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Inspection on 30/11/05 for Ravenscroft Nursing Home

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

This inspection was carried out on 30th November 2005.

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

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

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

What the care home does well

What has improved since the last inspection?

One lounge has been redecorated and refurbished a new purpose built wing has been opened and registered, providing a high standard of tasteful accommodation, suited to meet the needs of people with physical frailty or illness.

What the care home could do better:

The documented plans of care should be regularly reviewed and updated by the staff in the home. When changes in need occur, the plan to meet that need must also be changed, failure to do this poses the risk of care being inconsistent and some needs not being met. A safer system for recording medication administration and the storage of medication no longer in use needs to be put in place to ensure residents are given the correct medication and dose and to reduce the risk of medication being misused.

CARE HOMES FOR OLDER PEOPLE Ravenscroft Nursing Home Ravenscroft Nursing Home Old Crapstone Road Yelverton Devon PL20 6BT Lead Inspector Fiona Cartlidge Unannounced Inspection 30th November 2005 11.45 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.V253198.R02.S.doc Version 5.0 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.V253198.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ravenscroft Nursing Home Address Ravenscroft Nursing Home Old Crapstone Road Yelverton Devon PL20 6BT 01822 853491 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) Timothy O`Carroll Mrs Karen Louise O`Carroll Mrs Chantal King Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (12), Physical disability (12), Physical disability of places over 65 years of age (40), Terminally ill (4) Ravenscroft Nursing Home DS0000029227.V253198.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Old age, not falling within any other category (12) Physical disability over 65 years of age (40) Terminally ill (4) 2 Service Users under the age of 65 years (named elsewhere) Physical disability (12) A maximum of 50 service users at any time Date of last inspection 14/06/05 Brief Description of the Service: Ravenscroft is a care home providing nursing and/or personal care for a maximum of 50 residents of either gender with physical frailty, illness or disability. It is situated near Yelverton, West Devon, on the edge of Dartmoor National Park. The home is arranged on 3 floors within an old ‘Edwardian house’ and more modern extensions. A new purpose built wing was registered and opened in September 2005; all rooms in this wing have en-suite toilets and are attractively decorated and furnished. Further improvements to the existing environment are on going. The home is well equipped to meet the needs of those residents identified with moving and handling risks and disabilities that affect their capability to bathe. Specialist mattresses were seen in place for those residents requiring them as were height adjustable beds. Level access is accomplished via 3 passenger lifts. There are 3 lounges and a dining room. There are large grounds, with grass and paved areas, with level access from the house. Ravenscroft Nursing Home DS0000029227.V253198.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 5 hours 15 minutes and was unannounced. This was the homes second statutory inspection of the year 2005-2006 readers may wish to consider the content of both reports to gain a full picture of the homes achievements. A partial tour of the home took place when some bedrooms and all communal areas were viewed. Individual records of care held on behalf of 1 resident and personnel records of 2 members of staff were inspected. The inspector spent the majority of the time talking with 15 residents, 3 visitors, the registered manager, and registered providers and took time observing actual practise. What the service does well: What has improved since the last inspection? One lounge has been redecorated and refurbished a new purpose built wing has been opened and registered, providing a high standard of tasteful accommodation, suited to meet the needs of people with physical frailty or illness. Ravenscroft Nursing Home DS0000029227.V253198.R02.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ravenscroft Nursing Home DS0000029227.V253198.R02.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ravenscroft Nursing Home DS0000029227.V253198.R02.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4,5 A proper assessment is performed on people considering admission to this home, this provides information to the homes staff so they can be sure they can meet the individuals needs. EVIDENCE: The inspector examined personal care records held on behalf of 1 recently admitted resident; this included pre-admission information supplied from care management and a hospital setting. The manager at the home also performs a preadmission assessment on prospective residents, obtaining information about health, personal and social care to enable her to make a professional judgement about how needs will be met, before offering the individual the opportunity of admission. People are invited to visit the home before making a decision about admission. Residents told the inspector that they and or their relatives had chosen this home after viewing it and meeting with some of the staff and existing residents. All of those spoken to said they were pleased that they had moved to Ravenscroft. Ravenscroft Nursing Home DS0000029227.V253198.R02.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The health care needs of residents are regularly reviewed and action is taken to meet those needs. The Care plan seen had not been updated to reflect a change in need, this may pose a risk to residents, as staff may not be consistent in their approach to changes in a persons needs. Poor and inaccurate recording of medication administration has the potential to place residents at risk of either over medication or not receiving medication as it has been prescribed. EVIDENCE: The documented assessments seen, provided information about skin integrity, moving and handling, safety - including risk of falls, and social needs. The information generates the plans of care, which provide the basis for the care to be delivered. The inspector viewed a residents’ care plan; this had not been updated to reflect a change in condition requiring different management to that previously provided. Records are maintained for all visits to the home by social or health care professionals, all residents are registered with a GP. Records provided evidence that as well as visits from General Practitioners, district and specialist nurses, Ravenscroft Nursing Home DS0000029227.V253198.R02.S.doc Version 5.0 Page 10 chiropodists, physiotherapists and dentist’s visit. The home also employs a part time physiotherapist who visits regularly. Records of outpatient appointments show that visits to community and hospital health resources are enabled. Residents told the inspector that the staff respect their privacy and dignity, the inspector observed that when personal care was being provided this was done behind closed doors, the staff spoke to residents in a polite manner and were witnessed to knock on the doors to private accommodation before entering. Feedback was received by the commission from 1 relative/visitor indicating that they are usually satisfied with the overall care provided. The inspector examined the system of medication management, one administration record lacked signatories where medication should have been administered as prescribed, another medication was written as 1 or 2 tablets to be given, there was no indication of how many had actually been administered. Medication no longer in use had been placed in the correct bin for disposal by a licensed waste contractor; however this bin was being stored in a cupboard, which could be accessed by non-nursing staff. There was only one signatory beside some records made at the time of the medication being placed in the bin - best practise indicates a registered nurse and witness should record the actual date the medicine was added for disposal, with the name and strength of the medication, quantity, name of resident for whom the medication was prescribed, signature of the member of staff and witness and on removal by the contractor, date and signature of consignment of the waste to the contractor. Ravenscroft Nursing Home DS0000029227.V253198.R02.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Social activities are organised and provide stimulation and interest for residents on most days. Meals are nutritious and balanced offering a healthy and varied diet for residents. EVIDENCE: Some residents were seen socialising in the lounge or watching television others were spending time in their rooms, reading, listening to music, watching television and one was busy model making. A game of bingo took place in the dining room during the inspection. A monthly news letter is distributed to residents to provide information about the social activities available, those in December include exercise classes, a carol service, manicures, Christmas party, communion and entertainment by a guitarist. Residents told the inspector they are able to chose the times they rise and retire and when, where and how they spend their time. The feedback about food was positive all of the residents spoken to said how good it was; on the day of inspection lunch was served, residents were offered fish fingers, chips and vegetables followed by ice cream; residents said they are always offered 2 choices and if neither suit an alternative is found. A number of residents ate lunch in the dining room; all other residents ate their Ravenscroft Nursing Home DS0000029227.V253198.R02.S.doc Version 5.0 Page 12 lunch in their own accommodation. Records seen provided evidence that resident’s weights are regularly monitored. The people living in the home told the inspector they were happy with the visiting arrangements, visitors said they feel welcomed into the home and are able to visit their relative/friend in private. Ravenscroft Nursing Home DS0000029227.V253198.R02.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 People are safe living in this home and know who to speak to if they are dissatisfied. EVIDENCE: The inspector examined the homes complaints procedure this was found in the displayed in a notice in the entrance hall. The commission has received 1 complaint about this home since its last inspection. Records of the investigation of this complaint provided evidence that all complaints are taken seriously, fully investigated and reported including detail about outcomes and any actions taken to prevent a reoccurrence. Ravenscroft Nursing Home DS0000029227.V253198.R02.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,26 Most of the home is well decorated and furnished and clean, pleasant and hygienic. EVIDENCE: A tour of the home provided evidence that the providers continue to improve and maintain an attractively presented environment for residents and staff; the maintenance person was in the process of repairing radiators and assisting a contractor to replace a faulty boiler. Resident’s rooms contained personal items of furniture, ornaments and pictures. All of those spoken to said they liked their rooms, some were pleased that their rooms had views over the moors others were equally satisfied with rooms leading onto the enclosed mature garden. The home is well equipped to meet the needs of those residents identified with moving and handling risks and disabilities that affect their capability to bathe. Specialist mattresses were seen in place for those residents requiring them as were height adjustable beds. Ravenscroft Nursing Home DS0000029227.V253198.R02.S.doc Version 5.0 Page 15 A new purpose built wing was registered and opened in September; all rooms in this wing have en-suite toilets and are attractively decorated and furnished. Further improvements to the existing environment are on going. The home was fresh and clean in its appearance, hand washing facilities are available throughout as were protective gloves and aprons and procedures followed by the staff minimise the risk of cross infection. Service Users spoken to were happy with the accommodation they have. A tour of the home confirmed that all individual rooms have a suitable bed, drawers, a wardrobe, overhead and bedside lighting, a bedside table and comfortable seating. 40 of Service User doors have been fitted with locks. Rooms within the home are individually and naturally ventilated. The home has central heating throughout; each radiator can be controlled separately. Lighting in Service Users accommodation is suitable. Ravenscroft Nursing Home DS0000029227.V253198.R02.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 The procedures for the recruitment of staff are robust and offer protection to people living in the home. The deployment and number of staff on duty during the inspection met the needs of the residents. EVIDENCE: Most of the residents told the inspector that there were enough staff on duty, they said they ‘worked hard’ and were ‘very caring’ –‘nothing is too much trouble’. The staff spoken to said that they felt there was sufficient numbers of staff on duty and said they had access to training and development. The inspector examined the personnel files of 2 recently employed members of staff these provided evidence that the recruitment process is fair, equitable and safe and all required checks are performed to ensure the safety and welfare of those living in the home. The inspector examined training records these indicate that the staff receive regular training/updates. Two relatives/visitors told the inspector that in their opinion there were enough staff on duty to meet the needs of residents. Ravenscroft Nursing Home DS0000029227.V253198.R02.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,38 The home is being managed properly and there is evidence of clear leadership, guidance and direction to staff. EVIDENCE: Residents, visitors and staff made positive comments about the management team in the home saying they felt comfortable approaching them with Issues. Communication systems are regular through staff handovers, and formal meetings are held, a meeting for residents and relatives is planned on the 15th along with a buffet tea. The provider demonstrated a responsible attitude towards health and safety – all fire doors that were open were being held by ‘safe’ hold open devices and notices were displayed throughout the home. Risks to residents are individually assessed and documented with an agreed plan in place to minimise risk where possible. Ravenscroft Nursing Home DS0000029227.V253198.R02.S.doc Version 5.0 Page 18 Plans to provide transport and further landscape the gardens provide evidence of reinvestment in the business, as does the recent increased provision of accommodation. All of the records seen during the inspection were clear, well maintained and secure. Ravenscroft Nursing Home DS0000029227.V253198.R02.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 4 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 3 X X X 3 Ravenscroft Nursing Home DS0000029227.V253198.R02.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? N0 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 OP9 Regulation 13(2) Requirement Medication administration records must be accurate. Medication no longer in use must be stored in a safe manner. Timescale for action 01/01/06 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 OP7 Good Practice Recommendations Residents care plans should be updated when a change in need requiring a change in care occurs. Ravenscroft Nursing Home DS0000029227.V253198.R02.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ravenscroft Nursing Home DS0000029227.V253198.R02.S.doc Version 5.0 Page 22 - 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. 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