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Inspection on 29/10/09 for Ravenscroft Nursing Home

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

This inspection was carried out on 29th October 2009.

CQC found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

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

When we visited people told us: "Nurses are brilliant always have been and still are", "Staff are friendly, attentive and do their best". A G.P. said: "Good communication, happy patients and no concerns". Staff are keen to do the best for the people in their care, who are treated with respect and dignity. Staff told us: "The home has a great team of staff. As a team we work very well and all get on to meet the care of the clients and client`s relatives". People receive information about the home which informs them what the service has to offer and from which they can make a decision about its suitability. The manager visits any potential resident, where physically possible, and ensures there is a full recorded assessment of their needs. People are not offered a place at Ravenscroft unless the home is sure their needs can be met. Care plans give staff information on how the person`s needs are to be met. Staff also receive verbal information, have a diary of information and a daily work sheet with information. People receive a good standard of personal care. People are encouraged and supported to follow their chosen hobbies and interests. Most people enjoy the food provided and the choice on offer. Staff recruitment is robust and protects people from staff who may be unsuitable to work with vulnerable adults. The home environment is well maintained, provides a variety of social and personal space. Individual rooms are very personalised. Fittings and fixtures are of a good standard. The gardens are well maintained, accessible and interesting. The manager, Mrs. Sue Mason, is held in high regard by people who use the service and staff, who say: "The manager gives her full support to all her staff and is very approachable". Mrs. Mason leads by example, is fair but takes any necessary disciplinary measures.

What has improved since the last inspection?

The home has produced an updated Statement of Purpose and Service Users Guide which informs people what the service has to offer. Care plans include assessment and detailed plans of how the risk from pressure sores is to be managed. Where pressure sores have occurred they are improving. There is better accountability within the home. The manager, Mrs. Mason, no longer has to be the `nurse on duty` and so is able to fulfill her management duties. There is a designated `clinical lead` nurse to ensure health care is properly delivered and a senior care assistant to help monitor the standard of personal care delivered by care staff. It is now part of care planning under what circumstance a medicine prescribed to be given `as required` or `as necessary` may be administered. This helps ensure consistency and reduces the possibility of mishandling. The home now keeps the Commission informed of events, such as staffing shortage and pressure sores, as they are required to do. We were told in August that the providers do not always accept complaints about the home (in this case staffing numbers) but we believe all concerns and complaints will now be accepted as a way to further improve the quality of the service. Staff training is much improved. It is well organised, encouraged and its importance understood. People are now receiving a service from staff with improved numbers, skills and competence. In September we were told that the manager: "Is fighting a loosing battle and spends much of her time putting out fires". Now we are told by a G.P.: "A lot better. No concerns"; by staff: "The providers are listening and we need to prove that we can manage things but we still have a way to go" and by people using the service: "Definitely progressed a lot".

What the care home could do better:

Before people are admitted the home should ascertain whether they have a Lasting Power of Attorney, Independent Mental Capacity Advocate or Relevant Person working on their behalf. This information is required so that people who are unable to make their needs known are properly represented and their rights protected in law. It should be clear from records who has been involved in a person`s assessment prior to their admission. It should be clearly recorded who is involved in the review of the person`s plan of care. Should there be no person able to do so this should also be recorded. Care plans should include all aspects of the person`s needs, including acute episodes of ill health. All medicines received into the home must be recorded so that a full audit of their use is possible, so as to protect people. This is a repeat requirement and enforcement will be considered if it remains unmet. The home should employ a designated activities coordinator with expertise in that area. The whistle blowing policy should contain the contact details of the local authority safeguarding team so this information is readily available to staff who might have concerns which are abuse. There must be liquid soap available in the laundry and sluice areas so that hand hygiene can be maintained and the possibility of cross contamination reduced. More attention should be paid to the standard of hygiene in the laundry. Staff numbers and deployment should be under regular review and in line with people`s opinion. Staff induction should take into account lack of previous experience and the individual needs of the staff member. This should be determined by the manager based on her experience. Where people have consented to the use of bed sides any risk from this must be assessed so that any risk can be removed or reduced. All risk, either from the environment or staff practice, must be assessed so that any risk can be removed or reduced.

Key inspection report Care homes for older people Name: Address: Ravenscroft Nursing Home Old Crapstone Road Yelverton Devon PL20 6BT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Anita Sutcliffe     Date: 3 0 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Ravenscroft Nursing Home Old Crapstone Road Yelverton Devon PL20 6BT 01822853491 01822853444 enquiries@ravenscroftcare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ravenscroft Homes Ltd Name of registered manager (if applicable) Mrs Susan Mason Type of registration: Number of places registered: care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 54 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability (Code PD) Date of last inspection Brief description of the care home Ravenscroft is a care home providing nursing and/or personal care for a maximum of 54 residents of either gender with physical frailty, illness or disability. It is situated near Yelverton, West Devon, on the edge of Dartmoor National Park. The home is arranged on 3 floors within an older `Victorian house, plus a more Care Homes for Older People Page 4 of 32 Over 65 54 0 0 54 2 2 1 0 2 0 0 8 Brief description of the care home modern extension and purpose built wing opened in September 2005. All rooms in the wing have en-suite toilets. Further improvements to the existing environment are on going. Level access is achieved via 3 passenger lifts. There are 2 lounges and 2 dining rooms. There are large grounds, with grass and paved areas, with level access from the house. Information about the home was found in the entrance hall and people can request a copy of the latest inspection reports from the administration office. Information given to the Commission indicates the current range of fees is from 306 to 650 pounds per week. The actual fee is dependant on the needs of the person and the room occupied. Additional fees are for hairdressing, chiropody, privately funded eye care, outings (with the cost informed in advance) transport for hospital appointments, visitors meals and catering for birthday celebrations with family or friends. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Commission has collected information about Ravenscroft since the previous key inspection 22nd October 2008. Toward this inspection we sent surveys to people who use the service (12 were returned), staff (11 were returned) and health and social care professionals (3 were returned). We also met a G. P. who visits the home regularly and spoke with the family of two people who used to live at Ravenscroft. The home provided us with information about the service. This includes data, such as how many staff work there and when policies were last reviewed. It also gives the home the opportunity to tell us what they do well, any barriers to improvement and what improvements are planned. We did two unannounced visits to the home. We looked closely at the care of three people who use the service and at certain aspects of the care of others. This included meeting them, speaking with staff about their needs and examining records pertaining Care Homes for Older People Page 6 of 32 to their care. We also observed staff going about their work and their interaction with the people in their care. We saw most of the building at both visits and several bedrooms. We examined some policies, procedures and records. We asked questions of staff and the manager, who was present throughout. Since the last key inspection was completed a Random Inspection visit was carried out on 11th June 2009. The Random Inspection report is not published but is available on request from the Commission. Reference to the findings of the Random Inspection is made within this report. We were accompanied by an Expert by Experience for the visit. They are people who, because of their shared experience of using services, and /or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. People who use the service may be described within this report as residents, clients, service users or patients. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? The home has produced an updated Statement of Purpose and Service Users Guide which informs people what the service has to offer. Care plans include assessment and detailed plans of how the risk from pressure sores is to be managed. Where pressure sores have occurred they are improving. There is better accountability within the home. The manager, Mrs. Mason, no longer has to be the nurse on duty and so is able to fulfill her management duties. There is a designated clinical lead nurse to ensure health care is properly delivered and a senior care assistant to help monitor the standard of personal care delivered by care staff. It is now part of care planning under what circumstance a medicine prescribed to be Care Homes for Older People Page 8 of 32 given as required or as necessary may be administered. This helps ensure consistency and reduces the possibility of mishandling. The home now keeps the Commission informed of events, such as staffing shortage and pressure sores, as they are required to do. We were told in August that the providers do not always accept complaints about the home (in this case staffing numbers) but we believe all concerns and complaints will now be accepted as a way to further improve the quality of the service. Staff training is much improved. It is well organised, encouraged and its importance understood. People are now receiving a service from staff with improved numbers, skills and competence. In September we were told that the manager: Is fighting a loosing battle and spends much of her time putting out fires. Now we are told by a G.P.: A lot better. No concerns; by staff: The providers are listening and we need to prove that we can manage things but we still have a way to go and by people using the service: Definitely progressed a lot. What they could do better: Before people are admitted the home should ascertain whether they have a Lasting Power of Attorney, Independent Mental Capacity Advocate or Relevant Person working on their behalf. This information is required so that people who are unable to make their needs known are properly represented and their rights protected in law. It should be clear from records who has been involved in a persons assessment prior to their admission. It should be clearly recorded who is involved in the review of the persons plan of care. Should there be no person able to do so this should also be recorded. Care plans should include all aspects of the persons needs, including acute episodes of ill health. All medicines received into the home must be recorded so that a full audit of their use is possible, so as to protect people. This is a repeat requirement and enforcement will be considered if it remains unmet. The home should employ a designated activities coordinator with expertise in that area. The whistle blowing policy should contain the contact details of the local authority safeguarding team so this information is readily available to staff who might have concerns which are abuse. There must be liquid soap available in the laundry and sluice areas so that hand hygiene can be maintained and the possibility of cross contamination reduced. More attention should be paid to the standard of hygiene in the laundry. Staff numbers and deployment should be under regular review and in line with peoples Care Homes for Older People Page 9 of 32 opinion. Staff induction should take into account lack of previous experience and the individual needs of the staff member. This should be determined by the manager based on her experience. Where people have consented to the use of bed sides any risk from this must be assessed so that any risk can be removed or reduced. All risk, either from the environment or staff practice, must be assessed so that any risk can be removed or reduced. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are fully informed and able to make a judgement as to whether the home can meet their needs. Their needs are assessed and understood prior to admission. Evidence: Eight people told us through survey that they received enough information to help them decide if this home was the right place for them. Three told us they did not and one did not know. Seven people told us through survey that they had been given information about the homes terms and conditions, one said they had not and four did not know. The home reports: All potential service users or people acting on their behalf are allowed choice and time to make decisions about their future and People are provided with all the information they need to reach a decision and terms and conditions are always made clear in advance. Anyone staying at Ravenscroft does so on a trial basis and feedback is always sought during that period. Care Homes for Older People Page 12 of 32 Evidence: The home has recently updated its Statement of Purpose and Service User Guide so that people have sufficient information available to them when considering if the home can meet their needs. When admitted there is also a monthly Newsletter informing them of events at the home. We looked at the admission of the last two people to become resident at Ravenscroft. This involved meeting them, looking at assessment of their needs and wishes prior to admission and talking to the manager and staff about their care. Both new admissions appeared to be well cared for and their needs to be met. We were told of the manager, Mrs. Mason, visiting the one to make an assessment of their needs and ensuring the necessary information was available on the other person, who was then living in the north of England. Mrs. Mason and staff were found to have a good knowledge of the peoples needs. Time and effort had been taken to help them settle in. For example, internet access arranged and a personal rose garden being planned. One told us: The attention has been good. They are almost like friends. He added that he felt safe and had faith in the staff. We looked at the records of assessment. It is this information which is used to plan the care. Generally the assessment records were detailed and complete. However, there was no indication of who, other than Mrs. Mason, had been involved in the assessment. Also, the home had not ascertained whether they have a Lasting Power of Attorney, Independent Mental Capacity Advocate or Relevant Person working on their behalf. This information is required so that people who are unable to make their needs known are properly represented and their rights protected in law. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that their needs are understood and can be met. They are treated with dignity and respect. Evidence: Each person living in the home must have a plan of care that accurately reflects his or her care needs and identifies the action required by staff to meet those needs. The plan of care must be reviewed a minimum of monthly in consultation with the person or their representative and updated when the persons needs change. This is to ensure that a persons changing needs are assessed and met. The home reports: Staff now have far more insight into the reasons why care is delivered as stated in the care plan. The home has taken on board all previous findings by CQC and acted upon them. Due to robust review procedures carried out by the home the delivery of care is now given in an up to date professional manner. Eight staff told us through surveys (received in August) that they are always given up to date information about the needs of the people they support and care for, two said they usually are. Care Homes for Older People Page 14 of 32 Evidence: We looked closely at the full care of three people at the home and at certain areas of care of two others. We found, with one exception, that care plans contained sufficient detail from which staff are informed of the care to be delivered. Where one aspect of a persons care was not planned the care need was, none-the-less being, being met. Care plans are reviewed at least monthly, but, as with assessment records, there was no indication that the person receiving the service, or their representative, was involved in planning their care. This reduces the persons independence and autonomy. Five people told us through surveys (received in August) that they always receive the care and support they need, three said usually, three sometimes and one did not know. Seven people told us through survey that they always get the medical care they need and four said they usually do and one said they sometimes do. A person told us during the inspection: The home has definitely progressed a lot and Very good. They talk to me nice and friendly. They look after me very well. The staff always make sure that I am nicely dressed, clean and tidy. A visiting G.P. told us: A lot better. Good communication and happy patients. No concerns. A social worker told us: The person I visited was very happy with the home. He spoke very highly of the standard of care. We joined a hand over of information between staff and also saw written information given to staff. The home now has a clinical lead nurse and senior care staff whose task it is to monitor care work as it is delivered. These steps have been taken following a period of time when the standard of care at Ravenscroft was deemed to be unacceptable, some resulted in referral to the local authority safeguarding team. The safeguarding process is now concluded as the service is considered safe. We found that standards of care are now much more closely monitored and were much improved. Without exception, people indicated that they were confident in the ability of the staff to care for them. We were told: They are better trained than they were. They are very good now and What they do best is looking after me - I feel relaxed now. We looked at how medicines are handled at the home. The manager Mrs. Mason has recently updated the homes policy on medicines. We found that medicines were correctly and safely stored, records were detailed and clear and the home ensures people can manage their own if they wish and are able. Where medicines leave the home this is properly managed. However, despite a previous requirement that all medicines must be checked into the home so that a full audit of their use is always possible, we found some were not. This requirement is repeated. However, the Care Homes for Older People Page 15 of 32 Evidence: previous requirement to ensure as necessary medicines are part of planned care, is now met. We saw that staff treat people with respect and dignity is upheld. Where people make the decision to accept care from certain staff only this is understood and honored. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to enjoy a fulfilled life at Ravenscroft. Evidence: We wanted to see if people are enabled to lead fulfilled lives at Ravenscroft. Four people told us through surveys (received in August) that the home always arranges activities that they can take part in if they want, three said it sometimes does and five said this sometimes happens. The home reports: People continue to have choice and autonomy over their lives at Ravenscroft. They are encouraged to follow their interests and socialise both internally and externally by visiting family, clubs etc. but also maintain their rights as individuals regarding their futures /quality of life. We saw that one person is planning and planting a rose garden. Another has a small painting studio within their room. There are newspapers and magazines available. People are supported to leave the home (taken to view the local moorland) by staff. Two people who use the service go out regularly to clubs. There is no designated Activities Organiser at this time. However, people told us there is Holy communion once a month, fortnightly visits by a hairdresser and various musicians and singers including Folk and Country and Western once a month. The Care Homes for Older People Page 17 of 32 Evidence: manager, Mrs. Mason told us that, due to a changing population at the home the once very popular quizzes had lost popularity and thus ceased. During the morning of the visit staff were too busy with their tasks to really engage with people but this changed somewhat in the afternoon. One person told us she assists with laying up tables for meals, because I like helping and also enjoys walking on the nearby moorland. Another socialises with people who prefer to stay in their room. People are able to receive visitors at any time and choice is promoted wherever possible. To this end people have the opportunity to make their wishes known at regular residents meetings. Seven people told us through surveys (in August) that they always like the meals at the home. Four said they usually do and one said they sometimes do. Comments include: The food is very nice. I am very happy with the care I get. I enjoy the activities provided at the home. If you dont like the menu they will cook something else. And Sue Mason arranged for special fish to be brought in for dad. When we spoke to people directly opinions varied from: Depends on which cook is on duty, Very good, Breakfast is the best meal of the day when I get boiled egg and toast, Food not bad, Quite fair and OK. A regular visitor who takes lunch told us she enjoyed the food. On the day of the visit the chef said he had prepared six different menus to meet the specialist needs of people. We saw that pureed food is served in the constituent parts so that tastes are individual and presentation is more acceptable. Several people said they made menu suggestions at a recent Residents Meeting and were confident the suggestions would be acted on. People needing assistance with eating were seen to be given this in a discreet manner by a carer sitting along side engaging with them. People are able to choose where they eat, and to some degree when they eat. The dining areas appear attractive and pleasant to use. Every room visited and the lounges had water and /or soft drinks available. Records indicate that diet is properly considered although we did identify one new person where, although needing a specialist diabetic diet, the kitchen had not been informed. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to raise any concern or make a complaint in the knowledge that it will be appropriately responded to. They will be protected from abuse. Evidence: Ten people told us through surveys (received in August) that there is someone they can speak to informally if they are not happy and two said there was not. Nine people told us through that that they know how to make a formal complaint and three said they did not. The homes complaints policy is clearly displayed in the entrance of the home and is also provided within the Statement of Purpose and Service User Guide, given to people on admission. Previously people were not always confident that complaints or concerns would be listened to and acted upon, but information indicates that this is not now the case. People have a lot of confidence that the manager, Mrs. Mason. We saw records of complaints which had been investigated and the outcomes appeared to be positive. In addition, Mr. Carroll, the provider visits people to ask about their impression of the home. The Commission has received one complaint about the home in the last twelve months. This led to a random, unannounced visit to look at the issues described. Whilst not finding evidence to substantiate the complaint in full, we did find some Care Homes for Older People Page 19 of 32 Evidence: concerns relating, for the most part, to staffing. These have now been addressed. (Also see the Standard called Staffing). The home reports: We have an open and honest approach to complaints and adhere to a strict complaints policy. All complaints are discussed at a management meeting and then investigations and actions are reported back to the concerned individuals within 28 days (often much quicker). All complaints are treated with the utmost importance. People are notified that their complaints are being dealt with and then receive both verbal and written feedback. To date everyone has been satisfied with the action taken as a result. People we spoke with told us they were satisfied with the manner in which various issues had been handled and resolved. We asked the manager Mrs. Mason how she should respond to a concern which might be abuse. She had good knowledge of how she should respond. Staff receive training in the safeguarding of vulnerable adults from abuse and they know where to find the whistle blowing policy (how to alert concerns which might be abuse). The policy itself is clear but does not contain the contact details of the local authority safeguarding team, although there are details for the Commission. All staff told us through surveys (received in August) that they knew what to do if someone has concerns about the home. The home has a history of safeguarding alerts from when concerns have been raised. Those concerns are now resolved and the procedure closed as it believed the home is safe and people are protected. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home environment meets the needs of the people who use the service but hygiene standards in the laundry need to be improved. Evidence: We looked at how well the home environment suits and meets the needs of the people who live there. Currently one wing of the home is not in use and there are plans for refurbishment. All the people spoken with and seen appeared to be very content and secure in their environment. Many rooms have good views. There is a variety of sitting areas throughout the home offering personal, or shared, social space. The gardens are very attractive, well kept and contain sculptures of interest and amusement. The home is nicely furnished and in a good state of repair. Bedrooms have been presonalised to various degrees and people are encouraged to make their personal space individual the themselves. One person has a fridge and microwave, another has a kitchenette, another a small art studio. The manager, Mrs. Mason, told us she has the necessary equipment needed to prevent pressure sores and aid safe moving and handling of people. An old hoist, which had previously been a concern to staff, is now out of commission. Care Homes for Older People Page 21 of 32 Evidence: Five people told us through surveys (returned in August) that that the home is always fresh and clean and six said it usually is. One said it is never clean. The twice we visited the home was fresh and clean, with the exception of the laundry where we found items on the floor and on the sink drainer which posed a hygiene risk due, in part, to the proximity to clean items. We also found no liquid soap for staff hand washing in the laundry and one sluice. The laundry worker had not received training in infection control or the safe handling of chemicals. We saw that staff had protective clothing, such as gloves and aprons, available to them to reduce any likelihood of cross contamination and there was good signage encouraging visitors to be aware of good hand hygiene practice. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is improved confidence in the skills, knowledge and expertise of staff at the home but not proven competence over a period of time. Recruitment is robust and protects people. Evidence: There has been a history of concerns regarding staffing numbers, skills and knowledge at Ravenscroft. Where concerns have been alerted to the safeguarding team they have related to the standard of care provided. People told us toward this inspection: The carers and nurses are totally dedicated and caring and XXX and the nurses are brilliant. Totally dedicated to the welfare of patients. We did a random inspection June 2009 where issues about staff numbers and training were raised by people who use the service and staff. One person told us through survey (returned in August) that staff are always available when they need them, seven said usually, three said sometimes and one did not know. Comments included: The home is understaffed most of the time. The owners appear to not fully understand the need for more staff and We have been at the home many times when the buzzers never stopped. One staff told that that there are always enough staff to meet the individual needs of people, five said there usually are and four said Care Homes for Older People Page 23 of 32 Evidence: there only sometimes are. At these inspection visits we asked peoples opinion of staff numbers. Responses varied from: Yes sufficient, Nearly, They could do with one more person on duty and There are more staff on, but still a bit short staffed. The consensus opinion appeared to be that more staff were needed to cover the morning medication, rising, washing and breakfast period when people experience delays in receiving assistance. We found that at 9 am the call bells were continually ringing, but this reduced as the morning progressed and at other times call bell response was prompt. The home now has a better complement of support staff so nursing and care staff do not have to leave their caring duties for non care work. A visiting G.P. told us that staff turnover has now settled and he has no concerns. The first of our two visits there were 25 people resident. The manager was on duty, one registered nurse, four care staff providing care, one senior care staff monitoring the provision of care and six housekeeping support staff. We found that there is a balanced staff team, with both male and female and varying ages. Some new staff have previous care experience. We were told: The staff here work as a team to get as much as possible done. Surveys received in August highlighted dissatisfaction with staff knowledge, induction and training. However, people now tell us that staff are better trained than they were and They are very good now. We now find a training program in place and all care staff are strongly encouraged to undertaken National vocational (NVQ) qualifictions in care. One is an NVQ Assessor. We saw a good range of training available, including palliative care, care of people with dementia, infection control and protection of vulnerable adults. Staff receive training in moving and handling, an area of concern relating to safeguarding alerts, but we did not have the opportunity to observe people transferring from one place to another with staff assistance. We asked people about staff induction, the training they receive when they are new to the home. The home is using the Skills for Care Induction program and staff told us this is useful. They receive one day induction before starting work, as an extra member of staff and shadowing an experienced staff. For experienced care staff this may well be sufficient, but where staff are new to caring this may not, and in some cases, will not be sufficient. We discussed, with the providers, the need for staff induction to be based on the persons individual requirements and where necessary a Care Homes for Older People Page 24 of 32 Evidence: longer period shadowing. We looked at whether staff recruitment practice safeguards people from those who may be unsafe or unsuitable to work with vulnerable people. Of the three records were examined all had the necessary checks completed before the staff started work at the home. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the best interest of the people who use the service as the priority and there is a clear vision how to further improve the service. All potential hazards need to be risk assessed. Evidence: The current registered manager, Mrs. Sue Mason, has been at the home for about one year. She is well qualified to manage the home and is very well liked by people who use the service and staff. Comments include: A very happy home, Sue Mason, excellent matron; good as manager, The matron is brilliant, always here for the staff and We, as carers take pride in what we do in a safe manner and follow instructions from our manager (matron) and our matron is a very supportive manager to us carers and in return we respect and give 100 . Also, a very good role model. There was much previous concern that the manager was: Fighting a loosing battle and spending much of her time putting out fires. We were repeatedly told that she Care Homes for Older People Page 26 of 32 Evidence: was unable to manage the home as she wished. The provides told us that it has taken them a long time to have confidence in a matron/manager and step away from the day to day decision making. However, they responded very positively to our random inspection findings, from which has led much improvement. Mrs. Mason leads by example, keeps herself updated in current care and management practices and does not hesitate to take any necessary disciplinary action where her required standards are not met. There is now a hierarchical, structured and more accountable staff management with matron, a clinical lead nurse with much experience and who is undertaking management qualification and senior care staff who are to monitor day to day care activity. We looked at how the quality of the service is monitored at the home. The provider does a monthly unannounced visit, talking to people who use the service and staff about the home. There are regular meetings between the providers and manager, Mrs. Mason. Staff receive regular supervison of their work and are invited to staff meetings. There are also residents meetings, with family involved, where we saw issues have been raised regarding the menu, comfort of mattress, chiropody visits and the standard of laundry. Mrs. Mason audits some aspects of the care provided, such as medicines and accidents. The provides completes a yearly quality assurance audit of the service. Peoples opinion is surveyed once a year; sent August 2009. There is a comments box situated near the signing in book. Complaints are now accepted as a method for identifying areas in need of improvement. The Commission is now kept fully informed about events which affect people, such as staffing and accidents. No money belonging to people who use the service is handled within business accounts and any money kept for people is done so securely and with good records kept. People have the option to keep valuables locked safely in the room. We saw that most policies have been reviewed and we are told that all record keeping is more efficient. Seven staff told us through survey that the ways they share information about the people they support and care for always work well and two said they usually do. We looked at whether health and safety are properly managed at the home. Staff, for the most part, receive all necessary health and safety training, such as moving and Care Homes for Older People Page 27 of 32 Evidence: handling and infection control. However, one domestic staff, with a responsibility for hygiene and who uses chemicals, had not received the necessary training. We checked service records and found that all equipment is regularly serviced and there are weekly checks of the environment to ensure no necessary maintenance is missed. We looked at whether individual and general risk is assessed at the home. We found that people were using bed sides but any risk from this had not been assessed. We also found that general risk, for example, the use of stairs and walking to the moor with staff, was not risk assessed. This means that risk is not necessarily identified nor steps put in place to remove or reduce risk. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 (2) All medicines received into the home must be recorded. To ensure a full audit is possible so as to protect people. 30/11/2008 Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 (2) All medicines received into the home must be recorded. So that a full audit is possible so as to protect people. 04/11/2009 2 26 13 There must be liquid soap available in the laundry and sluice areas. So that hand hygiene can be maintained and the possibility of cross contamination reduced. 31/10/2009 3 38 13 Where people have 20/11/2009 consented to the use of bed sides any risk from this must be assessed. So that any risk can be removed or reduced. 4 38 13 All risk, either from the environment or staff practice, must be assessed. 31/12/2009 Care Homes for Older People Page 30 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action So that any risk can be removed or reduced. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Before people are admitted the home should ascertain whether they have a Lasting Power of Attorney, Independent Mental Capacity Advocate or Relevant Person working on their behalf. This information is required so that people who are unable to make their needs known are properly represented and their rights protected in law It should be clear from records who has been involved in a persons assessment prior to their admission. It should be clearly recorded who is involved in the review of the persons plan of care. Should there be no person able to do so this should also be recorded. All care should be planned, including acute episodes of ill health. There should be a dedicated activities organiser and coordinator so that the task does not fall to care or nursing staff. The whistle blowing policy should contain the contact details of the local authority safeguarding team. More attention should be paid to the standard of hygiene in the laundry. Staff numbers and deployment should be under regular review and in line with peoples opinion. Staff induction should take into account lack of previous experience and the individual needs of the staff member. This should be determined by the manager based on her experience. 2 3 3 7 4 5 7 12 6 7 8 9 18 26 27 30 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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