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Inspection on 12/11/07 for Ravenscroft Nursing Home

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

This inspection was carried out on 12th November 2007.

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

Staff work extremely hard. People who use the service complimented the care staff for their hard work. People who wish to live at the home have their needs assessed before admission. This allows the staff in the home to make a professional and informed judgement about if/how their physical needs are able to be met. Staff in the home make referrals to specialist health care professionals when needed, this promotes and maintains the health of those living in the home.People are able maintain contact with family/friends/representatives and the local community as they wish. People have entertainment available to them at the home. People like the food and appreciate the menu options. The cook received special praise. Parts of the home are attractively decorated and furnished. There are stunning views of the moor and the gardens are attractive and well kept.

What has improved since the last inspection?

Standards have deteriorated since the last inspection.

What the care home could do better:

Knowledgeable, skilled and competent staff are not provided in sufficient numbers to meet the basic needs of people who use the service. Staff are described as: "Well meaning but out of their depth", and "All charming but some haven`t a clue". Staff say that new staff are: "Just thrown in" having had no training and that other staff have to teach them in addition to their normal work. Staff said mornings they are: "Stretched to the brim". Some basic hygiene needs are being neglected. One person, having eaten breakfast, next to a full commode, complained she was unable to wash her hands prior to eating. Staff named several people who they said had never had a bath, shower or hair wash. We visited one person who smelt unwashed. People said: "I`ve never been as low as this" and "It`s awful". People are enduring indignity. Families are frustrated by lack of information and response to their concerns one saying her concerns were: "Dismissed by Matron", another that questions are "brushed aside". Not every complaint is investigated, and where one investigation occurred at the home it should have been passed instead to the Local Authority Safeguarding team. Staff have commenced employment before all necessary checks are in place to ensure they are safe to work with vulnerable adults. Staff are unaware of policies and procedures. These included how to inform the Local Authority Safeguarding team should they have concerns for people`s welfare. Care plans are not always updated and planning only includes problems to be solvedrather than goals to ensure a fulfilled life. Staff say they don`t have time to read care plans. One said they had looked in them for moving and handling information but some plans had none at all and one was out of date. The handling of medicines puts people at risk. We found an antibiotic was being signed for but not given. This could present a serious risk to health. There are insufficient systems in place to ensure the home is run efficiently. Poor stock control of medicines and medical equipment, laundry not returned and not available to dress people. Staff do not receive formal or informal supervision. Parts of the home were unclean; bed tables, laundry and table mats. The provider felt the home`s standard of quality assurance (measuring) was satisfactory, but was unaware of these serious shortfalls in the service. People feel communication is particularly poor. The quality of the service must be properly monitored. There has been no registered manager since July 2006. This is a breach of the Care Standards Act 2000 and may be unlawful. There must be a person registered to manage the home who is fit to do so.

CARE HOMES FOR OLDER PEOPLE Ravenscroft Nursing Home Old Crapstone Road Yelverton Devon PL20 6BT Lead Inspector Anita Sutcliffe Key Unannounced Inspection 12th November 2007 13:00 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.V354630.R02.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.V354630.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ravenscroft Nursing Home Address Old Crapstone Road Yelverton Devon PL20 6BT 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) 01822 853491 01822 853444 enquiries@ravenscroftcare.com 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.V354630.R02.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 Service Users under the age of 65 years (named elsewhere) Physical disability (12) A maximum of 54 service users at any time Date of last inspection 13th June 2007 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 ‘Victorian’ house and more modern extensions. A new purpose built wing was approved 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. 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 by the registered provider indicates the current range of fees is from £314 to £699 per week. The actual fee is dependant on the needs of the person and the room occupied. Ravenscroft Nursing Home DS0000029227.V354630.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection of the home took place following four concerns raised about the service provided within a two-week period. A fifth complaint was received soon after the inspection visits. We (the Commission) visited on two occasions, both unannounced, spending eight hours in total. We spoke with people who use the service, their family, nursing and care staff, cook, cleaner, the nurse in charge of care and the registered provider. We also spoke with community health care professionals with knowledge of the home. We were accompanied on the second visit by a Help the Aged representative working as an ‘Expert by Experience’. He spent three hours talking with people, also sharing lunch, and was able to observe staff going about their duties. His findings are integral to the report narrative and findings presented. All communal areas of the home and several bedrooms were visited. Care records, staff files and some policies were examined. All people involved in the inspection were helpful and friendly throughout the visit. This report includes events following the inspection visit but still within the timescale of the inspection. People who use the service may be described within this report as patients, clients or service users. It has been identified that the home’s registration, and therefore the Service Information presented within the report, is incorrect. We are currently making amendments to the registration but as the process is not yet completed the information remains incorrect at the time of publishing this report. What the service does well: Staff work extremely hard. People who use the service complimented the care staff for their hard work. People who wish to live at the home have their needs assessed before admission. This allows the staff in the home to make a professional and informed judgement about if/how their physical needs are able to be met. Staff in the home make referrals to specialist health care professionals when needed, this promotes and maintains the health of those living in the home. Ravenscroft Nursing Home DS0000029227.V354630.R02.S.doc Version 5.2 Page 6 People are able maintain contact with family/friends/representatives and the local community as they wish. People have entertainment available to them at the home. People like the food and appreciate the menu options. The cook received special praise. Parts of the home are attractively decorated and furnished. There are stunning views of the moor and the gardens are attractive and well kept. What has improved since the last inspection? What they could do better: Knowledgeable, skilled and competent staff are not provided in sufficient numbers to meet the basic needs of people who use the service. Staff are described as: “Well meaning but out of their depth”, and “All charming but some haven’t a clue”. Staff say that new staff are: “Just thrown in” having had no training and that other staff have to teach them in addition to their normal work. Staff said mornings they are: “Stretched to the brim”. Some basic hygiene needs are being neglected. One person, having eaten breakfast, next to a full commode, complained she was unable to wash her hands prior to eating. Staff named several people who they said had never had a bath, shower or hair wash. We visited one person who smelt unwashed. People said: “I’ve never been as low as this” and “It’s awful”. People are enduring indignity. Families are frustrated by lack of information and response to their concerns one saying her concerns were: “Dismissed by Matron”, another that questions are “brushed aside”. Not every complaint is investigated, and where one investigation occurred at the home it should have been passed instead to the Local Authority Safeguarding team. Staff have commenced employment before all necessary checks are in place to ensure they are safe to work with vulnerable adults. Staff are unaware of policies and procedures. These included how to inform the Local Authority Safeguarding team should they have concerns for people’s welfare. Care plans are not always updated and planning only includes problems to be solved Ravenscroft Nursing Home DS0000029227.V354630.R02.S.doc Version 5.2 Page 7 rather than goals to ensure a fulfilled life. Staff say they don’t have time to read care plans. One said they had looked in them for moving and handling information but some plans had none at all and one was out of date. The handling of medicines puts people at risk. We found an antibiotic was being signed for but not given. This could present a serious risk to health. There are insufficient systems in place to ensure the home is run efficiently. Poor stock control of medicines and medical equipment, laundry not returned and not available to dress people. Staff do not receive formal or informal supervision. Parts of the home were unclean; bed tables, laundry and table mats. The provider felt the home’s standard of quality assurance (measuring) was satisfactory, but was unaware of these serious shortfalls in the service. People feel communication is particularly poor. The quality of the service must be properly monitored. There has been no registered manager since July 2006. This is a breach of the Care Standards Act 2000 and may be unlawful. There must be a person registered to manage the home who is fit to do so. 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.V354630.R02.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.V354630.R02.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): 3 (Standard 6 does not apply to Ravenscroft, as intermediate care is not provided). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessment of needs prior to admission is undertaken by a competent nurse but does not take into account the person as a whole, only physical need. EVIDENCE: We met a person recently admitted to the home. She confirmed that she had received an assessment of her needs by ‘matron’ and had made a positive choice to move to Ravenscroft for a ‘period of convalescence’. She said everything in the home is “alright” and her room satisfactory. She had the specialist walking aid necessary for her convalescence. She had received an assessment of her needs the day before admission to the home and confirmed that she had been given written information about the home. Ravenscroft Nursing Home DS0000029227.V354630.R02.S.doc Version 5.2 Page 10 The assessment of her needs was limited to physical requirements: frame for walking, likelihood of pressure sores etc. We looked at two other assessment records and also found that people’s none physical needs, such as social, emotional and mental, were not adequately included. Assessments should take into account the person as a whole. Ravenscroft Nursing Home DS0000029227.V354630.R02.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 poor. This judgement has been made using available evidence including a visit to this service. People are at risk from the way the home manages personal care and medication. They suffer the indignity of poor personal hygiene. EVIDENCE: We did not survey opinion from all surgeries that attend people using the service at Ravenscroft. However, one with regular contact with the home felt the standard of nursing care to be adequate but that adequacy only maintained with their regular input. They said the home makes more than average request for out of hours visits from general practitioners and nurses at the home need a higher degree of support from the district nursing service than other nursing homes require. This has also been noted and commented on by family of people using the service within one of the complaints to social services. Ravenscroft Nursing Home DS0000029227.V354630.R02.S.doc Version 5.2 Page 12 We looked closely at the care of four people who use the service. This involved meeting them, observing what happened to them and reading records of their care. It was clear from records and listening to the nurse making arrangements that, where outside agencies such as doctor, dentist or audiologist are required, this is being arranged. Health care is generally well promoted in this way. We found the standard of basic personal care to be very poor. One person smelt unclean. She said: “I am never properly cleaned. I use the commode in the night, it sits here full whilst I eat my breakfast. I haven’t been able to wash my hands before I eat my breakfast”. Staff said: “Everyone is washed and dressed every day, but they’re not bathed as often as they should be due to lack of staff that know what they’re doing”. A family member said: “I’m not happy with the home and state of my mothers hair and that she cant remember when she was bathed last”. Staff listed people who they have never known to receive a bath, shower or hair wash. Another said that if staff run out of time they get people up without washing them. We looked at plans of care. These should inform staff how to meet people’s needs and aspirations. There was some good detail into how health care problems would be managed. However, the emphasis was on solving ‘problems’, not meeting needs, wishes and enabling a fulfilled life. There was no mention of how social, cultural or emotional need would be met. We asked staff how useful the plans were to them. One said: “ I did moving and handling (training) yesterday. We were told to use the care plans to inform us how to move a person. I went through the plans and in some I couldn’t find it at all”. A trained nurse said: “You’re used as a pair of hands so there is no time to do the paperwork, for example the care plans”. Staff have a ‘hand over’ sheet providing written detail of the needs of people at the home. All nurses and care staff also receive a verbal hand over of information. We looked at one care plan with the trained nurse and found it greatly out of date. Although recently reviewed, it continued to state the person could walk with assistance when they had been completely immobile for ‘some time’. Where a person had been admitted for convalescence following a fall and fracture, there was no moving and handling risk assessment to inform staff how to do this safely. Where a person had a chronic illness that requires specific monitoring, there were no guidelines as to what was normal to them so that staff can identify when abnormality occurs. One person was completely directing her care but there was little evidence that other people had been involved in the planning of their care. Where one person would be able to sign to confirm they had been involved this was not done. Ravenscroft Nursing Home DS0000029227.V354630.R02.S.doc Version 5.2 Page 13 We looked at how the home manages medicines, but we did not conduct a full audit. Where a person chooses to look after their own they have any risk assessed and help is given to minimise any risk identified. Most people have their medicines administered by the trained nursing staff. Medicines are safely stored and appeared orderly. There are records of medicines received into the home and those discarded. However, we found an antibiotic medicine was not given as prescribed, putting the health of that person at risk: eight tablets had been recorded as taken but only six had been taken. We checked the ‘controlled’ medicines against the record and this was correct. We found some stock to be out of date. This included a ‘controlled’ medicine; it had not been used out of date. We also found suction equipment out of date since 2001. Stock needs to be properly controlled so that out of date medicines and equipment is not used by mistake. We found that the temperature of the medicines fridge was not taken on a daily basis, so the correct temperature could not be guaranteed. We issued an immediate requirement that the home audits medicines to ensure that they are being given as prescribed. Staff were observed knocking on doors but then entering before being invited in. People who use the service are living with great indignity due to the overwork of staff. Ravenscroft Nursing Home DS0000029227.V354630.R02.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. The people with greatest need have limited opportunity to live a fulfilled life. The standard of food is good and much enjoyed. EVIDENCE: Some people said there were no activities but others advised of the occasional trip out in a vehicle hired from a charity for which they paid £2 per head. A recent trip was to Plymouth for shopping. One person who uses the service said he had all he needs. He is able bodied enough to enjoy his hobby. He talked of a classical guitarist visiting the home and going to the pantomime at Christmas. We were told that group ‘gentle exercises’ are usually a regular event, but currently the person who does this is unavailable. A member of staff said “Activities are sporadic”, adding that there was a musician this week; Communion is monthly and a ‘pat’ dog fortnightly. She said: “There’s a lot of sitting about”. Several people complained at the frustration of having to wait at the dining table for up to one hour after meals Ravenscroft Nursing Home DS0000029227.V354630.R02.S.doc Version 5.2 Page 15 before being taken to their room or to a lounge -“I could be reading or watching TV”. Staff say they can occasionally spend some time with people, but this is limited to afternoons and infrequent. We saw staff moving people either without speaking to them at all or telling them where they were ‘being taken’. Some were not given options and choice. People do not have their social, cultural or religious needs assessed and neither are they a part of planned care. The Service User’s Guide states: so that people can ‘realise their personal aspirations and abilities’ they will ‘inform themselves as fully as each resident wishes about their individual histories and characteristics…etc’. We did not find this to be the case. Some of the more able bodied people said they chose when to retire and rise, whilst others (less able) said they had no real choice. Staff said: “We have set people to get up and put to bed. Service users have decided. They’re not forced to. They have the choice. Lots want to go to bed early”. People confirmed that they have at least two choices at each meal, more at breakfast. We were impressed by the variety of choices available, for example, ‘ poached eggs, with brown bread, wanted weekends only’. All comments about the food were positive one person saying: “Lovely” adding that it was fresh vegetables and plenty of it. Another said: “The cook is very good”. Staff monitor the weight of people who have poor diet and a there is closer monitoring where concerns are identified. However, one person with poor sight taking meals in their bedroom said that food was not always cut up. We saw many people visiting the home. The Service User’s Guide makes it clear they are welcome and family links will be supported. A regular Newsletter helps people keep up to date with what’s happening in the home. Ravenscroft Nursing Home DS0000029227.V354630.R02.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 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People’s complaints and concerns are not listened to, taken seriously or acted upon. EVIDENCE: This key inspection was initiated because of four complaints about the home received within a two-week period. A fifth complaint was received following the site visit. Complainants said that when they had approached the home their concerns were ‘dismissed’, ‘just brushed aside’; one said that after raising concerns to staff they had complained to her mother that she had ‘made trouble for them’. Another said there was no ill will between Ravenscroft and themselves and some staff are very good. We looked the home’s record of complaints and found two received since June 2007. We then looked at some records of people’s daily care. There was reference to another complaint. This had not been handled under the home’s Complaints Procedure (merely recorded as an event). One of the two ‘complaints’ investigated at the home should have been referred to the Local Authority Safeguarding team, as it was an allegation of rough handling and abusive language, which might have proven to be abuse. Ravenscroft Nursing Home DS0000029227.V354630.R02.S.doc Version 5.2 Page 17 The home’s complaints policy states that the management and staff aim to listen to and act on the views and concerns of service users; evidence suggests this is not the case. It also states that, should the complainant not be satisfied with the way the home manages a complaint, the Commission can be contacted. It should be made clear within the policy that the Commission can be contacted ‘at any stage’ of a complaint, not only if otherwise dissatisfied. There has been recent training for staff in how to protect vulnerable people from abuse. We asked several staff, including those in employment for over a year, where they would find the home’s ‘whistle blowing’ policy (which would inform them what to do should they have any concerns about people’s welfare). None spoken to knew where to find it. It was not possible to determine who had written the whistle blowing policy or when. It did not contain contact details for either the Local Authority Safeguarding team or the Commission, which would help staff report concerns. Staff said they would report any concerns to the lead nurse or Mr. O’Carroll. One was aware she could also inform the Local Authority. The recent five complaints have led to a referral to the Local Authority Safeguarding team because the welfare of people who use the service is in question. Ravenscroft Nursing Home DS0000029227.V354630.R02.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, 22 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home environment is mostly pleasant and meets the needs of people who use the service, but lack of cleanliness and the poor standard of equipment impacts negatively on everybody in the home. EVIDENCE: We toured the home visiting all shared/communal areas and several bedrooms. Many parts are very attractively decorated and stylishly furnished. Some bedrooms are extremely personalised and very much ‘home from home’. The grounds and gardens are attractive and people are able to look at the beautiful moor views from many large windows. We found the carpets in some areas were in a poor state, on two staircases worn and threadbare. The state of decoration was excellent in some parts and Ravenscroft Nursing Home DS0000029227.V354630.R02.S.doc Version 5.2 Page 19 mediocre in others. The registered provider informed us of the ongoing programme of upgrading and repair within the home. Most staff raised concern about equipment at the home. One said: “Better equipment is needed. It is old. We only have one stand-aid for the whole building, so when we need it we have to find it”. All said they wasted time looking for hoists or wheelchair foot-rests. (See also Standard 27). One felt a hoist was actually dangerous. However, the registered provider said there are two stand aids available in the home and produced records which confirmed that all equipment is serviced regularly and therefore should be fully safe to use. The home appeared generally clean but looking more closely we found some bed tables and surfaces to be sticky and unpleasant. Tablemats were stained and had ingrained debris on them. Some commodes were old and stained. There was an unpleasant odour in some parts of the home. Staff are able to handle linen safely. One said: “We have gloves and aprons. There is always bags in the room to put dirty linen and red bags which go straight into the washing machine”. The laundry has commercial equipment, which should be adequate for the needs of the home. The laundry room wasn’t very clean. We found hand soap and paper towels available in areas where staff need to wash their hands to prevent cross infection. However, staff are not supplied with antiseptic gel. This is a concern to health care professionals who visit the home. One carer said she provides her own gel. Ravenscroft Nursing Home DS0000029227.V354630.R02.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 poor. This judgement has been made using available evidence including a visit to this service. People who use the service are not protected by the recruitment, training or supervision of staff. EVIDENCE: People who use the service, their family, staff and health and social care professionals all feel there are insufficient staff at the home to meet people’s needs. Comments include: “Staff are well meaning but out of their depth, due to insufficient numbers and lack of staff”. Most people who use the service claimed they waited between 15 and 30 minutes for their call bell to be answered. We observed a fifteen-minute wait. One person said they had lain on the floor for 35 minutes before a response. People said they can wait up to an hour to be taken from the dining room following lunch. When visiting the home we heard call bells ringing almost continuously, often two or three at one time. However, the call bell records did also show that bells were sometimes answered promptly. Staff responded immediately when the emergency alarm was sounded during our visit. People said that when a carer appeared they were in such a hurry that they only attended to the immediate need and left. Many spoken with commented Ravenscroft Nursing Home DS0000029227.V354630.R02.S.doc Version 5.2 Page 21 that the staff were good people, and worked hard, but were not fully trained in their tasks and under too much pressure. (See also Standard 8). At the time of the inspection there were thirty-six people resident at the home all with needs requiring skill and expertise, for example, to move them safely, and maintain their hygiene. We were told that, according to the rota plan, mornings there should be six care staff and one trained nurse. Afternoons four care staff and one trained nurse and nights two care staff and one trained nurse. We were given examples of when these levels were not reached. If the number of trained nurses on duty at any one time is low for the number of people with nursing needs care staff will be less supervised and nursing tasks may be rushed. (See medication mistake Standard 8). One family complained their mother did not receive her morning tablets until 11 am (nearly lunch time). District nurses are supporting Ravenscroft nurses with the nursing/health care tasks normally undertaken by the qualified nurses in a nursing home. A staff member said: “Induction training is satisfactory but can be poor for those who haven’t done care before. New staff make it hard for others. They’ve not got enough skills or knowledge and are not extra to normal staff numbers. They keep asking for help and you have to keep an eye on them. You can’t show them properly”. Another said: “New staff don’t learn the basics before they’re working on the floor”. Recently recruited staff say: “We shadow the first morning and are then ’chucked in’. A person using the service said: “They employ staff who have inadequate training and haven’t got a clue what they’re doing”. There are also concerns about the staffs’ level of understanding. We established that staff whose first language is not English receive the same level of induction, training and supervision as those with good levels of understanding and communication. The home employs an administrator, cleaners, laundry and maintenance staff, but this does not reduce the work-load on care and nursing staff to a level where there are sufficient staff to meet health and personal care needs. We examined the recruitment records of three recently employed care staff. We found one of those recruitments to have been adequate and robust. Two were not. This leaves people who use the service at risk from staff who may be unsuitable to work with them. No references had been received for one staff and two had started employment before the necessary (police) safety checks were in place. Neither had the list of people unsuitable to work with vulnerable adults (POVA) been checked prior to employment. Neither did staff who commenced employment before the checks were complete, have another staff member working along side/supervising them. Ravenscroft Nursing Home DS0000029227.V354630.R02.S.doc Version 5.2 Page 22 Ravenscroft Nursing Home DS0000029227.V354630.R02.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): 31, 33, 35, 36 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Both the people who use the service and the staff are put at risk by the way the home is managed. EVIDENCE: The provider is usually at the home and says he available to staff and people who use the service should they wish to speak with him. Relationships amongst staff, and people who use the service and staff, are generally good. Comments include: “Staff are all charming and very nice” and “Residents and staff are really nice”. Family who had made a complaint against the home said: “No individual staff are criticised”. Ravenscroft Nursing Home DS0000029227.V354630.R02.S.doc Version 5.2 Page 24 There has clearly been much investment in the fabric of the home, which in many parts is furnished attractively and pleasant to be in. Many people raised concerns regarding poor communication in the home. The most significant is that people’s concerns are not listened to. This has led to the family of five people who use the service taking their complaints to Social Services; those complaints were unknown to the providers. Local general practitioners say that when they are called in to Ravenscroft staff are often unaware of why they have been called. This is despite a written and verbal ‘hand over’ of information between staff, which should keep them up to date. Staff do not use people’s plans of care to keep them informed. One member of staff said: “I never felt I couldn’t go to the manager. Can’t fault that”. Another said: “The lead nurse doesn’t tell people what’s going on and the manager doesn’t like talking to people. He’d rather write it down”. This home is required to have a registered manager who has demonstrated to the Commission that they are fit to manage the service, especially people’s day-to-day care. There has been no registered manager at Ravenscroft since July 2006. The current ‘matron’ has been in post for one year now. She manages the health and personal care aspect of the service with the registered providers continuing to manage the business side. At the June inspection she said she was in the process of completing the application forms to register with the Commission. She said the same at this inspection. No application has yet been received. Previous concerns about the home’s management of people’s money have now been dealt with. The provider confirms that no person’s money is kept in a joint bank account and all but one person is invoiced for money they spend at the home. The amount of cash kept for one person is kept securely. We looked at the homes’ policy and procedures file. These are not named or dated and so it is not possible to determine when they were reviewed. A trained nurse at the home felt they were of no use to inform staff what is expected of them. Three staff, asked about the policy, which should be used toward the protection of vulnerable adults from abuse, said they where unaware of it. This leaves staff with no set guidelines on policy and procedure adding uncertainty and risk of mistakes. The provider has recently purchased a ‘tool’ to measure quality of the service at the home. Staff say they have occasional staff meetings, but problems they have voiced have not been dealt with, for example, inadequacy of equipment. Four staff said they do not receive one-to-one supervision of their work. We feel, based on the number of problems identified by people who use the service, that the day to day supervision of staff is poor, this most likely due to pressure of work/inadequate staffing numbers. There are no meetings for people who use the service. However, there is a regular newsletter of Ravenscroft Nursing Home DS0000029227.V354630.R02.S.doc Version 5.2 Page 25 information. It is clear from the inspection findings that the quality of the service is not monitored either to establish people are happy at Ravenscroft, or that standards of personal and health care are adequate and safe. Staff contacted us following the inspection visit. They said the provider’s had questioned them about information they had given us toward the inspection. One said she had been intimidated by their questioning and felt it was unprofessional to do this in front of people at the home. The providers are required to arrange a monthly, unannounced visit to have standards at the home assessed. A report of the findings should be forwarded to the registered provider, registered manager when in place, and the Commission. This is both a requirement and a way of monitoring the quality of service provided. The provider said this is unnecessary as he spends much time at the home. However, we have established that he is not aware of people’s poor opinion of the home and the service provided. We were shown records for servicing of moving and handling equipment, and we saw no maintenance concerns that might be a danger to people using the service. However, the worn carpet (see Standard 19) might pose a risk. The registered provider says it does not. Staff are unhappy with the standard of moving and handling equipment that is available to them. The maintenance worker said he undertakes weekly fire safety checks that all equipment is serviced and maintained as required. No people other than staff said the environment (including equipment) was unsafe. Ravenscroft Nursing Home DS0000029227.V354630.R02.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 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 1 17 X 18 2 3 X X 2 X X X 2 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 2 X 1 Ravenscroft Nursing Home DS0000029227.V354630.R02.S.doc Version 5.2 Page 27 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(1)(2) Requirement People’s 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, 01/03/07 & 31/07/08 People must be assisted to maintain the standard of hygiene and personal care which they desire and need, so as to maintain their health, dignity and wellbeing. Medicines must be given as prescribed, not signed for as administered when they have not, which is detrimental to their health. An immediate requirement was issued. People should be consulted about their social interests and needs so that staff are aware how they can be of assisted to meet those needs. Timescale for action 31/12/07 2. OP8 12(1) 13(4)(a) 30/11/07 3. OP9 13(2) 16/11/07 4. OP12 15(2)(m) 10/01/08 Ravenscroft Nursing Home DS0000029227.V354630.R02.S.doc Version 5.2 Page 28 5. OP16 22 6. OP26 23(2)(d) 7. OP27 18 8. OP29 19 Schedule 2 (1-9) All complaints must be listened to, recorded, investigated and followed up in a manner which is not intimidating or dismissive so that people will feel confident their concerns will be heard and dealt with properly. All parts of the home must be kept clean. Commodes must be emptied within a reasonable time. The home environment will then be more pleasant and hygiene improved. There must be, at all times, suitably qualified, competent and experienced trained nurses, care staff, cleaners, kitchen and laundry staff working at the home in sufficient numbers, appropriate to the needs of people using the service and taking into account the size and layout of the home, so that people’s needs can be properly met. Staff must not start employment at the home until all checks, required to ensure that person is safe to work with vulnerable adults, have been completed. Where meeting staffing shortfalls is a priority, the POVA 1st and both references have been received and are satisfactory, but the Criminal Record Bureau (CRB) is not yet returned, they may start employment with close, named supervision. An immediate requirement was issued. 16/11/07 30/11/07 16/12/07 16/11/07 Ravenscroft Nursing Home DS0000029227.V354630.R02.S.doc Version 5.2 Page 29 9. OP33 24(1)(b) 10. OP33 26 11. OP33 37(1)(e) 12. OP38 18 There must be a system for reviewing and improving the quality of care including nursing care. To this end there must be improved communication with all people who have involvement in the home, and systems to properly monitor what is happening in the home, so that failings can be identified and corrected. This requirement was met in part on 30/09/07. On behalf of the organisation there must be a monthly, unannounced inspection visit to the home by a person who is not directly concerned with the conduct of the care home. They must prepare a written report on the conduct of the home and supply a copy to the Commission and (when possible) the registered manager. This will be part of the home’s quality monitoring. The Commission must be informed where there are staffing shortfalls that affect the well-being or safety of people using the service, including dates and times. Staff must receive induction training to a sufficient standard that they are not a risk to people or themselves. They must be additional to normal staffing numbers until they have enough experience to work without close supervision. This will ensure staff providing care are sufficiently competent to do so. 31/01/08 30/11/07 16/11/07 31/12/07 Ravenscroft Nursing Home DS0000029227.V354630.R02.S.doc Version 5.2 Page 30 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. 2. 3. 4. Refer to Standard OP3 OP9 OP9 OP16 Good Practice Recommendations There should be a holistic assessment of need prior to admission so that emotional and social need is also understood and included in the planning of care. There should be a system of stock control of medicines at the home so that those out of date are removed. This will reduce the opportunity for using them by mistake. There should be a daily record of the medicines fridge temperature so as to ensure those medicines are being stored correctly. It should be quite clear within the home’s complaints procedure that a complaint may be taken to the Commission at any stage, not only if the person is unhappy with the way the home has dealt with it. The whistle blowing policy should contain the contact details for the Local Authority Safeguarding team so that staff are able to take their concerns outside the home if they feel the need to do so. The whistle blowing policy should be openly available for staff use should they have concerns they wish to be addressed. Staff should have antiseptic gel provided to reduce the likelihood of cross infection at the home. Policies, procedures and practices should be regularly reviewed in light of changing legislation and of good practice advice. 5. OP18 6. 7. 8. OP18 OP26 OP33 Ravenscroft Nursing Home DS0000029227.V354630.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Regional Office Colston 33 33 Colston Avenue Bristol BS1 4UA 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.V354630.R02.S.doc Version 5.2 Page 32 - 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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