors meals and catering for birthday celebrations with family or friends. Care Homes for Older People Page 3 of 10 What we found:
The Commission has received two complaints about the home since the previous key inspection October 2008. The first, relating to a specific service user, was transferred to their social services care manager. The second related to the particular working methods of one care assistant, staff numbers, training and aspects of management. We decided to do an unannounced random inspection of the home. The complete details of the complaint were delivered to us by the complainant the day after the inspection visit. We are satisfied that any issues raised that were not inspected for this visit can be so when we do our full, key inspection. We were shown the report from the homes investigation into some aspects of the complaint we received. The conclusion was that there had been a dispute between staff, voices had been raised and this was unprofessional. However, the manager Susan Mason, has since ensured that the care assistant involved has the competence to work safely. At our visit we spoke with two people who use the service who are able to communicate their opinion. We wanted to know their opinion of the care provided by the member of staff mentioned in the complaint. One told us: I have absolutely no problem with xxxxx care practice. The other told us: No he is lovely and always a smile. A nurse working at the home told us: At first he had no skills, especially moving and handling, but I have worked with him. I found him willing to learn and residents like him because he is gentle. The registered manager, Susan Mason, told us that since the complaint she has specifically observed the way the care assistant works so that she can be confident that the standard is satisfactory. There were twenty nine people resident in the nursing home when we visited. One nurse and five care staff, two of which were new to the home, were providing care. The manager, Susan Mason, was on duty. Six support staff were also on duty. We looked at concerns raised about staff shortages. A complainant had told us that the home were not permitted to get additional staff from an agency to cover staffing shortfalls. The manager told us that she did arrange agency cover when this was necessary. We did confirm that there have been occasions when staffing levels were particularly poor due to staff sickness. The manager was not aware that she is required to notify us of any event that adversely affects the well-being of people at the home, including staff shortage. We saw from records of staff and residents meetings that low staffing numbers are a concern to people. The manager, Susan Mason, told residents and their family, incorrectly, that the home followed the South and West Devon Health Authority Regulating Nursing Homes staffing requirements but those requirements do not exist. Under the Care Homes Regulations 2001, which the home is legally bound to comply with, the home must: Ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. We asked two people who use the service if they thought there were enough staff to
Care Homes for Older People Page 4 of 10 meet their needs. One told us: Not enough at night. She added that twice the week before staff could not give her a bath because they had been short staffed. Another told us: I am usually happy with call bell response times but then she continued by giving reasons why there were not enough staff. Staff, asked whether they felt there are enough staff, told us: It depends day to day. I believe not. Service users see us rushing around. They worry that they are taking too much of our time up, At times were short and it is difficult because of the geographic area of the home, Alright unless somebody phones in sick, Relatively good. When staff phone in sick you cant always get people in, On the whole theyre good and It has happened to me twice lately. We tried to cover the night shift with agency staff, but Sue (manager) was on the premises. We asked staff about the standard of training they receive as concerns had been raised that it was insufficient, especially that of moving and handling people safely. The manager told us that staff say they want more training. Staff told us they only get two days for induction training when they are new, whether they have previous experience of care work or not. One nurse told us: I would prefer the staff induction period to be more structured. It needs time and the person needs to be an extra pair of hands and only then an active member. This is where we could improve. Another nurse said: There is no proper orientation for new staff. They are only taught by partnering with care staff and sometimes they are not extra to numbers for long enough. A care assistant told us: Theres not very much training to be honest. A care staff who started at the home four days previous told us he was very happy with his induction so far. He said he had always been with a senior care staff and he was working his way through induction handouts. He told us he had not yet been given fire safety training, which we would have expected on day one in the home. A care assistant who has worked at the home for four weeks also confirmed she had not yet had fire safety training. Neither of them had received moving and handling training other than being shown how to use a hoist. One care assistant felt the training was OK. A nurse who had worked at the home for four weeks told us she had yet to receive any structured induction although she had read and signed appropriate paperwork and the policy folder. She had shadowed an experienced nurse for two days having previously shadowed the manager, so she could get to know the home, in her own time. One care assistant said she had received training in moving and handling, fire safety and food and hygiene and thought the training was OK. All but very new staff have concerns about the training staff receive. Where concerns had centered around the abilities of one staff member we could not substantiate that they lacked knowledge and expertise. However, we saw that the manager has concerns about the training provision for staff. She states: Care staff need the basic skills and training when they start. Moving and handling, basic food hygiene and health and safety. They also need to complete: safeguarding adults (from abuse), infection control and first aid, and of course their NVQ training. We saw from records of staff meetings that there has been much debate about skill mix and allocation of staff. Management have also been trying to address recent high levels of staff sickness.
Care Homes for Older People Page 5 of 10 We spoke with people who use the service about the management. We were told: Sue Mason works very, very hard. Trying to get hold of her is a non-starter. Staff told us: Sue the manager is spot on. You can approach her with anything at all. Brilliant, Manager is lovely and Brilliant. We can relate to her. We were also told: The manager should be allowed to do her job and Matron working with us doesnt give her enough time to manage. The manager, Susan Mason, is very highly regarded by the staff she leads. We took copies of the homes staffing rota for a six week period. Of those forty two days Susan Mason was the manager on call for thirty. This includes twenty five consecutive days. One aspect of the concerns raised with us relates to staff being unable to contact management out of hours when they are on call. Susan Mason was surprised about this, saying she has always been available for contact. One nurse at the home, asked if he has had any problems contacting the out of hours manager told us: That used to be the case before the current manager but Ive never failed to get hold of her. We noted from the staff rota that Susan Mason is sometimes working as the nurse in charge, which means she is providing care and not meeting her management obligations. She is also seen to have done some night duty cover, following a day duty. She also works week ends. Part of a complaint related to staff being unable to access the photocopier in order to copy important records to accompany people to hospital if admitted as an emergency. We saw from the records of a nurses meeting that this had been raised and nurses are now provided with the keys to gain access to the photocopier. What the care home does well: What they could do better:
There must be nursing and care staff in sufficient numbers to meet peoples needs. All but very new staff have concerns about staffing numbers. Staff must receive a level of induction training, and time to consolidate that training, that will equip them to work safely providing care to people. Staff must receive all mandatory health and safety training within reasonable timescales and there must be a roll-on program of training update. There must be adequate time alloted to the manager to ensure her management obligations can be fulfilled. She must not be used as an extra nurse or carer unless it is completely unavoidable. She must not be expected to provide an unreasonable amount of
Care Homes for Older People Page 6 of 10 duty manager cover. The Commission must be notified, within a reasonable timescale, or any event at the home which might adversely affect the well being of people who use the service. This includes staffing shortfalls and staff disciplinary action. We did not on this occasion look at whether the requirements made following the previous key inspection have been met. We will look at those and issues raised from this inspection, when we do the key inspection in the autumn. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans, and all 30/11/2008 information which informs staff what care is to be delivered, must be up to date and accurate. So that the needs and wishes of people are met and they are not put at risk. 2 8 12 (1) Where information 30/11/2008 suggests there is a risk from pressure sores steps must be taken to prevent this. To promote optimum health and welfare. 3 9 13 (2) Where a medicine is prescribed to be given as required or as necessary details of when it may be given must be part of planned care. So that its use is consistent. 30/11/2008 4 9 13 (2) All medicines received into the home must be recorded. To ensure a full audit is possible so as to protect people. 30/11/2008 Care Homes for Older People Page 8 of 10 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 31 37 The Commission must be notified, within a reasonable timescale, of any event which may adversely affect the wellbeing of people who use the service. It is a legal requirement that protects people. 23/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 10 of 10 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
