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Inspection on 14/06/05 for Ravenscroft Nursing Home

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

This inspection was carried out on 14th June 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

What the care home does well

What has improved since the last inspection?

Four bedrooms have been re-carpeted and 3 of these have been redecorated and 1 provided with new furniture. Three bathrooms have been redecorated. The middle landing and 2 corridors have also been redecorated. Quality assurance procedures have been improved and internal audits of the service and facilities have been performed, the outcomes have provided information for the provider to plan future improvements to systems and facilities. A number of new staff with varied experiences and skills have been employed and people living in the home commented positively about the staff team. People living in the home said that the food served in the home has improved and commented favourably on it.

What the care home could do better:

The homes activity programme could be improved to ensure that the preferences and needs of all individuals living in the home are met. The provider said that emphasis on social care has been reiterated to care staff but it seems that physical care needs often have to take priority if social activities are not delegated specifically. The staff training records could provide more detail about the duration of training sessions/courses to ensure that all staff in the home receive 3 days training/year and have up to date knowledge and skills to meet the changing needs of those living in the home. The recruitment process should include taking copies of birth/marriage certificates and proof of identity as well as qualifications and training to improve the safety of those living in the home and to ensure the staff have the skills experience and aptitude to meet the needs of the residents. The building works should finish in September, which will reduce disruption from noise levels and the inevitable increase in dust and provide further ensuite accommodation.

CARE HOMES FOR OLDER PEOPLE Ravenscroft Nursing Home Old Crapstone Road Yelverton Devon PL20 6BT Lead Inspector Fiona Cartlidge Announced 14 June 2005 th 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 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 D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ravenscroft Nursing Home Address Old Crapstone Road, Yelverton, Devon, PL20 6BT Telephone number Fax number Email 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 Ravenscroft Homes Ltd Chantal King Care Home with Nursing 40 Category(ies) of Old age, not falling within any other category registration, with number (12), Physical disability over 65 years of age of places (40), Terminally ill (4) Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home is registered as a Care Home with Nursing for a maximum of 40 Service Users in the categories of PD(E) 40, OP 12, TI 4 2. Old age, not falling within any other category (12) 3. Physical disability over 65 years of age (40) 4. Terminally ill over 65 years of age (4) 5. 2 Service Users under the age of 65 years (named elsewhere) Date of last inspection 16/12/04 Brief Description of the Service: Ravenscroft is a care home providing nursing and/or personal care for a maximum of 40 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 old ‘Edwardian house’ and a more modern extension. Level access is accomplished via 2 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. Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 7 and a half hours and was announced. Information was received from the registered provider before the inspection as was written feedback from 6 residents and 6 visitors/relatives. A full tour of the home took place and personal records of 3 residents and 3 staff were inspected. The inspector spoke to 20 of the residents as well as the registered owners and manager. What the service does well: What has improved since the last inspection? Four bedrooms have been re-carpeted and 3 of these have been redecorated and 1 provided with new furniture. Three bathrooms have been redecorated. The middle landing and 2 corridors have also been redecorated. Quality assurance procedures have been improved and internal audits of the service and facilities have been performed, the outcomes have provided information for the provider to plan future improvements to systems and facilities. A number of new staff with varied experiences and skills have been employed and people living in the home commented positively about the staff team. Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 6 People living in the home said that the food served in the home has improved and commented favourably on it. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3 People are provided with detailed information about the services and facilities to make an informed decision about their admission to this home. The admissions procedure enables the staff to make a professional judgement about how the needs of individuals will be met. EVIDENCE: Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 9 The Statement of Purpose and Service Users guide were examined and have been updated to reflect the homes current status. The information contained in the guide is written in plain English and includes a brief description of the services provided, a description of the accommodation and communal space provided, relevant qualifications and experience of the owners and staff, the number of places provided and special needs catered for and a sample of the menus and expected activities within the home. The Statement of Purpose explains that new residents are only admitted following an assessment of need undertaken in their current situation if possible. The inspector examined the personal documentation held on behalf of 3 residents all contained evidence that the manager or a senior nurse had completed a pre admission assessment in the persons’ current setting. The assessment is detailed and allows for the homes staff to determine if/how the home can meet the needs of the person concerned. The manager confirmed that prospective residents and/or their relatives are given the opportunity to visit the home, meet staff and other Service Users. This is also reflected in the Statement of Purpose. Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10 The health care needs of residents are regularly reviewed and action is taken to meet those needs. EVIDENCE: Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 11 All Service Users have a comprehensive care plan. The Statement of Purpose says that this ‘will allow us to identify your needs and potential risks and explain what courses of action we intend to take to meet the needs and manage the risk. We will ask you or your representative to sign this document to show that you agree with the proposed plan’. Plans of care examined during the inspection were up to date and reviewed on a monthly basis. Routine assessments are performed on moving and handling, nutrition and skin integrity corresponding plans of care are in place based on these assessments. A tour of the home confirmed that equipment necessary for the promotion of tissue viability and prevention of pressure sores is available. Service Users were observed being independently mobile in wheelchairs and with walking aids during the inspection. Some Service Users were being assisted with mobility. Records confirmed that every resident is registered with a General Practitioner. Referrals to and visits from community professional staff include Macmillan nurses, chiropodists, opticians, dentist, dieticians/speech therapists and physiotherapists as well as psychiatric nurses. Referrals to hospital professionals were also found and records indicate that residents are assisted to attend out patient appointments when required. A tour of the home and discussion with residents confirmed that privacy and dignity are maintained when personal and nursing care is being given and staff knock before entering rooms. Written feedback received from 6 residents indicates that they all feel well cared for, are treated well and that privacy is respected. Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Social activities are organised and meet the needs of most residents. Meals are nutritious and balanced and offer a healthy and varied diet for residents. The visiting arrangements are flexible and meet the needs of residents and visitors alike. Residents are encouraged to make choices about how they live their lives within the community of this home. EVIDENCE: Discussion with residents confirmed that they are able to exercise choice about the way they like to spend their day. A monthly newsletter was found in the residents rooms which gave information about the activities available in June this included, manicure sessions, a holy communion service, weekly social activities with a designated member of staff and an outside musical entertainer. Three out of six comment cards returned by residents indicated that the home only ‘sometimes’ provides suitable activities. A tour of the home confirmed that Service Users are able to bring personal possessions with them when they move into the home. Information about advocacy services and agencies that may be of use to Service Users is displayed in the reception. The inspector spoke with a number of residents about the food served in the home and received the following comments: ‘food is good’, food is variable but Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 13 has improved enormously in the past few months’, ‘food is feasible’ ‘food is beautiful’, food is excellent. All 6 residents who returned feedback cards indicated that they like the food. All of the residents spoken to confirmed they were satisfied with visiting arrangements and are able to see visitors in private in their own accommodation or socially in the lounges. Written feedback from 6 relatives/visitors indicates that they all feel welcomed into the home and are able to visit in private. Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 People are safe living in this home and know who to speak to if they are dissatisfied. EVIDENCE: The inspector examined the homes complaints procedure this was found in the statement of purpose, service users guide and displayed in a notice in the entrance hall. A record of all complaints is maintained these records evidence that all complaints are taken seriously, fully investigated and reported including detail about outcomes and any actions taken to prevent a reoccurrence. Six residents provided written feedback to the commission all said that they feel safe in the home and that if they were unhappy with their care they would know who to speak to similar feedback from six relatives/visitors indicates that three of them are aware of the homes complaints procedure. Training in adult protection is being provided to all staff using a package bought in that consists of videos and reading supplied with them; records confirmed that 16 staff have already received this training. Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,26 There was evidence that improvements to the décor of the home are being made to provide an attractively presented environment for residents and staff that is well maintained and safe. EVIDENCE: Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 16 Service Users spoken to were happy with the accommodation they have. A tour of the home confirmed that all individual rooms have a suitable bed, drawers, a wardrobe, overhead and bedside lighting, a bedside table and comfortable seating. Not all Service User doors are fitted with locks and not all rooms have lockable storage space within them. Rooms within the home are individually and naturally ventilated. The home has central heating throughout; each radiator can be controlled separately. Lighting in Service Users accommodation is suitable. The home was clean and odour free. Hand washing facilities are accessible throughout the home and had liquid soap dispensers and paper hand towel dispensers and bins within easy reach. Adequate supplies of disposable gloves were also evident. An extension is currently being built, the inspector thought this might be noisy and disturb residents, but all of those spoken to said it was a minor annoyance and one they could put up with. Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 The procedures for the recruitment of staff are adequate but could be further improved to better protect people living in the home. The number and skills of staff available in the home meets the needs of those living in the home. EVIDENCE: Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 18 The inspector spoke to a number of residents who commented on the staff working in the home: ‘ the best thing about the home is the staff’ ‘staff get top marks from me’ ‘staff are excellent’ ‘mostly there is enough staff but sometimes they seem to be short particularly at weekends’ ‘some staff are splendid, others just seem to be filling in time’. One resident included the following comment in their feedback card ‘what I like about the staff is that you can have a laugh and you can also speak your mind if your not happy about something’. 5 of the 6 relatives/visitors to the home indicate that they feel there is always sufficient numbers of staff on duty. In addition to the care staff administrative, domestic and catering staff are employed in sufficient numbers to ensure the standards relating to nutrition, cleanliness and record keeping are maintained Three personnel files were examined these contained 2 written references, Criminal Records Bureau (CRB) checks and checks against the Protection of Vulnerable Adults (POVA) List, application forms and proof of qualifications, they did not all contain proof of the persons identity. 2 of the personnel files showed evidence that the staff had recently received formal supervision. The training programme includes the induction and foundation standards provided by a reputable training provider. Individual training profiles were examined these require a little updating before they can evidence that all staff receive a minimum of 3 paid days training/year. Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,37,38 The home is being managed properly, there is clear leadership, guidance and direction to staff to ensure residents receive consistent quality care. EVIDENCE: Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 20 The manager is a level 1 nurse and is competent and experienced to run the home. Her training record shows that she undertakes regular training to update her knowledge, skills and competence. All of the residents spoken to commented favourably on the approachability and effectiveness of the manager. During the inspection the manager communicated a clear sense of direction and leadership that staff and residents related to. The process of running and managing the home is clear and transparent and the staff are working as a coherent team. An effective quality assurance system is in place. Examples of a Service User survey were examined. Most comments were positive, any negative comments are investigated and actions and outcomes are recorded. Recent ‘in house’ audits were also examined. The administrator manages Service Users personal allowances for those not able to manage their own affairs. The written records were examined and found to be in order. Records examined were up to date and accurate and included the accident book, personnel records, personal records held on behalf of residents and personal allowance recording. Service Users can have access to any records or information held about them within the home and can be given the opportunity to help maintain their records if they wish. Information provided to the Commission indicates that a fire officer last visited the home on the 1st February 2005; fire equipment is checked regularly, a fire drill was last performed in January and fire lectures were last given in February. The fire alarms are tested weekly. The environmental health officer visited in January. An approved engineer checked the central heating system in May 2005, there was no evidence of when the last electrical wiring certificate was issued. The provider said that day to day maintenance is performed by the homes own maintenance person and a book is used for staff to communicate issues such as light bulbs needing replacing the maintenance person signs the book to confirm when and what action they take to rectify the problems. Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 4 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 4 3 3 x 3 x 3 3 Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 22 N/A Are there any outstanding requirements from the last inspection? 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 29 Regulation 19 Requirement The registered provider must obtain proof of the information and documents specified in paragraphs 1 to7 of Schedule 2 on behalf of all people employed in the home. Timescale for action 01/09/05 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. Refer to Standard 12 30 Good Practice Recommendations The social activites made available should be flexible and varied enough to suit the needs, preferences and capabilities of all people living in the home. The individual staff training profiles should provide enough information to evidence that all staff receive a minimum of 3 paid days training/year. Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ravenscroft Nursing Home D54-D07 S29227 Ravenscroft Nursing Home 222203 140605 Stage 4.doc Version 1.30 Page 24 - 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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