Inspection on 28/09/05 for Ravensmere

This inspection was carried out on 28th September 2005.

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 22/06/06

Ravensmere 11/02/06

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 Sharon Lacey Announced Wednesday 28 September 2005 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ravensmere Address 13-15 Manor Road Westcliff-on-Sea Essex SS0 7SR 01702 330347 01702 330347 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Health And Home Limited Vacant CRH Care Home 19 Category(ies) of DE(E) Dementia (19) registration, with number MD(E) Mental Disorder-over 65 (19) of places Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. To provide care and accommodation for one service user who is under 65 years of age whose details are known to the commission. 2. The named responsible individual shall undertake a recognized training course in adult protection within three months of issue of this certificate. Date of last inspection 2nd and 15th November 2004 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 ninteen older people. The home is registered to provide care for residents with dementia and mental disorders. Accommodation is provided on three floors in eleven single and four double rooms. All but one room now has en suite facilities. The home has recently undergone an extensive refurbishment process. This has included a large extension to the rear of the home were new communal space and a kitchen are provided. As a result of the extension and refurbishment the home hope to provide five additional places and accommodate up to twenty four residents. The new rooms are not yet registered. A passenger lift provides access to most levels within the home. Two bedrooms cannot be accessed by the lift. Limited parking is available at the front of the property. There is a courtyard garden ajacent to the new lounge area. Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced and took place over seven hours. As two inspectors were present this equated to fourteen hours of inspection time. Since the previous published inspection report (November 2004) six additional visits to the home have taken place. This reflects the level of concern that the CSCI has felt for resident’s welfare during the refurbishment process. Although the reports of these visits are not published they are available on request from CSCI’s local office in Southend on Sea. The previous inspection report identified that the home was offering a very poor service and the home had an agenda for action of thirty four requirements and twelve recommendations. This inspection identified that there has been a significant reduction in this and the home is now operating at a more satisfactory level. Staff at the home are to be commended on the progress made. On the day of inspection the home was full and nineteen residents were being accommodated. This inspection concentrated mainly on assessing the progress the home had made against the previous agenda for action. A tour of the building took place. Staff, care, medication and other records were inspected. Staff on duty were spoken with. Two visitors and several residents were also spoken with. The inspectors were provided with copies of eleven completed relatives/visitors comment cards that had been compiled and distributed by the home. These all gave very positive feedback on the home. As this was an announced inspection some documentation was sent out to the home several weeks before the inspection was due to take place. This included a pre-inspection questionnaire, to be completed by the home and returned to the CSCI before the inspection. This was not received by the inspector prior to the visit to the home. Relatives and residents feedback cards were also sent out. Of these two were received at the point of inspection. These cards were however noted to be freely available to visitors in the homes entrance hall. The notice advising of the inspection was also on display. The home has no registered manager. The registered responsible individual was not available at the inspection. The company secretary for Health and Home who plans to apply for registered manager took the lead role at this inspection. Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 6 What the service does well: What has improved since the last inspection? What they could do better: A service users guide needs to be developed so that prospective residents and their families can be given written information about the home and services offered. The home states that it offers specialist provision for residents with dementia and mental health needs. Therefore a greater level of individual assessment of resident’s social and occupational needs should be considered. This will help staff to gain a better understanding of the best way to meet these needs in a therapeutic way. Staff recruitment and induction needs to be carried out to a consistent and high standard. This will ensure that suitable staff are taken on, and that they are given the knowledge and skills they need to meet residents needs. Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 7 Gaps in staff training such as dementia training, moving and handling and other areas identified in the body of the report must be addressed to make sure that residents receive skilled care. Formal supervision for staff needs to be put in place so that staff have the opportunity for individual discussion and development. The outstanding premises issues such as making radiators safe, providing a suitable laundry area and clearing the courtyard need to be addressed without delay to ensure the safety of residents and staff. The home must be able to evidence at all times that all equipment and systems are inspected, serviced and safe. 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 I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 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 standard(s) 1, 2, 3, 4, 5 Residents have their needs assessed before moving into the home. People are encouraged to visit the home before admission and are made aware of the terms and conditions of their stay. A service users guide is not in place and needs to be developed to assist in this process. Development work is needed to ensure that all staff receive training in dementia and other relevant conditions. EVIDENCE: The home has produced a statement of purpose. The company secretary has received full feedback on this document as some of the statements made in this are open to question, and others could be misleading. A service users guide has also been produced by the home so that residents and their families can have written information about the service on offer. Most residents at the home are placed and funded by a Local Authority. The home therefore contracts with them as to the service to be provided. Files showed that residents/relatives are made aware of the terms and conditions of their stay. Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 10 Residents files sampled at this inspection showed that their needs are assessed before they move into the home. The home uses a set format for this and those viewed were well completed. Information from Social Services departments was also available. The assessment and offer of a placement are confirmed in writing by the home. The admission itself is well managed and staff use checklists to ensure that residents needs and the homes processes are consistently managed during this potentially difficult period. Observations during the inspection, discussion with staff show that the home are able to meet residents general needs. However this would be enhanced by greater levels of training in and awareness of conditions specifically identified in individual residents. The home is registered to provide care for residents with dementia. Training records identified that only three staff had received training in dementia care. The local authority where the home is situated suspended placements while the home was being refurbished. Therefore current residents at the home are often placed some distance from their previous residence. Staff confirmed that it is generally families who visit on resident’s behalf. A file of a recently admitted resident confirmed that their family had visited the home prior to them moving in. Intermediate care is not provided at Ravensmere Rest Home. Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9, 10. Care planning at the home is generally comprehensive and provides an adequate basis to ensure that residents’ health and care needs are met. Medication at the home is well managed. EVIDENCE: Each resident has an individual care file containing the care plan and other relevant information. Several care plans were sampled during this inspection. Those viewed were detailed, well completed, and incorporated risk assessments for relevant areas. Staff were able to give anecdotal evidence of working with families to ensure that care plans reflected residents needs. A senior member of staff expressed the importance of this. In some cases this process of working with families was documented. Regular reviews of care plans were recorded. Care plans are completed by senior staff and discussed with the resident’s key worker, who passes on information to other staff. Daily records and care notes are kept separately from individual files which may not encourage their full use. The possibility of providing more in the way of background information in care files was discussed, in order that staff may gain a greater insight and understanding of individual residents. This will be particularly helpful where residents suffer from dementia. Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 12 The family of one resident were very happy with the level of care their relative is receiving. Another relative related that the staff had dealt quickly and professionally after their relative had an accident. From this and records it seems that the home are proactive in dealing with any medical issues that arise. Optical and dental care is arranged and incontinence assessments were evidenced on files viewed. Where a resident cannot remain with their own GP, the home asks the resident/family to confirm that they are happy to use the practice used by the home. District nurses are involved in care as appropriate to meet individual needs. Good nutrition records are maintained by the home to assist in monitoring resident’s health. Medication at the home is well managed. No anomalies were seen in records sampled. Staff training has been through the providing pharmacist. Due to refurbishment and reorganisation at the home, the home’s controlled drugs cupboard needs to be reaffixed to a wall. During the inspection staff were noted to treat resident’s with respect. Doors were kept shut when personal care was taking place. Staff managed tasks such as assisting residents with eating appropriately. Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15. A reasonable level of activity and interaction is provided at the home. However to reflect the homes stated specialism, development work to fully assess and provide for residents individual occupational and activity needs should be considered. Visiting at the home is very open. EVIDENCE: Residents preferred routines and activities are recorded to a degree on care plans, but this tends to be quite bland such as ‘enjoys watching TV’. As the home feels that it offers specialist care for people with dementia or mental health needs, this is an area that could be better developed. Staff spoke of routines being flexible to accommodate individual needs, with a specific example being given. During the announced inspection additional staff were on duty therefore the level of staff interaction observed was generally good. Residents were encouraged to take part in daily living tasks such as giving out fruit as well as taking part in other activities. An activities book identifies that two activity sessions take place each day. Three staff have undertaken training in ‘dementia and activity’. In a survey conducted by the home relatives expressed satisfaction with this aspect of care. Senior staff said that spiritual support was organised on an individual basis in accordance with residents or relative’s wishes. Visiting at the home is unrestricted. Visitors spoken with and whose survey questionnaires were viewed all said that they were always made very welcome Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 14 and offered refreshment. The home now has a private area that can be used by relatives or visiting professionals. Three residents at the home currently have an independent advocate. Residents are able to take personal possessions into the home. The refurbishment of the home has included the provision of a new kitchen. Menus at the home are prepared on a four weekly basis. The cook reported that individual likes and dislikes are known, and that residents are offered choice on an individual basis. Lunch on the day of inspection looked appetising and portions were a good size. Staff offered residents appropriate levels of help. Residents spoken with felt that the food offered by the home was good. One resident had particularly enjoyed a recent birthday with ‘lots of cake and drink’. Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 Residents and relatives feel that they can raise any concerns or issues and that these will be dealt with appropriately. To ensure that residents are fully safeguarded development is needed to ensure that all staff are trained in adult protection and managing challenging behaviour. EVIDENCE: The home has a clear complaints process in place. To ensure that all interested parties are aware of how to raise concerns the procedure should be on display in the home. Relatives said that they would feel comfortable in raising any concerns. Documentation viewed showed that a process is in place for recording and managing complaints. Since the previous inspection one complaint has been recorded by the home. One complaint has been investigated by the CSCI. This related to the condition of the premises and was upheld. Training records indicated that five staff have completed training in the protection of vulnerable adults. Appropriate policies and procedures were available. The home offers placements to residents whose behaviour may be challenging. So far only four staff have completed video training covering this area of care. Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25, 26. Although the refurbishment process at the home is nearly completed there are still some concerns about the suitability and safety of the environment provided for residents. EVIDENCE: The home is just coming to the end of an extensive refurbishment and extension programme. Although many minor issues remain to be addressed most major works are completed. During the refurbishment process the home was subject to frequent monitoring visits. The CSCI, Environmental Health Department and the Fire Service have had many issues with the way the project has been managed and concerns for the health, safety and welfare of residents. The project was managed by the company secretary who did not follow establishd procedures, or seek to work effectivly with, or take advice from the relevant bodies. Following the refurbishment the home is left with a pleasant courtyard garden. This is currently marred by the storage of some building and household materials and a large refridgerator. Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 17 The new extension at the home provides a large and pleasant lounge and dining area. The dining area is quite small and does not provide sufficient room for ninteen residents, (or the proposed 24), to sit up and eat at a table should they wish to do so. The current arrangement is that two large tables are set up in a ‘T’ shape so that residents all sit together. Although the company secretary feels that this arrangement is appropriate and enjoyed by the residents, it restricts their options, and does not encourage them to make choices about where and who they might like to sit with. Furnishings are comfortable, lighting domestic in character. To finish this area and make it more homely for residents curtains are on order and delivery is awaited. The home has three assisted bathrooms. All rooms have en suite facilities. The small size of many of these makes their use by residents, particularly where assistance is required, as in most cases, impractical. The home does not provide a sluice facility to assist with hygeine maintenance. The refurbishment process did not include consultation with an occupational therapist or other professional to ensure that the environment, aids and adaptations were suitable for the residents. Grab rails are provided in toilet areas to assist residents. The call bell system has been upgraded, but at inspection no call bells were provided in the communal areas of the home. The company secretary said that no residents would use them, but undertook to ensure that these were put in place. To assist residents signage at the home is starting to be developed and this process needs to continue. The home has four shared rooms. It is not clear that residents occupy these rooms by positive choice. One resident had been moved from a single room to a shared room. This process had been documented and was accounted for by an increase in the residents needs. However the meeting to decide this only included the company secretary and staff from the home. The resident was initially moved to a room that the company secretary had been advised on several occasions during monitoring visits that the room was unsuitable for occupation due to extreme odour and poor condition, and should not be used. This situation showed poor regard for the resident’s quality of life. (The room in question is now out of commission). The refurbishment process did not upgrade resident’s bedrooms to current standards. Wardrobe space is limited in some rooms. Most rooms have no lockable storage or bedside lighting. Residents do not have the option of keeping their rooms locked, as most bedroom doors are not fitted with locks. Although, through advice, these have now been fitted with blinds or covered with sticky backed plastic, bedrooms were refitted with doors with glass inserts. This showed lack of thought for resident’s privacy. Many rooms do not have a homely feel. The company secretary is aware that new bedrooms at the home will not be registered until they comply with current expected standards and provide a suitable environment for residents. Residents spoken with were happy with their rooms. One resident took pleasure in showing inspectors Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 18 their room. The resident was a wheelchair user and it was seen that the en suite area was very tight for space. On the day of inspection the home was well heated and ventilated. In spite of assurances and missed deadlines some radiators at the home have still to be made safe for residents through the fitting of appropriate guards. To ensure that residents are kept safe water temperatures are checked weekly and recorded. The company secretary said that he undertakes to ensure that the home is kept safe from legionella. However there was no risk assessment in place or evidence to show what actions are taken. On the day of inspection the home seemed clean and, apart from isolated areas, was odour free. The laundry area of the home, although functional is not yet completed. There is no ceiling in place. There are no suitable hand washing facilities for staff. This poses an infection control risk and must be urgently addressed. Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 29, 30. The home have a stable group of staff. Development work is needed to ensure that recruitment and induction procedures are established, and maintained to a high level to ensure good care for residents. EVIDENCE: The home now has a stable group of core staff. Residents and relatives spoke highly of the staff at the home, and positive interactions were observed. The homes rotas were viewed and showed that staffing levels at the home are currently being maintained at two care staff and one person in charge during the day, and two awake night care staff. These levels need to be kept under review to ensure that resident’s needs are fully met. To assist this process the company secretary was advised to establish a reasonable definition of what constitutes high, medium and low levels of dependency. One member of staff is employed for domestic and catering duties. Apart from this care staff do additional shifts to cover these duties. Agency staff are not used by the home. As at previous inspections the home cannot evidence that any staff have achieved NVQ level two or above. The company secretary reported that 80 of staff are trained to NVQ level 2 by virtue of the fact of having nursing or other qualifications from their country of origin. Staffing records indeed showed that staff were often highly qualified in their country of origin. The issue that staff recruited from abroad require NVQ level 2 or equivalent qualifications to enable them to receive a work permit was discussed again with the company secretary. The company secretary’s views have not been confirmed by the Skills for Care Council. It was explained once again that CSCI Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 20 would require written evidence from the home office, or confirmation from a local college that qualifications are NVQ equivalent, otherwise it would not be possible to confirm that this standard had been met. Staff files of recently recruited staff were viewed. In general they showed that residents are safeguarded by satisfactory procedures being in place, and relevant checks on staff carried being out. However some shortfalls remain. In spite of current guidance one staff member started at the home in August and a Criminal Records Bureau (CRB) check was not sent for until September. No POVA first check was in place. Another member of staff had a CRB in place from another home. These are not portable and again no POVA first check was in place. This poses potential risk to residents. The company secretary outlined the induction processes that are in place at the home. However a clear and consistently completed staff induction, taking place over the first six weeks of employment, could not be evidenced from staff files sampled. Unless staff have a proper induction they may not be quipped to fully meet residents needs and understand the procedures of the home. Staff training at the home has improved and training records identified that staff have undertaken much relevant training to assist them in meeting residents needs. Much of the training undertaken is ‘in house’ video training, which is followed up by staff completing a written test. Although training has improved important shortfalls have been identified in other areas of this report. Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36, 37, 38. Structures are in place to ensure that the home runs smoothly, but the home lacks an established and experienced registered manager. Development is needed to ensure that all residents and relevant others have the opportunity to comment on the service and affect the delivery of this. Resident welfare needs to be maintained by staff being fully trained and competent in areas such as moving and handling. The home needs to ensure that all equipment and systems are kept maintained and safe for residents and staff to use. EVIDENCE: In spite of previous requirements and correspondence Health and Home have consistently failed to put forward a suitable applicant to become the registered manager at the home. The home has therefore been without a manager for over two years. This has not been an acceptable situation, and has called into question the fitness of the company. The company secretary is therefore completing the Registered Managers award and stated that he intends to apply to be the registered manager at Ravensmere Rest Home. Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 22 The company secretary said that he provides staff with clear orders. Staff spoken with had a clear idea of structures in the home and of their individual responsibilities. The inspectors were provided with copies of a relatives/visitors questionnaire completed by the home in September 2005. The company secretary said that he intended to collate these and produce a report. There were eleven responses to the questionnaire. All responses were positive. Three questions concerned ‘nursing care’ received at the home. This is not appropriate, (as the home is not registered to provide nursing care), and could be misleading. The company secretary was advised that quality assurance should include seeking resident, staff and other professional views. The company secretary stated that the home was also working towards achieving an Investor’s in People award. As the home is registered as being run by a limited company, a representative of the company is required to carry out a monthly visit to the home to seek resident’s views and ensure that the home is being run properly. Reports of these visits are required to be sent in to CSCI. These reports are received only infrequently from the Ravensmere Rest Home. The company secretary said that annual accounts for the home are completed and would be available on request. An in date employers liability certificate was in place. Although not seen the company secretary said that full insurance was in place for the home. The company secretary said that the home do not hold personal allowances or valuables for any residents. Formal staff supervision is not yet established at the home. This needs to be commenced so that staff have the opportunity to have one to one discussion on practice issues, training needs and other issues that will assist them in carrying out their role with residents. Records at the home are held securely and resident and staff confidentiality maintained. Health and safety procedures and processes are in place to ensure that staff work safely and residents are protected. Staff training records show some shortfalls in core training, such as basic food hygiene, infection control and fire safety. A particular concern was that moving and handling training could not be evidenced for all staff. Safety certificates were sampled some viewed were satisfactory. Certificates to show that the homes hoisting equipment is checked and serviced was not available. The company secretary was asked to send this in to the CSCI as soon as possible. This has not been received. There is not as yet a full electrical certificate available for the home. This must be supplied as soon as works are completed. The fire system is checked and tested on a regular basis. No cleaning schedules are in place for the kitchen area of the home to ensure that adequate standards of cleanliness are maintained. Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 2 3 2 2 1 2 2 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 3 1 3 3 1 3 1 Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 4 Regulation 18 Requirement Timescale for action 01/02/06 2. 12 16 3. 18 13 4. 19 23 Staff must receive training appropriate to the work they are to perform. This refers to the need for all staff to receive training in dementia care. 01/02/06 The registered Person 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. Although improvement in this area recognised: Previous requiirement of 01/01/05 not yet fully met. The registered person must 01/02/06 ensure that residents are protected from harm. This refers to the need for all staff to be trained in adult protection issues, and in managing challanging behaviour. External grounds must be 01/11/05 suitable for and safe for use by residents. This refers to the need for household and other items to I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Ravensmere Page 25 be removed from the courtyard area. 5. 20 23 Sufficient dining space and choice must be provided for the number of residents registered for. The registered person must ensure that the home is run in a manner that respects the privacy and dignity of service users. This refers to the need for the home to evidence that service users occupy shared rooms by positive choice. Previous requirement of 01/01/05 not met. Accommodation must be provided for each service user, which is furnished and equipped to assure comfort and privacy, and meets the assessed needs of the service user. This refers to the issues identified in the body of the report. Previous requirement of 01/02/05 not met. The registered person must ensure that all parts of the home to which service users have access are free from hazards to their safety. This refers to the need for pipe work and radiators to be subject to risk assessment, or means put in place to ensure that they are properly guarded or have guaranteed low temperature surfaces. Previous requirement of 14/01/05 not yet fully met. The home must provide suitable and adequate laundry facilities. This includes proper handwashing facilities to maintain infection control. 01/01/06 6. 22 12 01/12/05 7. 24 12, 16 01/03/06 8. 25, 38 13 01/12/05 9. 26 13, 16 01/12/05 Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 26 10. 29 19 Previous requirement of immediate not met. The registered person must operate a robust and thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. POVA 1st checks/CRB checks must be undertaken before staff commence their duties. 01/12/05 11. 30 18 12. 33 24, 26 Previous requirement of immediate not met. Staff must receive training 01/01/06 appropriate to the work they are to perform. This refers to the need for all staff to receive a comprehensive induction into the home and care practices. The Registered person must 01/02/06 ensure that the home has effective quality assurance and quality monitoring / audit systems in place. Systems must seek the views of all stakeholders. The results of any surveys must be made available and sent to the CSCI. Visits as required under regulation 26 must be undertaken on a regular basis and copies of reports sent to the CSCI. Previous requirement of 01/02/05 not yet fully met. The registered person must ensure that care staff receive regular formal supervision. Previous requirement of 14/01/05 not met. Staff must receive training appropriate to the work they are to perform. This refers to the need for all staff to receive training in and be kept up to date in moving and handling 13. 33 24, 26 01/01/06 14. 38 13, 18 01/01/06 Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 27 15. 38 23 techniques, and other aspects relevant to health and safety at the home. Up to date certification must be sent in to the CSCI in respect of electrical equipment and lifting equipment used in the home. 01/12/05 16. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 4 7 Good Practice Recommendations Staff should receive awareness training relevant to the specific conditions of individual residents. The practice of keeping daily records and care notes separate from care planning information should be reviewed. The homes controlled drug cupboard needs to be re-fixed securely to a wall. The homes complaints procedure should be on display for residents and visitors. Call bells should be provided in all rooms and communal areas. Appropriate signage to assist residents should continue to be developed. A risk assessment should be in place in respect of Legionella. Staffing levels need to be kept under review. The registered needs to be able to evidence that 50 of staff are trained to NVQ level 2 or above. Staff induction should take place over the first six weeks of employment and be in line with Skills for Care standards. I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 28 3. 4. 5. 6. 7. 8. 9. 10. 9 16 22 22 25 27 28 30 Ravensmere 11. 12. 36 38 Care staff should receive formal supervision at least six times a year. Cleaning schedules need to be developed for use in the kitchen area. Ravensmere I56 I06 S15463 Ravensmere V245860 280905 Stage 4.doc Version 1.40 Page 29 Commission for Social Care Inspection 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. 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