Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 29/04/08 for Ravenscroft Nursing Home

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

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?

Communication, about the needs of people who use the service, has been reviewed and changes implemented. However, it is the quality of information that will most improve the outcome for people and that quality is still lacking. Accountability within the home has been increased at all staff levels and we are told that where staff under perform they risk disciplinary action. To this end staff record when care tasks are completed. The standard of personal care, and people`s cleanliness and therefore dignity, has much improved. The management of medicines especially with relation to level of stock held at the home is improved. Also, attention has been paid to removing date expired products safely so removing the risk of using these and the potential adverse effects this may have. The home`s complaints process is working more effectively. Staff were made fully aware how complaints must be handled. People and their representatives have been informed via the newsletter and meetings that the provider is available to talk to them. Complaints are being dealt with swiftly. However, this is a work still in progress as people still speak negatively about the home`s management of complaints and the inaccessibility of the provider. Staff now know where to find the Whistle Blowing policy. This informs them what to do if they have concerns for the welfare of people at the home. It also contains the contact details for the local authority Safeguarding team so concerns can be taken outside the home if this is felt necessary. The general state of decoration and carpeting has improved and the communal areas and bedrooms visited were far cleaner than on the previous inspection; they gave no cause for concern. There is new carpet fitted on the stairs and we were told of future plans to increase the number of en suite facilities as part of ongoing improvements. Staff say they now have the necessary equipment they need and they know where it will be found. They are also provided with antiseptic gel to help reduce the possibility of cross infection. Staff are not under such pressure. Call bells do not ring unanswered for as long as previously and people are able to leave the dining table within a reasonable amount of time. Staff engage with people more, providing them with more information from which they can make choices. They appeared friendlier. Staff say they are being encouraged to undertake National Vocational Qualifications (NVQ) in care. This training will be a measure of staff competence. Several have signed up for NVQ 2, one for NVQ 3 and two are considering taking an NVQ Assessors Award. Staff recruitment is now more robust with all necessary checks complete before staff start employment. This protects the vulnerable people at the home from people who might be unsuitable to work with them. There are more effective ways for monitoring the quality of the service provided. Mr. O`Carroll has made himself more available at the home, there are resident and staff meetings and a survey of opinion was sought in January, although not all people spoken with were aware of this. Mr. O`Carroll, as the Responsible Individual on behalf of the company, is now ensuring a monthly, unannounced visit to the home as required. This is part of the quality monitoring where the home is owned by an organisation. This requirement was not met by the due date, and initially the information was Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 9limited in content, but the last report indicated that people were given the opportunity to discuss what it is like to live at Ravenscroft. The home now has up to date policies and procedures, which are being customised to the home. These provide staff with information on what is expected of them. Staff were aware of them, unlike the previous key inspection.

CARE HOMES FOR OLDER PEOPLE Ravenscroft Nursing Home Old Crapstone Road Yelverton Devon PL20 6BT Lead Inspector Anita Sutcliffe Unannounced Inspection 29th April 2008 09:00 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.V363636.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.V363636.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 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 Ravenscroft Homes Ltd Vacancy Care Home 54 Category(ies) of Old age, not falling within any other category registration, with number (54), Physical disability (54) of places Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability (Code PD) The maximum number of service users who can be accommodated is 54 12th November 2007 2. Date of last inspection 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. Additional fees from 1st. April 2008 are: • Hairdressing (ladies from £8.00 and men from £6.00 • Chiropodist (£8.00 for routine treatment) • Privately funded eye care • Outings with the cost informed in advance Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 5 • • Transport for hospital appointments (starting at £5.00 per journey) Visitor’s meals (advanced cost of £3.50) and catering for birthday celebrations with family or friends. Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. We (the Commission) have collected information about the home towards this inspection since the last key inspection, November 2007. The home also sent us their annual quality assurance assessment (AQAA). The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Since the last key inspection November 2007 we have undertaken two Random Inspections to Ravenscroft. The first, on 14th January was to check compliance with two immediate requirements made during the November inspection. The second, on 13th March, was to collect information relating to an accident at the home. References to the findings of those Random Inspections are made within this report. This key inspection included three unannounced visits. Surveys were sent to people who use the service (five were returned), their families, (six were returned), staff, (only three were returned) and three doctor’s surgeries who have patients at the home - one was returned. However, we spoke to three family representatives of people at the home, many people during our visits and held discussion with several staff. We looked in detail at the care and support that three people received, speaking with them or/and their family and looking at their records. We looked in less detail at other people’s care. We spoke with the director of Ravenscroft Homes Ltd., who is the ‘Responsible Person’ acting on behalf of the company. We also spoke with staff and observed them going about their work. We were accompanied on the first visit to the home by a Help the Aged representative working as an ‘Expert by Experience’. He spent three hours talking with six of the twenty nine people, also sharing lunch, and was also able to observe staff interaction with people. His findings are found within this report. We also received information from a representative of the Health and Safety Executive who looked into the details of a hoist accident, which led to our second Random Inspection. Our regional Pharmacist Inspector examined how the home manages medication at the home and a second nurse inspector examined the standard of assessment, care planning, record keeping and care delivery. Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 7 As part of the visit to the home we looked at all communal areas, some bedrooms and the kitchen and laundry. Throughout the inspection all staff at the home and representatives of Ravenscroft Homes Ltd. were helpful and provided assistance. People who use the service may be described within this report as residents, clients or service users. What the service does well: What has improved since the last inspection? Communication, about the needs of people who use the service, has been reviewed and changes implemented. However, it is the quality of information that will most improve the outcome for people and that quality is still lacking. Accountability within the home has been increased at all staff levels and we are told that where staff under perform they risk disciplinary action. To this end staff record when care tasks are completed. The standard of personal care, and people’s cleanliness and therefore dignity, has much improved. The management of medicines especially with relation to level of stock held at the home is improved. Also, attention has been paid to removing date expired Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 8 products safely so removing the risk of using these and the potential adverse effects this may have. The home’s complaints process is working more effectively. Staff were made fully aware how complaints must be handled. People and their representatives have been informed via the newsletter and meetings that the provider is available to talk to them. Complaints are being dealt with swiftly. However, this is a work still in progress as people still speak negatively about the home’s management of complaints and the inaccessibility of the provider. Staff now know where to find the Whistle Blowing policy. This informs them what to do if they have concerns for the welfare of people at the home. It also contains the contact details for the local authority Safeguarding team so concerns can be taken outside the home if this is felt necessary. The general state of decoration and carpeting has improved and the communal areas and bedrooms visited were far cleaner than on the previous inspection; they gave no cause for concern. There is new carpet fitted on the stairs and we were told of future plans to increase the number of en suite facilities as part of ongoing improvements. Staff say they now have the necessary equipment they need and they know where it will be found. They are also provided with antiseptic gel to help reduce the possibility of cross infection. Staff are not under such pressure. Call bells do not ring unanswered for as long as previously and people are able to leave the dining table within a reasonable amount of time. Staff engage with people more, providing them with more information from which they can make choices. They appeared friendlier. Staff say they are being encouraged to undertake National Vocational Qualifications (NVQ) in care. This training will be a measure of staff competence. Several have signed up for NVQ 2, one for NVQ 3 and two are considering taking an NVQ Assessors Award. Staff recruitment is now more robust with all necessary checks complete before staff start employment. This protects the vulnerable people at the home from people who might be unsuitable to work with them. There are more effective ways for monitoring the quality of the service provided. Mr. O’Carroll has made himself more available at the home, there are resident and staff meetings and a survey of opinion was sought in January, although not all people spoken with were aware of this. Mr. O’Carroll, as the Responsible Individual on behalf of the company, is now ensuring a monthly, unannounced visit to the home as required. This is part of the quality monitoring where the home is owned by an organisation. This requirement was not met by the due date, and initially the information was Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 9 limited in content, but the last report indicated that people were given the opportunity to discuss what it is like to live at Ravenscroft. The home now has up to date policies and procedures, which are being customised to the home. These provide staff with information on what is expected of them. Staff were aware of them, unlike the previous key inspection. What they could do better: The home continues to lack effective clinical leadership and there is still no registered manager. It has been nearly two years without this leadership. This affects the quality of the service provided at Ravenscroft, in particular that of health care. A health care professional who attends the home says it still requires: “Continuity of enthusiastic and well trained staff”. Written information about the home, which helps people decide if the home is suitable for them, needs some additional detail (for example, regarding staffing) and some currently lacking information (such as the breakdown of fees and the last inspection report) must be included. People who use the service and the Commission must be supplied with the information as up dated. This ensures that all people with involvement in the home know what is offered. Assessment and care planning lack detail that ensures staff have the necessary information about care needs. Where this relates to a risk, for example, adequate diet, this lack of information puts the person using the service at risk. Where additional information would enhance the person’s standard of life, for example through improving their ability to communicate or relating to them as individuals, staff would be better informed how their diverse needs could be met. Again we find that people are not properly consulted about their social interests, what they enjoy and that which helps to give their life value. People using the service cannot feel confident that their nursing needs will be properly met. Where observations should have been undertaken to check for a head injury this did not happen; risk is not properly managed and lack of clear and accurate records add to the hazard. The standard of staff competence must be raised through quality training and proper supervision of their work. People must not be restrained, and liberty removed, without their, or a person acting on their behalf, being involved in discussion as to whether that is the required course of action. Consent must be given. This applies to the use of bed rails, which are in use at the home. All staff should receive training in how to protect vulnerable adults from abuse. Some staff have yet to receive any and some have not had a training update for some years. Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 10 For a second time we found the laundry to be dusty, increasing the likelihood of cross infection. We also found dust and grease in the kitchen rooms. The provider must ensure cleaning is properly prioritised and carried out. There are continuing concerns from people about the numbers, knowledge and competence of staff. Each of the survey responses from people’s family mentioned this; some comments were very derogatory. There has been a high staff turnover, which can reduce continuity of care and reduces people’s confidence in the home. The home use a lot of agency staff to cover staffing short falls in numbers. Some, including professional visitors, felt that staff whose first language is not English do not always understand, or are softly spoken causing communication difficulties. People do not have confidence in the trained staff and have said care staff are: “Doing their best in difficult circumstances”. Although many steps have been taken to ensure people who use the service and their family ‘have a voice’ and can take concerns, complaints or comments to the provider, our survey and discussion indicate there is still work to do to regain people’s confidence. Some are still concerned that complaints will result in less favourable care for the person living at the home although we found no current evidence to support this. Record keeping at the home is particularly poor. Gaps in information, lack of detail and lack of signature and dates. Records are a legal requirement and must be treated as such. The poorly recorded accident records, lacking detail, reduce the probability of effective monitoring of accidents at the home. Where the provider is expected to keep us informed of events which affect the wellbeing of people, including our requests for additional information, the information is not always provided promptly and has been very limited in content. Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 11 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.V363636.R01.S.doc Version 5.2 Page 12 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.V363636.R01.S.doc Version 5.2 Page 13 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3 (Standard 6 does not apply to Ravenscroft) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The written information about the home helps people to make an informed choice, to some degree, as to whether the home is suitable or them. However assessment of need is not person centred. EVIDENCE: We looked at the current written information available to people who are considering admission to the home. This information should inform them what the service can offer and provide current information, for example, about staff training. We found that the information had been updated in April 2008. For the most part it is well organised and informative and provides a lot of important details about the service. Particularly good is the information on how the home intends to meet the diverse needs of people who live there, recognising how disability and shared living can be a challenge and difficult to Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 14 come to terms with. Although most required pieces of information are present some are missing; one example is the brake down in fees between accommodation, nursing and personal care. It is also required that we are supplied with a copy of any changes to the written information about the home so that we are kept up to date about the home. We spoke with a person recently admitted to the home. She said her family had looked at the home for her and that she had started to settle in adding: “Staff are very nice and kind”. She said she had received a welcoming letter advising her to bring personal possessions and welcoming her into the home. This made her feel welcomed. We looked at the assessment of two people who use the service. The assessment record should be the basis of the person’s plan of care, informing staff what to do for them. There has been a recent change at Ravenscroft in the method used to record people’s assessment, the provider believing this will eventually lead to much improvement. We looked at the records that had been transferred to the new system. The assessment and initial admission information we looked at was very basic. Examples include: • ‘Some loss of hearing’ with no explanation given of what that meant. • ‘Falls in the past’ with no detail of why, when, how and what injuries, if any, were incurred. • ‘Poor sleeper’ with no detail of why it is poor or of their normal pattern of sleep. • ‘Has depression’ with no detail of why, the time scale, treatment etc. Some parts of one person’s assessment information were not completed, an example being cultural and spiritual needs. This person said they had been bereaved of close family but there was nothing recorded about this loss or how it affected them. Information about interests, friends, history, likes and dislikes was limited or non-existent. The section called ‘Medication Record’ noted that the person gave her own medicines. However, there was no information of what those medicines were and no consideration of possible risk, especially of concern where the person is described as having depression. The person told us they had lost weight but there was no information recorded on weight so that it can be effectively monitored. The home’s provider reports within the AQQA: “Assessments will be more holistic”. Whilst this is commendable the home has been recommended to do Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 15 this since the previous key inspection November 2007 and it has not yet been achieved. Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 16 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 put at unnecessary risk by the way care is planned and delivered. EVIDENCE: Plans of care are required to be clear so that staff can look after people in the correct way, and as they wish, once their needs have been assessed. Having received several requirements to improve care planning at the home, which continued unmet, the provider’s recently changed the method used to record people’ plans of care, believing this will lead to those necessary improvements. Many of the care plans had been transferred to the new method. When we asked the nurse in charge what records were kept for people living in the home she directed us to a cupboard with folders but was unable to find the files we requested. She did not know that the method of care planning had been changed in the time she had been away from the home. Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 17 We looked at the care of three people in detail looking specifically at their dietary needs, prevention of pressure sores and safety. We looked at other people’s care but in less detail. Examining the new plans we once again found insufficient detail and information. This included: • Lack of detail regarding how the person communicates with people without which they are less likely to be able to make their needs known. • Lack of detail in how their drinks are required to be prepared to reduce the likelihood of choking but to still be enjoyed. • Poor or non-existent risk assessment and management of risk regarding moving and handling, diet, prevention of pressure sores, handling of medication and use of bedsides. We attended the nurse and care staff handover of information between one ‘shift’ and the next to ascertain how well staff were informed. Care staff were silent throughout and at no point joined in to ask for further information or to clarify what people had been doing throughout the day. The ‘handover’ consisted of the nurse reading from a ‘handover sheet’, which detailed the name of the person using the service, their room number and some care needs. The hand over, which was to a nurse who had not been at the home for some time, was very limited in content, for example (with names removed): • • • • • Etc. Rashes on back/betnovate applied Was supposed to have a bath but he didn’t he refused Enjoyed food, stayed in his room in the lounge now he’s ok No problems Fine We also looked at the ‘hand over sheet’ which provided written information for the week 28/04/08. Although used as a ‘prompt’ for staff the information was minimal, for example, where one person needs complete assistance with moving it merely said: ‘hoist’. Where they need assistance with eating it said: ‘soft, needs feeding’. We found similar basic information within the nurses and carer’s diary book. Staff said the way information is now provided is improved. However, care plans do not provide sufficient information about people’s needs or how to meet them, staff handover of information and the handover sheet both contain only minimal information. We asked three staff to describe the needs of one person whose care we were examining. We found that they were able to describe how the person communicates, although the one new member of staff said she had ‘picked the information up’ saying when asked that it had not been part of her induction to the home. Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 18 We were told that systems are now in place to improve staff accountability. Towards this each member of staff is allocated to a person every shift. They are not responsible for delivering all care, but they are responsible for seeing that it has been delivered and recorded. We then looked at how effective staff are at meeting people’s needs. We found that the standard of personal/intimate care delivered has much improved. One person said she is bathed twice a week as she had requested. People looked more cared for and one said she was much happier about the arrangements for her hygiene. However, one person volunteered that she would appreciate the opportunity to take a shower rather than a strip wash. Records show that routine health care checks are completed, for example for eye and hearing care. Hospital visits and contact with people’s doctors is arranged when necessary. However, there are concerns about the standard of health care at Ravenscroft. These include: • Very poor monitoring/management of diet where adequate diet is a concern. This can lead, amongst other things, to an increased likelihood of pressure sores. We saw records which indicated very long gaps between drinks. A social work professional, visiting the person at 10:15 a.m. found their “lips and tongue looking very dry”. Asked if she had had breakfast the person shook her head for No. The nurse stated she would have had breakfast. However, her fluid chart showed no fluids recorded since the day before at 6 pm. The nurse had no answer for this. Family of the same person said through survey: “There are occasions when I have seen her drinks, and her drugs, left on the table in front of her. I am very concerned that residents who cannot speak for themselves or feed themselves are sometimes neglected and that the paperwork is not reliable for monitoring such things as it is filled in retrospectively by whoever sees a blank on the form”. When looking at the medication we found that for people prescribed nutritional supplements that the information relating to why and when the supplements were to be used was not present in the care plan and for one person in receipt of a supplement the nutritional screening tool in the care plan had not been filled out. This means that it is difficult to determine if they are receiving the correct supplements. Also the administration of the supplements was not recorded. • Poor nursing practice. Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 19 Having fallen at 2.30 pm sustaining a head wound no observations (which would determine if brain damage had occurred) were taken until 10.30 pm that night. (The nurse in question was subsequently disciplined). • Lack of concern where a person is described within their assessment as depressed. No further information had been sought and the implications of this had not been considered within the care planning process. Although care staff who were asked were able to describe people’s care needs we take into account that the home employs agency staff regularly. These will be either less familiar or not at all familiar with people. There has also been a lot of staff change. This could present a risk if the person on duty was not familiar with the person they are caring for. (See Staffing). We looked at how the home manages medicines. This has led to previous requirements to improve. We found that for one person who was prescribed a medicine to be taken “when required” there was no information relating to this available within the care plan. The nurse on duty was able to explain how the medicine was used but again this could present a risk if the person on duty was not familiar with the person receiving the medicine. We found that provision had been made for the secure storage of Controlled Drugs however we also found that for one person, this had not happened. During the inspection this was corrected. We found that since the last inspection a clear system for auditing the expiry dates and stock levels had been introduced and that stock held at the home was now appropriate and suitable for use. The home is also recording the temperature of the medicine fridge and records demonstrated that these medicines were being stored within the appropriate temperature range. We found that one person had medicines supplied to them on a daily basis but no record was made of the actual number of tablets given. The administration record only indicated a “tick”. When asked the nurse in charge explained that this signified that the person had been prompted to take the medicine. On checking the care plan this action is not documented and there is no risk assessment available to support this. Staff were seen (and heard) to always knock but did not await a response before entering people’s rooms. The people themselves confirmed this as the case. However, staff were seen to be respectful and caring towards people. We also saw one member of staff in the dining room asking people if they had finished their breakfasts or wanted anything. They were very polite and pleasant. People being accompanied to and from the dining room were heard to be informed and were addressed correctly. Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 20 Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 21 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 good. This judgement has been made using available evidence including a visit to this service. People are encouraged to make choices and lead fulfilled lives but this could be much improved through effective assessment and planning. People enjoy the meals at the home. EVIDENCE: Staff were observed throughout the inspection visits. We saw them talking to people, greeting them by name, asking how they were and asking if they could help them with meals. One member of staff was seen talking to three people in the conservatory while taking her morning break. There was discussion about the weather and plans for the summer, and laughter was heard. People were asked how much control they have over their daily routine. They said there is a choice of menu and location to take meals. There are two lounges and a conservatory to sit in which means that those choosing not to join activities have a peaceful place to sit. Rising and retiring tends to follow a set pattern but no one complained about this and felt they would be able to Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 22 retire early if they wished. Staff also confirmed that, whilst most people have a routine of their choice, people can and do make changes. We saw staff offering choice and providing people with information. We looked at how people are informed about events and activities at the home. People confirmed that they receive the home’s newsletter, which is produced monthly. This lists events, activities and other information about the home and service provided. Examples include: • Visiting arrangements at the home. • Arrangements, including cost, where family wish to hold a celebration. • Arrangements for religious observance. We felt that the information could be presented in an easier to read way, for example, with larger type. This was discussed with the providers. Recent activities have included an outing to the Wharf, various musical events, exercises, Communion and visits by the hairdresser. There is now a shop trolley, taking items around the home for people to purchase. However, once again we find that people do not have their social, cultural or religious needs sufficiently assessed and neither are they a part of planned care. The provider recorded that the home now has more accurate records of people’s social interests and the home’s written information makes it clear that they intend to treat people as ‘unique individuals’. We did not find this to be the case. We also discussed how a person unable to communicate verbally might be able to communicate more fully using aids, such as picture cards. This should be part of planned care so that the person is not disadvantaged by their disability. People are encouraged to bring personal possessions with them to the home and some rooms were very individual. The home also offers a variety of rooms and spaces for use. The gardens are well kept and we regularly saw certain people using them. However, the home is a long way from shops and amenities should people wish to use them. With one exception people said they enjoyed the food and were aware that the choice was selected the previous day from a menu of two main and two dessert choices. One day’s choice had been cottage pie or salmon fish cakes both with mixed vegetable, broccoli and potatoes, followed by ice cream or apple pie with custard or cream. The meals looked appetising and were of a suitable temperature. (For dietary health please see Standards on Health and Personal Care). Carers assisted some in a discreet way, gently encouraged reluctant eaters and always checked before removing un-cleared plates. We saw people at lunch the day of the first visit. The event could have been more pleasurable for people as family were crowded around the table, taking space from people who use the service. There were empty tables nearby but Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 23 staff did not think to offer that suggestion. We saw meals served on trays rather than served nicely. We saw people who need a wheelchair to move about were left in them to eat rather than transferred to a dining room chair. These points were discussed with the provider and did not occur the following visits. Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 24 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The provider’s approach to complaint management is much improved but there is still a need to provide more information and regain people’s confidence. The way the home protects people from abuse and ensures their legal rights are protected could be further improved. EVIDENCE: The registered provider records in the information provided to us that ‘complaints are being dealt with with the utmost seriousness’, recognising that ‘previously the proper process was not followed’. We found that since the last key inspection, November 2007, much effort has being spent to encourage people and their families to take any concerns or complaints to the provider. This is mentioned in the monthly newsletter, stated in the home’s written information and been expressed at ‘resident’s meetings’. We asked people if they knew who to speak to if they were not happy. The mixed responses were: “Sister on duty”, “No one available since Matron left”, “The Carers”, “Tim O’Carroll or the lady on reception” and “God knows - I don’t”. Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 25 Three of the five people who responded to surveys said they did know how to make a complaint. One said they knew who to speak to if not happy but would not. One said: “I’m unaware of whom I can talk to”. Two said they usually knew who to speak to. One said they never did adding: “No contact with owners”. Four of the five family representatives who responded to survey said they knew how to make a complaint and one said they did not. Three said they usually received an appropriate response, one said they sometimes did one said they never did. However, where more recent complaints or concerns have been raised records show that they have been investigated and actions taken where need was identified. Within the staff handbook it says: ‘Any complaint no matter how small should always be considered as significant’. We looked at the home’s complaints policy. This we found within the home’s written information and also in the policies and procedures file. We discussed the advantages of displaying it more prominently to ensure visitors see it on arrival and also know when the provider would be available. The policy is newly reviewed and includes timescales for response and the Commission’s contact details. However, 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. This was a previous good practice recommendation that has not been acted upon. The providers say they intend to strive for ‘continued transparency and greater access’ to them. We looked at whether people are protected from abuse. We found that people who use the service are now properly protected by the way recruitment is managed. We are told that training in protection from abuse is to be provided twice a year. We found some staff lack up to date training, one trained nurse not having an update since September 2006. There is no mention within the information provided to us about how the home protects people from abuse. However, staff knew where the Whistle Blowing (how to report concerns about people’s welfare) policy was kept and it contains the contact details for the local authority Safeguarding team and the Commission. We discussed how it would be good practice to include this information within the staff handbook, given to each staff when first employed. Where a person is restricted in any way without their consent, especially where there is no record of the rationale for doing so, this is considered restraint as it restricts their liberty. We found several people who use the service have bedrails in place, which restrain them from getting out of bed. Records showed, and staff confirmed, that their use is not part of planned care. We were told consent for their use was present in the old records. Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 26 Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 27 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, 20, 22, 23, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a pleasant, safe and well maintained home. EVIDENCE: We toured the home visiting all shared/communal areas, several bedrooms, the kitchen and laundry. We also spoke with people who use the service and staff about the home. We saw that the outside of the building appeared clean and tidy, well kept. Large garden areas were laid to lawn and made accessible to people by ramps. There is seating and garden ornaments to create features of interest. People are also able to look at the beautiful moor views from many large windows. Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 28 Many parts of the home are very attractively decorated and stylishly furnished. Some bedrooms are extremely personalised and very much ‘home from home’. The state of decoration was excellent in some parts. The registered provider informed us of the ongoing programme of upgrading and repair within the home. This has included replacement of older carpets. The Expert by Experience, who accompanied us for this inspection, reported that the general state of decoration and carpeting had improved since the last inspection. Staff were asked whether they had sufficient moving and handling equipment at the home. They said that they did, they now knew where it would be found when needed and all was in working order. This equipment was checked by a visiting Health and Safety officer who confirmed it was in a safe condition to be used. Communal areas and peoples rooms appeared clean. People who use the service and staff confirmed this was improved. There were no odours in the areas visited – this included peoples rooms, bathrooms, toilets, corridor areas, lounge, dining and conservatory areas. However, we visited the kitchen, food storage areas and food transfer area and found floors that were dirty, stained and in need of cleaning. Some shelves were dusty. Some walls were dirty. We also found the laundry room was dusty. This is the second inspection at which we found the laundry was not very clean. The laundry has commercial equipment, which should be adequate for the needs of the home. Staff said they have protective clothing, hand washing facilities and now also antiseptic gel to help prevent the transfer of germs. Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 29 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are protected by the way the home recruits staff but can not be confident they are in safe hands at all times. EVIDENCE: Previously the staff deployment, in relation to the needs of people at the home, was insufficient to properly meet those needs. This now appears improved. Visiting health care professionals describe the home as “less frenetic” indicating that staff are less rushed. We found people’s basic needs are better met. In the opinion of people spoken with the response time when a call bell is used varied from 30 minutes to less than 10 minutes. One person added the rider “It depends on how busy the staff are”. During this visit there were lengthy periods when no alarms were sounding and the impression was that the response time was less than 5 minutes. This is an improvement. Neither did we see undue delays assisting people away from the tables following lunch. This had been a concern raised by people previously. However, one staff said: “Mornings you have to rush everybody just to get them up” and another: “Staff do try to do their best for people but sometimes you need more”. Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 30 Staffing remains a concern for some people who use the service and their family. One said her mother is left in bed until lunch time or later most week ends. She attributes this to lack of staff. We were unable to find evidence of her being left in bed awake – she was asleep at 10:30 when we visited - and staffing numbers at weekends are the same as during the week. Another said: “Due to the high turnover of staff and inexperience of many staff, there is often neither numbers of staff available nor the commitment/willingness/ability to deal with my relatives special needs”. The home employs agency staff to meet staffing shortfalls. Although they may be quite familiar with the home this does introduce a weakness; their knowledge of people will not be as good as regular staff and the continuity of care delivered will be affected. People, including care professionals who visit the home, also made comment that, where English might not be the first language of staff, communication and the understanding of staff, concerns them. Care staff were described as: • “Exceptional and excellent”. • “Doing their very best under difficult circumstances” • “Usually friendly and as helpful as possible in the circumstances”. • “Often approachable and try to do their best to make my mother comfortable”. Trained staff were described less favourably. The data we received shows that 56 of care staff have achieved National Vocational Qualification (NVQ) level 2 or above which should be an indicator of their knowledge and competence. However, there is a lack of confidence in staff ability at the home. We base this on concerns raised by family, findings at review of people’s care by social services and an accident found to be the fault of staff, who dropped a frail person whilst moving her in a hoist. However, staff said they are being encouraged to take National Vocational Qualifications in care and we found that training needs of staff are under review. A recently employed care staff said her induction was sufficient and she was able to describe a person’s needs to us. However, we were told by her, as we have been told by staff at previous visits, that where staff already have experience in care the induction training is sufficient, but where staff are new to care the induction/starting arrangements do not prepare them sufficiently for independent work at the home. We found at the random inspection, and again at this key inspection, that recruitment of staff is now robust, with safety checks completed prior to a new member of staff starting at the home. These checks reduce the possibility of staff being employed who are unsafe to work with vulnerable adults. Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 31 Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 32 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, 32, 33, 35, 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Despite the provider’s commitment, drive and achievements since the previous inspection safety at Ravenscroft is not yet properly managed, which leaves people at risk. EVIDENCE: This home must have a registered manager who has demonstrated to the Commission that they are fit to manage the service, especially people’s day-today care. There has been no registered manager at Ravenscroft since July 2006. The most recent ‘matron’ left recently, leaving no persons in charge of the day-to-day care. During this inspection the providers were actively engaged in recruiting a nurse manager plus additional trained staff. Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 33 It took some time for the provider to accept all the findings of the November key inspection and we feel valuable time was lost in making some required improvements. For example, some people’s representatives are still unsure (or concerned) about giving their opinion of the home six months on. (See the Complaints section). However, there have been many positive changes within the home and we find that some standards, and the atmosphere at the home, improved. Improvements achieved include: more accountability of staff and ways of working, the standards of personal care, call bell response times, safer recruitment and handling of medicines. Social care professionals tell us the provider is now more in evidence when they visit. The provider organisation of Ravenscroft is Ravenscroft Homes Ltd. and the person from the organisation who is responsible on behalf of the organisation is Mr. Tim O’Carroll. As required, towards providing information to us and as part of the home’s quality assurance measures, there must be a monthly unannounced visit, involving discussion with people who use the service and staff, to gauge the standard of the service. Although it took a long time to get this organised this requirement has now been met. The home have produced a questionnaire, designed for the purpose of getting people’s opinions on the service they received. Newsletters were posted to relatives that do not live locally to the home so they could arrange to complete a questionnaire if they wanted. We saw those questionnaires, which covered all areas of service such as management, staff, care and environment. We have been provided with a summary of the findings and the steps which the providers have taken to address areas of weakness. People said they sometimes attended the Residents meeting (said to be chaired by Mr O’Carroll or the Senior Nurse) where they had the opportunity to ask questions. Staff also have meetings and receive supervision of their work. The standard of formal staff supervision was, however, somewhat lacking in substance. However, all those with involvement in the home now have more ‘voice’. Staff said they are being encouraged to take training, especially National Vocational Qualifications in care. The standard of health and safety training is under review and changes planned. Staff need policies and procedures so they are properly informed what is expected of them and can work in a consistent way. We looked at the policy and procedures file. All are new to the home, which has adopted standard ‘over the counter’ policies and are customising them. Staff are now aware of the new policies and where to find them. The home sent us the annual quality assurance assessment (AQAA) when we asked for it. It includes a self-assessment that focuses on how well outcomes Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 34 are being met for people using the service. We found that it lacked any depth of information, especially disappointing as the providers need to demonstrate how much the home is improving. Information, which the home is required to provide, is not sent within a reasonable timescale, and where investigation has been requested, for example, the accident with the hoist, the information provided is limited in detail and with little supporting evidence. However, throughout our key inspection visits we have found the provider and staff helpful, informative and keen to improve. The provider confirms that no money belonging to people who use the service is kept in a shared 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 with good records of money spent and the balance. The outer door from the car park to the ground floor lounge lobby is unlocked and used by people to access the garden. The notice on the door directing callers to reception would not deter intruders and the absence of staff in the area could result in those without a valid reason to be in the building entering. This lack of security was discussed with the provider who said he would consider how the security of the building might be better managed. Safety of people who use the service continues to be a concern. This includes: • Assessment of risk being non existent or lacking in information, for example, the use of bed-rails and moving and handling a person in a hoist. • Very poor record keeping, an example being of how much diet a person received, of particular concern where that person is frail, unable to communicate verbally and is vulnerable to pressure sores. • Poorly completed accident records – not dated, not in subsequent order so they can be properly monitored and in one case referring to ‘cuts on face and arm’ and unsure how these had been obtained. The person to who they refer being unable to move independently, there being no record of an accident within her care review, or mention in any communication book or the care plan. • Lack of detailed information when assessing a person’s needs and planning their care. • Poor nurse practice – not taking any observations following a head injury. • An accident caused by staff. HM Inspector of Health and Safety visited the home following the hoist accident. She looked at risk assessment, staff training, the usefulness of care plans and the provider’s role in relation to health and safety as an employer. She will be revisiting the home to discuss progress. Equipment at the home is serviced and properly maintained and fire safety properly managed. Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 35 Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 36 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 2 18 2 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 3 3 X 3 2 3 1 Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 37 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 OP1 Regulation 4,5 Requirement Timescale for action 31/07/08 2 OP3 14 3 OP7 15(1)(2) The Statement of Purpose and Service User’s Guide must be supplied to the Commission. They must meet all requirements (full information about fees; correct contact details for the provider; the number, relevant qualifications and experience of the staff working at the home and the most recent inspection report) so that prospective service users will be fully informed about the home and service offered. People’s assessment of need 31/07/08 must provide the information necessary for the home to determine if those needs can met, to ensure any risk is identified and to enable the person’s care to be planned. It must be person centred so that emotional and social need is included. All people using the service must 31/07/08 have an up to date, detailed care plan. This will ensure that they receive person centred care and support that meets their needs. Amended requirement not DS0000029227.V363636.R01.S.doc Version 5.2 Ravenscroft Nursing Home Page 38 4 OP8 12(1) 5 OP9 13(2) 17(1) 6 OP12 15(2)(m) 7 OP17 13(7) 8 OP18 13 (6) met on due dates: 01/08/06, 01/03/07, 31/07/08 or 13/03/08 Health care needs, relating to adequate diet, prevention of pressure sores and mental and emotional health needs, must be adequately monitored. This will ensure concerns are identified quickly and necessary actions can be taken. Arrangements must be made to record the administration or supply of medicines to people, in order to support the monitoring of the effect the medicine is having. Arrangements also must be made to ensure that clear directions are available for all medicines prescribed to be given “when required” so that people receive these consistently People should be consulted about their social interests and needs. Then staff will be aware how they can be of assistance to meet those needs. Not met on due date of 13/03/08 Restraint, in the form of bedrails, must only be used if: • There is a clear, recorded rationale for their use. • It is part of the individual’s planned care. • Consent from the person, or the person acting on their behalf, has been received. This will ensure people are not held against their will. All staff must receive information on how to recognise abuse and what actions are necessary to protect people. This should include information at induction and regular training. DS0000029227.V363636.R01.S.doc 31/07/08 06/07/08 31/07/08 31/07/08 31/08/08 Ravenscroft Nursing Home Version 5.2 Page 39 9 OP26 23(2)(d) 10 OP27 18(1) 11 OP28 OP33 18 (1) 12 OP33 37(1) 13 OP38 13(4) (c) 13(5) 14 OP38 13(4) (c) All parts of the home must be kept clean including the kitchen areas and laundry. Not fully met by due date of 31/11/07 The ratio of staff to people using the service must take into account the needs of the people using the service, lay out of the home and knowledge, skills and experience of the staff so that people regain confidence in the service provided and are safe. The provider must have systems in place to ensure staff are competent to provide the necessary care to people so he can be confident they are in safe hands. We must be informed, without delay, of any serious injury to a person who uses the service or any allegation of misconduct by a person who works at the home. It is unlawful not to do so and helps protect people who use the service. Not met by due date of 13/03/08 Moving and handling risk assessment must be done by a competent person and contain sufficient detail to fully inform staff how to safely move a person who needs this assistance. This includes detail of equipment to be used. Not met by due date of 13/03/08 Risks must be assessed and steps taken to reduce or remove the risk. This included: • Use of bed-rails • Self medication • Nutritional needs • Prevention of pressure sores • Mental health needs DS0000029227.V363636.R01.S.doc 31/07/08 31/07/08 31/08/08 31/07/08 31/07/08 31/07/08 Ravenscroft Nursing Home Version 5.2 Page 40 including depression Swallowing difficulties Security of the home environment Where this relates to a specific person it must be part of their planned care. • • RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP16 Good Practice Recommendations 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. This good practice recommendation is repeated. All staff should receive induction training to a sufficient standard that they are not a risk to people or themselves. They should 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. There should be a programme of staff training to ensure all necessary training is received. Formal staff supervision should be more effectively managed so that it is more benefit to the staff and home. 2 OP30 3 4 OP30 OP36 Ravenscroft Nursing Home DS0000029227.V363636.R01.S.doc Version 5.2 Page 41 Commission for Social Care Inspection South West 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.V363636.R01.S.doc Version 5.2 Page 42 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!