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Inspection on 13/06/07 for Ravenscroft Nursing Home

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

This inspection was carried out on 13th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

A residents guide was provided, which gave information about the care and services provided at the home. Each person was given a copy of this information when they were admitted to the home. This enables people to make an informed choice about whether the home can meet their needs. The way pre admissions assessments are recorded has been improved since the last inspection. These give clear information about the individuals care needs. The people whose care was followed also had copies of their shared assessments completed by Health and Social Care teams with their assessment information. This should ensure that the staff have sufficient information to plan the care for individual people living at the home. People living at the home asked said they enjoyed the activities provided and looked forward to them. A monthly newsletter provided for the people living at the home gives them information about the coming months activities organised. The meals provided are attractively presented and appear to be nutritionally balanced. Those asked said they looked forward to meals times and food was always good. Staff value the people living at the home and try to ensure they have the things that are important to them. All those people asked said the staff were friendly and approachable.

What has improved since the last inspection?

The systems for managing medication have changed. Separate drug trolleys have been put in place to allow staff administering medication for people to take the trolley to them. The way medication is stored, ordered and monitored has improved. This has reduced the risk of over stocking and medication being out of date. A separate record of complaint`s and concerns has been introduced since the last inspection as well as continuing to record in individual peoples plans of care.

What the care home could do better:

Of the four people whose care was followed, one person had not had a plan of care developed from their assessment of need and another had not had their plan of care reviewed regularly and changes recorded. This puts people at risk of not receiving a consistent level of care, as the way their care is delivered will be dependant on staff who know and understand their needs being available.

CARE HOMES FOR OLDER PEOPLE Ravenscroft Nursing Home Old Crapstone Road Yelverton Devon PL20 6BT Lead Inspector Rachel Proctor Key Unannounced Inspection 13th June 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ravenscroft Nursing Home DS0000029227.V338380.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.V338380.R01.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 Registered provider Web address Name of registered 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.V338380.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 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 10th January 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 ‘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 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.V338380.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced Key inspection, which took place on 13th June 2007 between 9.30 am and 5.30pm. Information received since the last inspection has also been taken into account. A tour of the home was completed, some individual peoples rooms and all the communal areas were visited. Four people had their care followed as part of this inspection. This included speaking to them in their own rooms about the care and services they received and seeing their care planning information records. Some of the comments made during the inspection by people living at the home and staff have been incorporated into this report. Personnel records for four staff and other records relating to the management of the home were also inspected. What the service does well: What has improved since the last inspection? The systems for managing medication have changed. Separate drug trolleys have been put in place to allow staff administering medication for people to take the trolley to them. The way medication is stored, ordered and monitored Ravenscroft Nursing Home DS0000029227.V338380.R01.S.doc Version 5.2 Page 6 has improved. This has reduced the risk of over stocking and medication being out of date. A separate record of complaint’s and concerns has been introduced since the last inspection as well as continuing to record in individual peoples plans of care. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ravenscroft Nursing Home DS0000029227.V338380.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ravenscroft Nursing Home DS0000029227.V338380.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good, 1,3,6 This judgement has been made using available evidence including a visit to this service. The information about the home and its services is easily available in the reception area of the home. This provides sufficient information for people to make an informed choice about whether the home can meet their needs. However information regarding fees for different areas in the home and how rooms are allocated for respite could be clearer for those people accessing the home for respite. People have their care needs assessed by a competent caring staff team who have their best interests at heart. The home does not provide intermediate care. EVIDENCE: The home has a residents guide, this set out clear information about the home and the services it provides. Copies of these were seen in individual peoples Ravenscroft Nursing Home DS0000029227.V338380.R01.S.doc Version 5.2 Page 9 rooms. Two people admitted to the home recently said they had been able to visit the home prior to their admission and were given enough information to make a decision about the home. The assessment completed for two people admitted to the home since the last inspection were seen. These had been completed by the clinical manager prior to their admission to the home. One of these people said that they had had the opportunity to discuss their care needs and what was important to them with the clinical manager prior to their admission to the home. The four people whose care was followed all had comprehensive assessments of need completed and kept with their plans of care. Where Social Service and Health teams had completed a care plan and assessment these were also provided with the person plan of care. The clinical manager confirmed that she had changed the way assessments are recorded since the last inspection and they now provided more information. However one person with complex health and social care needs did not have a plan of care, which had been developed by the home staff. A plan of care provided by the community health team was provided and the manager had completed an assessment of care need. When this person was spoken to they said that staff understood their care needs and they had been pleased with the support and assistance they received. They went on to say that staff understood when to offer help and when to encourage them to do things for them self. One person who contacted the Commission prior to the visit to the home raised concerns about the information provided when they visited the home to arrange a respite placement for their relative. They said it was unclear about how rooms are allocated and how the fees are decided. The Registered provider advised that people who visit are always given clear verbal information about this, however a written record of this is not currently provided. The registered provider confirmed that this information would be provided in writing in future. Ravenscroft Nursing Home DS0000029227.V338380.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. 7,8,9,10 This judgement has been made using available evidence including a visit to this service. The staff were meeting the health and personal care needs of the people living at Ravenscroft. However by not ensuring all care plans are reviewed regularly and people have a plan of care for staff to follow; this may put people at risk of not receiving the care they need. People who live at Ravenscroft are treated with respect and their rights to privacy upheld. EVIDENCE: Four people had their care followed as part of this inspection. Their individual care plans; medication records and the rooms they were using in the home were viewed during the inspection. One of the four plans of care viewed did not have a care plan developed from their assessed need. However this person had an assessment and care plan which the community health teams prior to their admission had developed. This person was spoken to during the inspection they advise that staff understood their care needs and you had to Ravenscroft Nursing Home DS0000029227.V338380.R01.S.doc Version 5.2 Page 11 look after them well. However the information this person gave had not been captured within the care plan. This could put this person at risk of not receiving a consistent level of care. Another person whose care was followed had not had their care plan reviewed on a regular basis. The last review documented was from April 2007. This person indicated that staff cared for them well and allowed them to achieve as much independence as their disability allowed. However the care planning documentation had not captured changes in their care needs which had occurred since April 2007. By not updating and making care plans clear that staff may not be fully aware of the persons needs. There was clear information within the four care plans for people whose care was followed regarding referrals to specialist health care professionals and visits by their general practitioner. The staff appeared aware of the peoples overall care needs such as if they needed assistance with washing and dressing or eating their meals. Since the last inspection the manager has provided an information sheet for handover for each of the health care assistants working in the home. This gave basic information about the individual’s health problems, manual handling requirements, continence, the diets they need and if they need assistance to eat their meals. The clinical manager advised that care staff had been split into two teams. These also show which residents the carers in each team were responsible for during a shift. Observation of the staff revealed that they were aware of peoples overall care needs such as what they like to eat and if they needed assistance. Staff were seen to knock on individual people’s doors prior to entering a room. They were speaking to them respectfully using their preferred name. The people living at the home spoken to said staff understand the things that are important to them and what food they like. One person commented, The staff couldnt be more helpful and kind. A relatives comment card received commented in I am most impressed by the kindness shown to my (relative) by the owners and staff especially the matron. One of the people whose care was followed was able to staff medicate. A risk assessment had been completed regarding their ability to manage their own medication. The person advises how they stored their medication in their room. The manager advised that individuals who are assessed as able to manage their own medication are given the opportunity to do this now if they wish. One health care professional contacted expressed concern that medication prescribed for individuals was not always collected on the day it was prescribed. They felt this put individual people at risk. During the inspection the staff were organising for a prescription to be collected from the pharmacy by a member of staff. A GP comment card received indicated that they were generally satisfied with the overall care provided but occasionally not. They Ravenscroft Nursing Home DS0000029227.V338380.R01.S.doc Version 5.2 Page 12 also indicated that they did not feel the people at the home always had their medication managed appropriately. Since the last inspection further drug trolleys have been introduced. The clinical manager advised that she was a process of reviewing where stock medication was stored within the home. The medication stock cupboard was seen. The way medication was stored had been changed since the last inspection. This allowed staff to identify individual peoples medication easily and maintain proper stock control. No out of date medication was seen in the home during the inspection. One of the registered nurses advised that the drug trolleys are used to take the medication to individual people. The practice of carrying medication in pots on trays had stopped. The receipt and returns of medication was well documented. The staff completing this had signed this. A clinical waste disposal company disposes of the medication no longer required. Peoples rooms entered during the inspection had prescribed creams for the person in that room. A controlled drug register was checked against the stock for one person as correct. Two members of staff had signed the controlled drug record. Where medication was administered and controlled drug medication disposed of these were recorded in line with good practice. A drug fridge was provided for storage of medication in the treatment room. The temperature of this drug fridge was being regularly recorded. Ravenscroft Nursing Home DS0000029227.V338380.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good, 12,13,14,15. This judgement has been made using available evidence including a visit to this service. The people who live at Ravenscroft are given the opportunity to maintain contact with family and friends. Staff actively encourage them to continue with activities that interested them prior to their admission to the home where possible. Meal times are a pleasant social occasion for the people who live at Ravenscroft. The meals provided are varied and appear to be nutritionally balanced. EVIDENCE: During the afternoon of the inspection several people had gathered in one of the communal lounges for the exercise programme that had been arranged by the staff team. The people were enthusiastically taking part when the lounge was visited again. Staff said the people living at the home usually enjoyed taking part in this. One person whose care was followed said staff helped them to buy the materials they needed to carry on their hobby of painting. The clinical manager advised that staff regularly take this person shopping for supplies. Another person living at the home had prepared a model of the old Ravenscroft Nursing Home DS0000029227.V338380.R01.S.doc Version 5.2 Page 14 airfield opposite the home, which showed the layout during the war. This was displayed in the reception area of the home. Visitors were coming and going through out the inspection. They were seeing their relative in the privacy of their own room or in one of the communal lounges. One relatives comment card indicated that staff always keep them informed of issues relating to their relative. The clinical manager confirmed that they have an open visiting policy with in reason as long as it doesn’t affect the person’s health. One person spoken to said staff had been very supportive when they did not want to see a visitor that had come to the home to see them. They had spoken to the visitor on their behalf and they had left. The monthly newsletter was provided for inspection. This gave information about the activities planned for the month, which included a trip to a local garden centre that people could attend if they wished. The opportunity for some people to go to Plymouth to see Riverdance was also listed. The feedback received about the meals provided was positive people said they looked forward to meal times and they usually enjoyed their meals. Three people asked said alternatives would be found if they did not like what was on the menu. The lunch time meal observed in the dining room of the home was unhurried with people eating their meals at their own pace. Three choices had been provided for the lunchtime meal, including salads with a baked cheese filled potato, sausage and mash and sausage and chips. Those who required assistance to cut up their food were being given this in a discrete helpful manner by the staff assisting them. One person spoken to say they really enjoyed the sausage they had for lunch, as they don’t have this very often. People whose care was followed had a record of their weight recorded. Ravenscroft Nursing Home DS0000029227.V338380.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good, 16,18 This judgement has been made using available evidence including a visit to this service. People living at Ravenscroft have their concerns listened to by staff. They know how to raise concerns and have confidence in the staff team who care for them. The improved procedures for recording their concerns should ensure that staff continue to deal with these appropriately. EVIDENCE: Since the last inspection the Commission has received two complaints. These have been investigated within time scales, copies of correspondence regarding these complaints were available. One of these complaints was substantiated. The registered providers had taken the issues highlighted by the complaint seriously and action had been taken to ensure the same situation did not reoccur. The registered providers have a complaints and concerns record they are keeping of any issues raised by people at the home. A policy and procedure folder was provided for staff use. The preinspection information indicated that the home had the policies and procedures it required. Records of adult protection training were available. A record of training staff had received was contained in the staff files viewed. The clinical manager advised that training was discussed with the staff at supervision/training sessions and staff understanding of their learning was assessed at this point. Ravenscroft Nursing Home DS0000029227.V338380.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The people who live at Ravenscroft have a pleasant reasonably wellmaintained environment to live in, which is fresh and clean and free from odour. However some individual rooms in the older part of the building had worn carpets and older style furniture and furnishing. This means that not all the people who live at Ravenscroft have the same standard of accommodation EVIDENCE: A tour of the home was completed and some peoples rooms are entered. Individual peoples rooms viewed during the inspection had been personalised with items of the persons choice. Some carpets in the older parts of the home had been replaced, others looked worn. The registered provider confirmed that carpets would continue to be replaced as needed. There are three distinct areas within the home, a new extension all with larger en suite rooms (Willow). Ravenscroft Nursing Home DS0000029227.V338380.R01.S.doc Version 5.2 Page 17 The central section of the home has smaller rooms some of which have shared en suite with baths (Beech). The registered provider advised that they were considering making the shared en-suit facilities in this section into individual en-suit facilities. The older section of the home (Oak) has been adapted as a care home from an old Victorian style house. The people spoken to during the inspection said they liked their individual rooms and had had the opportunity to personalise them with items of their choice. The furniture furnishings and equipment in individual rooms and communal areas appear to be meeting the needs of the people living at Ravenscroft. A complaint about the stability of some of the freestanding wardrobes in individual rooms was raised prior to this inspection. The registered provider advised that all freestanding wardrobes had now been fixed to the wall to prevent them falling. A tour of the home viewing rooms in use where freestanding wardrobes were available showed that these have been fixed to the walls. One shared room in the older part of the building had a call bell, which wasnt working. This room wasnt in use at time of the inspection. The clinical manager advised that the company that provided the call bell system was in the process of checking the system to repair the fault. A temporary call bell had been set up, which used the call bell from the toilet next to the room. The clinical manager explained the system that printed out the times of a call from individual rooms and the time they were answered. This information confirmed that the call bell system was working. Passenger’s lifts are provided between the three floors to allow easy access for staff and people living at the home. Maintenance information was available for these lifts during the inspection. The maintenance man spoken to during the inspection said the mobile equipment such as commode chairs, which had been damaged and worn, had been repainted since the last inspection. The commodes and hoist seen during the inspection were well maintained. The home was fresh, clean and free from odour in all areas entered during the inspection. Disposable gloves and aprons were easily available for staff, who were seen using these as they attended to the personal care of individual people. A clinical waste disposal company has been contracted with to remove the homes clinical waste. A yellow bag system was seen to be in place for infected material. Staff had access to infection control policies and procedures in the office of the home. The clinical manager advised that she was updating some of the policies within the policy folder to ensure they met good practice guidelines. Ravenscroft Nursing Home DS0000029227.V338380.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. 27,28,29,30 This judgement has been made using available evidence including a visit to this service. The people who live at Ravenscroft have a caring staff team with appropriate skills and knowledge to provide care for them. The recruitment practices in place should protect the people who live at Ravenscroft from unsuitable staff. EVIDENCE: The clinical manager provided duty rota, which showed the number of staff on duty and in what capacity they were employed. This showed that more staff on duty at peak times during the day. Where agency staff had been used to fill shift shortfalls the names of the agency member of staff covering the shift had been recorded on the duty rota. The manager advised that the care staff had recently been split into two teams, which covers different areas in the home. Since the last inspection new hand over sheets had been provided for staff working in the home. These included the number of the room the person occupied and basic information about their manual handling, diet and if they required assistance to eat. The four people whose care was followed commented that staff were friendly and supportive towards them and they understood their care needs. One relatives comment card received indicated, Overall and care and support appears to be good. Ravenscroft Nursing Home DS0000029227.V338380.R01.S.doc Version 5.2 Page 19 Pre-inspection information indicated that 10 of the 18 full-time staff employed, which includes registered nurses had achieved an NVQ level 2 or above in care. This also indicated that a further two staff were working towards NVQ qualification. The staff spoken to say they felt supported to do their work and had access to training that improved their knowledge and skills. Four staff files were reviewed during the inspection these contained application forms, two references and evidence that police checks had been carried out prior to them starting work. Proof of identity had been established in all staff files seen. Although photographs were available from copies of passports/driving licences, the registered provider had not included a recent photograph of staff with their information. An interview pro forma had been used for the staff. This recorded response the staff member had made at interview. Ravenscroft Nursing Home DS0000029227.V338380.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is adequate. 31,33,35,38 This judgement has been made using available evidence including a visit to this service. The new individualised systems introduced for the management of people’s money should protect their interests. The health safety and welfare of the people living at Ravenscroft has continued to be promoted by the safe temporary system of management in place. EVIDENCE: The home does not have a manager who is registered with the Commission. The registered provider advised that the clinical manager who is a first level registered nurse with several years experience was being put forward as the registered manager for the home. They also commented that the management of the home would not change in its systems as this was working well. The clinical lead would continue to manage the Health and personal care Ravenscroft Nursing Home DS0000029227.V338380.R01.S.doc Version 5.2 Page 21 aspect of the service with the registered providers continuing to manage the business side. The clinical manager advised that she was in the process of completing the application forms for the Commission. The registered provider and the clinical manager advised that the senior management meeting have continued. Since the last inspection carers meeting have been introduced. A copy of the minutes of the meeting from May 2007 was provided. This showed that care staff were able to express their opinions and comment on the working practices introduced. The results of quality audits undertaken had not been made available for the people who live at Ravenscroft at the time of this inspection. The registered provider advised that they intended to provide a summary of the quality audit completed for the Commission with the next newsletter. A copy of the Ravenscroft newsletter was forwarded to the Commission on 26.06.07. This contained information about the audit. However this did not confirm how monitoring and quality audit of the home and its services would continue. Information about the satisfaction of health care professional and GP opinions of the home and its services had not been recorded. Informal measures of customer satisfaction have continued. These included letters and examples of positive outcomes for people using the service. Comment card received from relatives indicated that they are kept informed by staff at the home. One person spoken to advised that staff regularly check if they are OK and if their care needs are being met how. The majority of the requirements made at the last inspection have been met. However three requirements had not been met with in the agreed time scales. The registered provider was able to show that significant progress had been made towards meeting these therefore the time scales have been agreed and extended further. The registered provider advised that they were in the process of closing the pooled bank account people had used at the last inspection. Two remaining people who used the bank account were having their funds transferred to individual bank account set up by their representatives. Confirmation was received on 26.06.07 that the bank account was no longer being used by any of the people living at the home. A system of billing individual people for fees and other expenses such as chiropody has continued. Receipts for expenditure were being kept with individual peoples information in the administrators office. One example of how these were processed was seen during this inspection. The registered provider continues to demonstrate a responsible attitude towards health and safety of the environment. Actions have been taken to address identified risks. Fire doors are held open with devises that would close the door in the event of a fire. Equipment seen around the home such as hoists had the date of the last maintenance recorded on them. The Ravenscroft Nursing Home DS0000029227.V338380.R01.S.doc Version 5.2 Page 22 maintenance man advised that he checks that all equipment is serviced and maintained as required. He also reported that he manages the checks and systems for the prevention of legionella. Records of these temperature checks carried out were available for inspection. Ravenscroft Nursing Home DS0000029227.V338380.R01.S.doc Version 5.2 Page 23 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Ravenscroft Nursing Home DS0000029227.V338380.R01.S.doc Version 5.2 Page 24 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 Residents must have a plan of care developed form their assessment of need that states how their care should be delivered to meet their needs. Timescale for action 31/07/07 2. OP31 8 3. OP33 24 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 & 01/03/07 The registered person must 30/09/07 appoint an individual to manage the care home because there is no registered manager in respect of this care home. Not met on due date: 30/04/07 30/09/07 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 & 01/03/07 DS0000029227.V338380.R01.S.doc Version 5.2 Page 25 Ravenscroft Nursing 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 2 3 Refer to Standard OP9 OP29 OP35 Good Practice Recommendations The clinical manager should ensure that visiting professional health care staff and the persons GP can have confidence in the homes medication practices. Photographs of staff employed should be provided with their staff file information. The registered person should 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 with carrying on or management of the home. Ravenscroft Nursing Home DS0000029227.V338380.R01.S.doc Version 5.2 Page 26 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.V338380.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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