Inspection on 22/06/06 for Ravensmere

This inspection was carried out on 22nd June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ravensmere 24/05/07

Ravensmere 11/02/06

Ravensmere 28/09/05

Ravensmere 02/11/04

Ravensmere 13/05/04

Ravensmere 04/02/04

Ravensmere 18/12/03

Ravensmere 27/11/03

Ravensmere 18/09/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Ravensmere 13-15 Manor Road Westcliff On Sea Essex SS0 7SR Lead Inspector Vicky Dutton & Ann Davey Key Unannounced Inspection 22nd June 2006 08:00 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 Ravensmere DS0000015463.V300524.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. Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ravensmere Address 13-15 Manor Road Westcliff On Sea Essex SS0 7SR 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) 01702 330347 01702 330347 Health and Home Limited Manager post vacant Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (24) Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To provide care and accommodation for two service users, who are under 65 years of age whose details are known to the Commission. 11th February 2006 Date of last inspection Brief Description of the Service: Ravensmere Rest Home is a care home run by a small limited company, Health and Home. Ravensmere Rest Home is situated in a Residential area in Westcliff on Sea. The home is close to the seafront and a short walk from bus routes, main line railway station and local shopping facilities. The home currently provides care and accommodation for up to twenty four older people. The home is also registered to provide care for older people with dementia and mental disorders. Accommodation is provided on three floors in sixteen single and four double rooms. All but one room now has some form of en suite facility. A passenger lift provides access to most levels within the home. Four bedrooms at the home cannot be directly accessed by the lift. Residents in these rooms must be able to negotiate some stairs. Limited parking is available at the front of the property. There is a pleasant courtyard garden with outdoor seating. A copy of the homes Statement of Purpose and Service Users Guide are available in a folder in the homes lobby area. Copies of the homes inspection reports are not readily available but must be requested from the homes office. (This is referred to in the Service Users Guide) Current fees for the home were quoted in the pre-inspection questionnaire as being a flat rate of £551.25 per week. However when teased out during the inspection process it seems that there is a scale of charges in operation at the home that range from £530.00 to £600.00 plus. (Precise amount not confirmed.) It was stated that there are no extra charges and that chiropody, toiletries, newspapers etc. will all be provided within the weekly fee. It is acknowledged that the fax number shown above is incorrect and should read 01702 337585. This will be corrected in the next report template. Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced ‘key’ site visit. The inspection was undertaken by two inspectors over a nine hour period. At this inspection all the key standards, and the homes progress against their previous agenda for action were assessed. A tour of the premises took place and care, staff, and other records were selected at random and inspected. A number of residents, and staff were spoken with. A notice was displayed by the homes signing in book to advise any visitors to the home that an inspection was taking place, and with an open invitation to speak with an inspector. Questionnaires to seek peoples view about the quality of the service were given out to two visitors to the home. Individually addressed questionnaires were left for a sample number of staff at the home, with spare copies and envelopes left for any other staff that wished to participate. Questionnaires were also sent out in the post to relatives, and health and social care professionals that have contact with the home. The views expressed in the responses have been incorporated into this report. The home had been sent a pre inspection questionnaire before the site visit took place with a request that this, and other information to facilitate the sending out of questionnaires, be returned to the Commission for Social Care Inspection (CSCI) by the end of April. This information was received by CSCI on 09/06/06 with further additional information received on 16/06/06. During the inspection the inspectors were assisted by the acting manager, who is also the managing director and company secretary for Health and Home. At the start of the inspection the acting manager took the decision to call in an additional member of staff in order that a care manager at the home could also assist in the inspection process. Findings and feedback was given to the acting manager and care manager constantly throughout the day, with the opportunity given to clarify information, or produce additional evidence or documentation. What the service does well: Visitors said that they are always made welcome at the home, and are able to talk to staff about their relative/friend. Feedback from one survey in particular praised the helpfulness of staff, and their dedication to meeting resident’s needs. Residents spoke well of staff at the home. During the inspection staff and resident’s chatted, undertook activities and seemed to have a good rapport with one another. Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 6 Care and other staff at the home were helpful and accommodating to inspectors. The home has a stable core group of staff that have worked at the home for some time. This helps to provide consistency of care for residents. What has improved since the last inspection? What they could do better: Ravensmere Rest Home has a poor history of compliance with regulations. However in recent months this appears to be changing, and management at the home are starting to address many issues. In a response (received on 12th June) to the previous inspection that took place on 11th February the acting manager indicated that all requirements made at this (11th February) inspection had been met. This with the exception of a requirement relating to standard twelve. This deals with daily routines and activities for residents, and was said to be ‘partially met’. This inspection however has shown that the interpretation given is not quite the case, and shortfalls were noted in a number of areas. Care planning needs improvement so that wherever possible residents are consulted about their care needs and wishes. It is accepted that some residents may not be able or willing to contribute to this process, but some will be. The home should be able to show, how they have tried to involve residents and/or their families in compiling care plans. Resident’s needs should be fully identified with plans in place to assist staff in meeting these needs. The environment provided for residents also needs improvement with adequate furnishings/fittings/facilities being made available to them. Management at the home need to continue to work towards meeting the requirements and recommendations made as a result of this inspection. Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 7 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. Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 8 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 Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3, 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff from Ravensmere Rest Home visit potential residents to assess their needs before they move into the home, and confirm that the home is able to meet their assessed needs. This should ensure that potential residents receive care in a home that is suitable for them. Staff have received training consistent with the homes registration. EVIDENCE: The home has a Statement of Purpose and Service Users Guide available. These documents were reviewed in June 2006. The acting manager stated that a copy of the service users guide is always given to potential residents when a pre-admission assessment takes place. The home is registered for people who may have dementia or mental health problems. Therefore, where possible, the format of this document should be suitable for them to understand and gain information about the home. The acting manger said that he had been thinking about developing this, and hoped to produce a more user friendly brochure format. Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 10 A sample Statement of Terms and Conditions and contract was provided. For two residents, one admitted in March, no statement of terms was available on their files. It was stated that these had been provided to families but had not yet been returned. The files of recently admitted residents were viewed. These showed that the home visits potential residents before they are admitted, and carry out an assessment. It was seen that the home also gathers information about potential residents from different sources such as social workers. In one case good practice was noted in that the acting manager had kept a record of contacts with the residents pre-admission placement to verify the steps taken to facilitate admission. The management of the home confirm in writing to the resident or their family that, in their view, the home is able to meet their assessed needs. The home is registered to provide care for residents with dementia and/or mental health conditions. Training records for staff were provided with the homes pre-inspection questionnaire. These showed that all but two staff are recorded as having undertaken training in dementia care. Training has also taken place for staff in mental health issues. It is worthy of note that dementia training for most staff took place in March of this year, and training in mental health issues in May of this year. This follows many repeated requirements in inspection reports for staff to be adequately trained to meet the needs of residents, and to reflect the stated specialisims of the home. Training in these areas has been undertaken using in house packages, the quality of training, and staffs’ knowledge was not tested at this inspection. In the homes service users guide it is stated that the manager of the home is ‘an accredited trainer on dementia.’ Again the basis for this statement was not examined at this inspection. During the inspection observations showed that staff were attentive and caring towards residents. Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning, healthcare and medication are core areas of residents care. Although positive things, and good practice were noted in all these areas, closer monitoring is needed by management at the home to prevent gaps in information, recording, and practice occurring that could effect residents care, and wellbeing. EVIDENCE: Each resident has an individual care file containing care plans and other relevant information. As part of this inspection a number of care plans were viewed. Those viewed were generally well completed, and incorporated risk assessments for relevant areas. Some individual care plans for different aspects of care were very good in the level of detail and staff instruction that they provided. However, some significant areas of shortfall were discussed with the acting manager. These shortfalls have the potential to adversely effect the care offered to residents. Where residents are receiving input from the district nurse, this fact, and any necessary actions were not recorded in Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 12 care planning. The acting manager said that the home took the position that staff would access the district nursing notes, but accepted that at the very least should be a ‘linking’ care plan in place. The daily observation notes identified that one resident had expressed thoughts that needed to be supported and managed. Although it was established that the resident was under the care of a psychiatrist, there was no risk assessment or care plan in place relating this aspect of their care needs. Another resident needed to use a specific piece of equipment, there was no mention of this in their care plans. The acting manager felt that the shortfalls identified were a ‘question of documentation, not of care.’ Regular reviews of care plans were recorded. However these mostly indicated that there were no changes. This was not always the case. Reviews had not identified changes and care plans had not been updated. One resident where this was identified had suffered a fall that (according to the care manager, as an A and E report had not been provided/could not be found, had resulted in a fracture.) This clearly had resulted in a change in needs that had not been planned for. Reviews had carried on stating ‘no changes’. The acting manager felt that this incident did not necessitate a change of care plan, but that a falls risk assessment would be sufficient, and had been undertaken, with actions taken. As well as monthly reviews undertaken by staff files evidenced that ‘case reviews’ were also held as necessary, with progress reports prepared by senior staff at the home. Daily records and care notes are kept separately from individual files, which may not encourage the full use of care plans by staff. In both daily records and care planning, the language used by staff was noted to be an issue. Medical terminology such as ‘paranoia’ and phrases such as ‘refused to go to bed’ were seen to be used. The acting manager said that he did not often read the daily records but relied on verbal handovers from senior staff. He felt that the terminology used was the work of a new member of staff, whose work he was due to review during the following week. The acting manager also felt that care notes must now be screened for quality before they were filed. Records showed that Ravensmere provides residents with a good level of health care support. Medical assistance is sought as needed, with appropriate referrals made to other professionals. Falls risk assessments are undertaken. Currently two formats for this are being trialled to decide which will best meet the homes, and the resident’s needs. As part of the homes falls risk management strategy pressure mats are used beside residents beds. A high number of these are in use, but their use is not linked into proper assessment and care planning processes. This needs to be addressed in order that residents right to independence, dignity and privacy are protected. District nurses are involved in care as appropriate to meet individual needs. (See above). Records showed that regular optical care is offered. The acting manager was unsure how dental care was offered, but the care manager was able to confirm the details of this. One relative said that a specific health issue took a long time to be sorted out by the home. Good nutrition records are maintained by the home to assist in monitoring resident’s health. It was Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 13 established that staff at the home are monitoring some resident’s blood sugar levels. Training (in March 2005) had been given by the Primary Health Care Trust (PCT.) There was no protocol/memorandum of understanding in place to show that the PCT retained responsibility for this clinical procedure. No evidence was presented to show that staffs’ competence was monitored or checked. It was seen that in general the systems for ordering and managing medication at the home are satisfactory. In a recent development the home has tried to maintain best practice in terms of prescription monitoring, and has kept CSCI informed of a local difficulty. However, the inspection revealed areas of practice that show that closer monitoring and management is required. Where medication is prescribed ‘as and when required’ (PRN) a protocol should be in place so that staff offer the medication appropriately. These were in place for some medicines, such as inhalers, but medication such as diazepam, lorazepam and Zolpidem was in use with no guidance for staff as to when/in what circumstances these medications should be administered. In one case it was unclear whether the medication was still to be used by the resident. A homely remedy was in use by one resident but this did not appear to be recorded anywhere. The administration instructions for one medication had been changed but this was not reflected on the pharmacy label. The home uses a system of blister packed medication but do not use a rack to store these. The packs are instead stored in boxes. In the bottom of one of these boxes loose medication (two tablets) were found. It was later explained that this had been refused medication that had fallen out of the blister pack. The acting manager was later seen replacing the medication into the blister pack. It was advised that a refused medication container should be kept for such refused medication to be safely contained, with details kept of the refusal/route of disposal. (Confirmed by CSCI pharmacist). The acting manager felt that it was better and safer for medication to be replaced in the blister pack. For best practice boxed/bottled medication should be dated when started/opened. A member of staff undertaking the lunchtime medication confirmed that she had received in house training from a senior member of staff, but no external training. The privacy issues identified at the previous inspection have been addressed by the home. Care staff were polite and caring in their interactions with residents. Doors were noted to be kept shut when personal care was taking place. Screening is provided in the homes shared rooms. The acting manager said that it would be his understanding/expectation that all staff/people working in the home will have been instructed in basic things such as knocking on doors. However a workman was observed to enter a shared room where two female residents were in bed (one semi covered) without knocking. The acting manager undertook to address this. Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 14 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some level of activity and interaction is provided at the home. However to reflect the homes stated specialisms, and provide residents with individually meaningful stimulation, occupation and activity development work is needed. Visiting at the home is open. EVIDENCE: Ravensmere Rest Home state that they offer specialist care for people with dementia and mental health needs, therefore social stimulation and occupation based on individual needs is a very important area. In a response to the previous inspection report the acting manager acknowledged that the home need to take activities to ‘a higher level’, with an estimated timescale of four to six months for achieving this. This in spite of the fact that this area of care has been an issue raised with the home on many occasions, over a considerable period of time. On the day of inspection staff were attentive, and residents, in the main communal area of the home, were well supervised at all times. During most of the day residents were encouraged to play with a balloon or throw (magnetic) darts at a board. The television remained on for the whole day and at one point there was music playing at the same time. Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 15 Some one to one interaction was observed. An entertainer visits the home every two weeks. On viewing the activities record it was seen that some residents go out for walks and visit local shops and amenities. ‘Playing with balloons’ featured heavily in the activity record, and, on one occasion, ‘playing with toys’. The acting manager felt that this was just poor use of language. Each resident has a social activity needs assessment and care plan in place. For one resident specific interests were identified, but there was the assumption that due to their condition they could no longer participate in these interests at any level. On speaking with this resident, interest in these areas was still being clearly expressed, but this need was not being addressed/met. Observations during the inspection indicated that, for those residents who can express their wishes, choices and preferences regarding rising/retiring times, how they use the building and so on are respected by staff. The care manager said that a person from a local church visits the home on a regular basis to help meet any spiritual needs. Visiting at the home is unrestricted. During the inspection visitors were noted to come and go. The home previously allocated an area that could be used by relatives or visiting professionals. However this is now used by residents who smoke, so is in effect unusable as a visitor’s room. A visitors facility must be available. The acting manager confirmed that no residents at the home are able to manage their own financial affairs. One however does manage a weekly personal allowance. This is facilitated by the home. No information was readily available for residents or their families about advocacy services. This should be arranged so that people are aware of theses services. Residents are able to bring personal possessions with them into the home. On arrival at the home some residents were up and having breakfast. Clearly choice was being offered and residents could have cooked breakfast or whatever they wished. A four weekly menu plan is used. This showed that a range of different foods are offered to residents. Lunch on the day of inspection was plentiful and looked appetising. Residents spoken with made generally positive comments about the food offered at the home. The dining area at the home is quite cramped and does not provide sufficient room for twenty four residents to sit up and eat at a table should they wish to do so. The current arrangement is that large tables are set up in a ‘T’ shape so that residents all sit together. This restricts their options, and does not encourage them to make choices about where and who they might like to sit with. One resident, who appears to find social interaction difficult, was noted to come and get their lunch quite late, sat at the end of the table and then quickly went again. The dining situation has been previously discussed with the acting manager who feels that the current arrangement is accepable to residents, who would be offered choices. At lunchtime during the inspection three residents were in bed and one was in hospital so numbers at the home were reduced. Even so the dining space was full, and some residents ate their Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 16 lunch in armchairs from over bed style tables. Staff were not observed to offer these residents choice about where they would like to sit. This practice means that some residents may not have the opportunity for a change of outlook or position for many hours at a time. The acting manager has identified strategies to improve this situation and these should be considered. Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 17 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, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A process is in place to manage any complaints made to the home, but residents/visitors need to be made more aware of this so that they are clear about how to raise any concerns. The acting manager has a clear view of how any allegations of abuse should be dealt with. This is at variance with current ideas about best practice as held by CSCI and the Local Authority. Care staff at the home have received training in adult protection and in assisting residents who may have challenging behaviour. This will help them to care safely for residents. EVIDENCE: The home has a complaints process in place, and this is now available to residents and visitors in a folder in the homes lobby. The homes complaints folder showed that no complaints had been recorded since the previous inspection in February. Out of six responses/returned surveys received back from relatives, five said that they were not aware of the homes complaints procedure. Staff training records showed that since the previous inspection further training has taken place. All staff at the home have now completed training in adult protection issues and in managing challenging behaviour. The acting manager has questioned CSCI’s expectations in relation to reporting/management Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 18 procedures for any suspected protection of vulnerable adults (POVA) incidents. To aid understanding, this area has been clarified with the local authority POVA co-ordinator. Their comments have been passed on to the acting manager. The homes policies and procedures need to be clear, and reflect current best practice. Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 19 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): 19, 20, 21, 22, 24, 25, 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although a refurbishment of the premises has been completed, there are still areas to address to provide a comfortable homely and safe environment for residents. EVIDENCE: At the previous inspection many items that needed to be addressed in order to provide privacy and comfort for residents were identified. Many of these issues have now been addressed. The acting manager said that all remaining tasks were scheduled. The home has a central courtyard garden with tables and chairs available for residents to sit at. Feedback from one relative said that this area would be enhanced by the provision of umbrellas to provide shade, as this area can get very hot for residents. The front entrance to the home needs to be made fully safe for residents/visitors by the provision of side protection for the ramped area. This has been raised with the acting manager on several occasions. Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 20 The new extension at the home provides a large open plan lounge and dining area. A small quiet seating area is also available. An area (previously the visitors area) is available for residents who wish to smoke. The home has three assisted bathrooms, one on each floor of the home. All bedrooms apart from one has an en suite facility. The small size of many of these makes their use by residents, particularly where assistance is required, as in most cases, impractical. Also there were no emergency call facilities in en suite areas. The home does not provide a sluice facility to assist with hygeine maintenance. The home is registered to provide care for residents with dementia. The need to provide adequate and appropriate levels of signage has been pointed out to the acting manager on a number of occasions. Since the previous inspection names have been placed on residents bedroom doors, and bathrooms/toilets given a text label. There is still inadequate orientational/directional signage at the home to assist residents. Grab rails are available in bathrooms, toilet and en suite areas to assist residents. Hoisting equipment is available at the home. A refurbishment process has recently taken place at the home. This did not upgrade resident’s bedrooms to current or adequate standards. After shortfalls being pointed out on many occasions, the acting manager has now started to address this and provide facilities such as bedside lighting and lockable facilities in resident’s bedrooms. Much remains to be done to provide all residents with suitable facilities. Wardrobe space is limited in some rooms, and does not provide all residents with sufficient storage. Residents do not have the option of keeping their rooms locked, as most bedroom doors are not fitted with locks. Many rooms do not have a homely feel. The acting manager felt that this area was the responsibility of resident’s families. Furnishings in many rooms are of poor quality and shabby. This includes wardrobes, chests of draws and beds. The carpet in one room was noted not to fit to the edges. The acting manager felt that this was due to shrinkage. The lack of headboards for resident’s beds is also something that has been pointed out to the acting manager at several inspections. It is understood that these are now ordered and awaited. At this inspection it was also noted in a number of rooms that residents had a mattress cover, but no bottom sheet on their beds. It is understood that this issue has now been addressed by the acting manger and proper sheets provided. On the day of inspection the home was comfortable for residents in terms of heat and ventilation. Residents cannot control the heat in their own rooms should they wish, and be able to do so. It was noted that in one ground floor bedroom it would be difficult for the resident to have safe nighttime ventilation. The acting manager undertook to address this. Water was randomly tested at different outlets around the home. In most instances it took Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 21 a very long time for water to run warm and this did not always happen. This does not support good infection control. On the day of inspection the home seemed generally clean and, apart from isolated areas, was odour free. The home has good cleaning schedules in place, but items such as extractor fans are not included in this, and were seen to be dirty in some areas. The acting manager agreed that he would add these items to the cleaning schedules. Closer monitoring and management is needed to ensure that good infection control is maintained by, for example monitoring the condition of toilet brushes and ensuring that used disposable gloves are disposed of properly and securely. The laundry area of the home, although functional, has not yet been fully completed. Although tiled to a high level the remaining walls are not yet painted so do not provide an impervious and washable finish. There is no workspace or shelving available. The laundry area is ventilated by a hole in the roof, through which the tumble drier outflow pipe goes. This hole is open to the elements but protected by a ‘special insulation board’. The acting manager says that this is a temporary arrangement. It was noticed that staff at the home were using yellow ‘clinical waste’ bags to contain laundry. The acting manager was not sure why this practice was in place but agreed that it could lead to confusion. The acting manager was unsure of what residents might currently have MRSA. He was aware of two that were possibly active but was unsure of any other. This was later confirmed with the care manager. Training records showed that staff at the home have undertaken infection control training. The laundry area only provides one washing machine. It is questionable whether this is adequate for the size of the home, and allows no ‘safety net’ in the event of a breakdown. Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 22 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, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a stable core group of staff. This provides consistency of care for residents. Systems for safe recruitment practices and staff induction are in place to protect residents. However the home must show that these processes carried out consistently. Monitoring and attention to detail is needed to ensure that documentation is adequately maintained. EVIDENCE: The acting manager had not completed the section of the pre-inspection questionnaire relating to dependency levels and staffing hours provided. Dependency levels at the home appear to be quite high due to dementia and some resident’s mental health needs. The homes rotas were viewed and showed that staffing levels at the home are currently being maintained at two (from 07.00 to 08.00) then three care staff and one person in charge during the day (until 20.00), then two plus one in charge until 21.00. At night there are two awake night care staff, one of whom is in charge. Staffing levels, particularly at night need to be kept under review. The building is on three floors and clearly, from the amount of pressure mats in place, some residents may be quite active. The previous inspection made a requirement for a review of staffing levels to be undertaken and the results of this review to be sent to CSCI. This was not received. Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 23 Although one member of the care team is on a crossover shift working a 12/13 hours shift there is no handover period allowed for on the rota. Staff are expected to start early/work later to achieve this. It was noted that the acting manager did not appear on the homes rota. It was stated that this was an oversight. No staff at the home have received any NVQ training in care. The registered provider (acting manager) takes the view that all staff hold nursing or other qualifications from their country of origin, and therefore do not need to undertake NVQ qualifications in this country. It has been stated by the acting manager that this has been confirmed to him by an official source. He has however, despite several requests, failed to provide any evidence of this. Due to poor recruitment practices going back over a number of inspections a statutory enforcement notice was issued in respect of recruitment practices on 20th March this year. The pre-inspection questionnaire identified that since the previous full inspection three new staff had been recruited. These files were viewed. It was possible to see that in general, recruitment practices that protect residents were being maintained. In one case a POVA first check could not be found, although it had clearly been applied for, and the Criminal Records Bureau check, when it came, after the person had started work, was clear. The home uses a checklist proforma for referees to complete. It was advised that for best practice an official stamp/evidence of status should be requested from referees. One new member of staff had been recruited as a mental health nurse, where no such post exists at the home, which is not registered for nursing care. Surveys/questionnaires received back from members of staff stated that they had undergone appropriate recruitment procedures. The home has a system for staff induction in place that should ensure that residents are cared for by staff with initial skills and knowledge that can then be built on. On files viewed the ‘first day induction’ for staff had been well completed. A housekeeping member of staff had then received no further induction into their role and responsibilities, or, this was not evidenced. For another member of staff the induction had been well completed. For a member of staff left in charge at night it was initially stated that they had not received moving and handling since being employed by the home. It was then stated that they had completed the theory part. This was not however evidenced in the induction pack as only day one had been completed. Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 24 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): 31, 32, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some issues raised at this inspection show that management at the home needs to be more robust in monitoring practices at the home. The home are working towards achieving good and regular quality assurance systems. Some health and safety issues need to be addressed to ensure the safety of residents. EVIDENCE: Ravensmere Rest Home has been without a registered manager for over two years and the Company have consistently failed to put forward a suitable person for this role. The acting manager, who is also the managing director and company secretary for Health and Home has applied to be registered manager at Ravensmere. This application is currently being determined by the Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 25 CSCI. While awaiting an outcome on this determination this standard has not been given a rating. The management style, as stated in the homes service users guide is a ‘flat, de-centralised style of management’ with senior staff being delegated set areas of responsibility. However the acting manager of the home must still retain responsibility for monitoring and managing these areas, and support staff in achieving improvements. In some areas, as identified in this report, there was insufficient evidence of robust monitoring and management. Although a clear sense of leadership is provided by the acting manager, the management style as observed at this and other inspections would not necessarily encourage staff to be independent and creative in their areas of responsibility. Staff were firmly held to account for shortfalls found in front of inspectors. This said, feedback from the staff about the management of the home was very positive. Answers on surveys received said that views were listened to and that the acting manager was supportive. They also indicated that regular staff meetings are held. The statement of purpose for the home states that residents meetings are not held but that views are sought on a one to one basis. The Company (now acting manager) undertook a survey of stakeholder (Relatives and social workers) views last year and produced a report from this, which was sent to CSCI. This survey showed that amongst respondents there was a high level of satisfaction with the service offered by the home. It is understood that the company have now employed the services of a consultant to assist them in broadening the scope of future quality assurance exercises. Visits as required to comply with regulation 26 are undertaken, but do not necessarily represent an independent view as undertaken by the acting manager. The home achieved an Investors in People award in December 2005. Only one resident chooses to hold their personal allowance. The home assists the resident, and good records of this process are maintained by the home. Records seen, and staff surveys received indicate that the home has sufficient staff supervision processes in place. This will assist in ensuring that staff provide consistent care for residents. Details of health and safety checks were provided as part of the information included in the pre-inspection questionnaire. Safety certification checked was satisfactory. It was advised that for the future, the homes gas certificate should be of a type that can show a record of maintenance carried out. Although information and maintenance schedule was in place in respect of legionella the acting manager was advised that for best practice a risk assessment should be in place. Fire records were satisfactory and showed that residents are kept safe by regular checks and tests being carried out. It was advised that a better record of staff attending drills should be kept to show that all staff attend regular fire Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 26 drills and training. This must be addressed so that residents can be confident that staff will react appropriately in the event of an emergency There were some concerns in relation to how the kitchen is monitored and managed. No fly screens were fixed to open windows. The cook had just prepared a hot pudding, which had been left uncovered on the side. This was discussed. The acting manager said that suitable food coverings would be purchased. Sandwiches were noted to have been prepared for teatime before 09.20. Foodstuffs were not always dated when started/taken out of the freezer. A wet mop was left in the dry stores room, which the acting manager agreed was not ideal. At lunchtime a member of staff was noted to be taking an uncovered lunch upstairs on a tray. Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 27 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 3 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 2 2 X 1 2 2 STAFFING Standard No Score 27 2 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 3 X 3 3 X 2 Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered person(s) must ensure that, in consultation where possible with residents, care plans are in place that show how all individual residents health and welfare needs are to be met. Plans must be kept updated and reviews undertaken identify and record any changes. This refers to the issues raised in the body of the report. 2. OP8 12 The registered person(s) must ensure that where specific equipment is used to promote resident’s health and well being, that this is subject to robust assessment and care planning processes. This refers to the use of pressure mats at the home. 3. OP8 12 The registered person(s) must ensure that if clinical procedures are to be carried out to promote resident’s health and wellbeing, that this is only done within a strict protocol and with staffs’ DS0000015463.V300524.R01.S.doc Timescale for action 01/09/06 01/09/06 01/09/06 Ravensmere Version 5.2 Page 29 competence regularly monitored. This refers to blood glucose monitoring practices at the home and is detailed in the body of the report. 4. OP9 13 The registered person(s) must make arrangements for the safe management of medicines in the home. This refers to the practice issues identified in the body of the report. 5. OP12 16 The registered Person(s) must ensure that the routines of daily living and activities made available, are flexible and varied to suit service user’s expectations preferences and capacities. This refers to the need for all service users to have meaningful activity and stimulation in accordance with their assessed needs. Previous requirement of 01/01/05, 01/02/06 and 01/04/06 not yet fully met. 6. OP15 23 The registered person(s) must ensure that the premises are suitable for achieving their stated aims and objectives. This refers to the need to provide sufficient dining space and choice for the number of residents registered for. Previous requirements of 01/01/06 and 01/05/06 not met. 7. OP18 13 The registered person(s) must make arrangements to protect residents from harm or abuse. 01/09/06 01/09/06 01/09/06 01/09/06 Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 30 This refers to the need for the homes policies and procedures for managing any adult protection allegations/incidents to be reviewed, and for all staff to be clear about procedures to be followed. 8. OP20 23 The registered person(s) must ensure that the premises are suitable for achieving their stated aims and objectives. This refers to the need to provide facilities for residents to meet visitors in private accommodation that is separate from the residents own personal room. The registered person(s) must ensure that the home is conducted so as to protect the health and welfare of residents. This refers to the need for en suite areas to be made safe within a risk assessment framework and call bell facilities to be provided as appropriate. 01/12/06 9. OP21 12 01/10/06 10. OP22 23 The premises must be suitable to 01/10/06 achieving the aims and objectives of the home. This refers to the need for appropriate aids and signage to be available to assist residents with dementia. Previous requirement of 01/05/06 not yet fully met. 11. OP24 12, 16 The registered person(s) must provide accommodation for each service user, which is furnished and equipped to assure comfort and privacy, and meet the assessed needs of the service user. This refers to the issues identified in the body of the DS0000015463.V300524.R01.S.doc 01/10/06 Ravensmere Version 5.2 Page 31 report. Previous requirement of 01/02/05 and 01/03/06 not yet met. 12. OP25 23 The premises must be suitable to 01/09/06 achieving the aims and objectives of the home. This refers to the need for adequate supplies of hot water to be available for residents at any time. The home must provide suitable and adequate laundry facilities. This refers to the issues raised in the body of the report. Previous requirements of 01/12/05 and 01/03/06 not met. 14. OP27 18 The registered person(s) must ensure that at all times sufficient staff are deployed to meet the health and welfare needs of residents. This refers to the need for a review of night and day staffing levels to be undertaken with the process and outcome being sent to CSCI. Previous requirement date of 01/04/06 not met and no review received by CSCI. 15. OP27 17 Schedule 4 A duty roster of persons working at the care home, and a record of whether the roster was actually worked must be maintained. This refers to the need for the acting manager, and hours worked to be included on the roster. Staff must receive training appropriate to the work they are DS0000015463.V300524.R01.S.doc 13. OP26 13, 16 14/09/06 14/08/06 14/08/06 16. OP30 18 01/10/06 Page 32 Ravensmere Version 5.2 to perform. This refers to the need for the home to better evidence that all staff to receive a comprehensive induction into the home, good practices and their role. 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 OP1 Good Practice Recommendations The registered person should develop ideas for providing information about the home to service users that is in a format that can be accessed and understood by them. The practice of keeping daily records and care notes separate from care planning information should be reviewed. The registered person(s) should ensure that all staff/visitors to the home follow guidelines that protect resident’s privacy and dignity. Suitable facilities should be provided for visitors. Information on advocacy services should be readily available for residents and visitors. The home should be proactive in ensuring that residents and visitors are aware of the homes complaints procedure. Consideration should be given to the provision of umbrellas or other forms of shade on the homes patio area. The registered person(s) should ensure that the ramped front entrance is made safe by the provision of side protection. 2. OP7 3. OP10 4. 5. 6. 7. OP13 OP14 OP16 OP19 8. OP19 Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 33 9. 10. 11. OP28 50 of care staff should be trained to NVQ level two or above. The best practice advice in relation to staff recruitment should be actioned by the home. The registered person(s) should continue to develop ways of involving all stakeholders in the running of the home and develop an open culture that encourages innovation. A risk assessment in respect of the prevention of legionella should be developed. The homes gas certificate should be of a type that clearly shows what maintenance should be carried out to systems. Records of what staff have attended fire drills should be improved. The provision of fly screens and suitable food covering systems should be considered for the homes kitchen area. Practice relating to food provision such as uncovered food and the early preparation of tea should be addressed. OP29 OP32 12. 13. OP38 OP38 14. 15. 16. OP38 OP38 OP38 Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Ravensmere DS0000015463.V300524.R01.S.doc Version 5.2 Page 35 - 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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