Inspection on 11/08/08 for Ravensmount

This inspection was carried out on 11th August 2008.

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

Ravensmount 15/01/09

Ravensmount 13/08/07

Ravensmount 22/01/07

Ravensmount 06/12/05

Ravensmount 04/07/05

Ravensmount 25/11/04

Ravensmount 13/07/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Ravensmount Alnmouth Road Alnwick Northumberland NE66 2QG Lead Inspector Anne Urwin Brown Key Unannounced Inspection 11th August 2008 08:30 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 Ravensmount DS0000060366.V370052.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. Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ravensmount Address Alnmouth Road Alnwick Northumberland NE66 2QG 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) 01665 603773 01665 605901 ravensmount@tiscali.co.uk Moorlands Care Homes (N.E.) Limited Manager post vacant Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 13th August 2007 Brief Description of the Service: Ravensmount is a large detached house that has been extended to provide more spacious accommodation. It is registered to accommodate up to thirty older people. Moorlands Holdings NE Ltd is the service provider. Ravensmount is located on the edge of Alnwick and there is a local bus service to Alnwick town centre from just outside the home. Main line train services run from Alnmouth a few miles away. There are attractive public rooms in the home and all bedrooms have en-suite toilet and washbasin. Accommodation is arranged over three floors and a shaft lift is fitted. Fees range from £375.94 to £429.56 per week. A Statement of Purpose and User guide is available at the home that provides good information about the service. Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 0 star. This means that people using this service experience poor quality outcomes. How the inspection was carried out Before the visit: We looked at: • Information we have received since the last visit on 13th August 2007. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on 11th August 2008. During the visit we: • • • • • • Talked with people who use the service, relatives, staff, the manager & visitors. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around the building/parts of the building to make sure it was clean, safe & comfortable, Checked what improvements had been made since the last visit. We told the manager what we found. What the service does well: Good assessments are carried out so that people are assured that their needs can be met by the service. Daily records kept by staff provide good information about how peoples’ needs are met, however this information is not always reflected in individual care plans. Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 6 Good systems are in place for administering medicines that safeguard people living in the home. The relationships between staff and people living at the home are good and personal support is given in such a way as to promote and protect privacy and dignity. Staff are respectful of individuals’ dignity. An activity organiser has been appointed and is working to develop an interesting and supportive programme of events that suits the needs and interests of the people living at Ravensmount. Each room has en-suite accommodation. What has improved since the last inspection? Some refurbishment works have been carried out that have improved the environment for people living there. However there continues to be a lack of consistent planning that results in an ineffective maintenance programme. Work is generally carried out piecemeal when a problem occurs. People living in the home have limited choice about the decoration, equipment, improvements or facilities provided. Paper towels and liquid soap are now available in the public bathrooms and toilets. Work on the first floor bathroom is completed, although some of the finishing detracts from the improved appearance of the room. The call system pull cord still needs to be replaced. The laundry floor has been repainted to provide an impermeable surface, but again needs attention. The practice of hanging clothes in the dining area has been discontinued. A full record is now kept of all complaints made concerning the running of the service. The uneven paving in the garden has been replaced with concrete that provides an even surface for walking on. This has improved the accessibility of the garden. Some work on tidying of the garden has also been completed. A carpet has been laid in the conservatory covering the cracked tiles and is more homely and comfortable. The policies and procedures have been reviewed when there was not a manager in post. Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 7 What they could do better: Care plans and risk assessments are not being kept up to date so that there is clear information for staff about peoples’ current needs and how they are being met. The arrangements for purchasing, planning menus and cooking food were not satisfactory and there was no evidence that residents were regularly consulted or asked for their views about the food. The cooker and cooker hood needs to be replaced after failing tests carried out by the engineer employed to service these items. All staff working in the home must have safeguarding training to ensure that people living at Ravensmount are protected. Items identified within the last inspection report have not been addressed and these include: • First floor lounge - roof continues to have a leak next to light fitting and the smoke alarm, which has been disconnected. • Guttering requires cleaning out. • The shower room on the second floor is not yet available for the use of residents. • An annual plan of refurbishment and upgrading, and routine/ planned safety checks must be drawn up in consultation with the Manager that identifies priorities and timescales. The plumbing/heating system continues to cause problems with leaking pipes, low water pressure, lack of hot water and radiators not working cited as issues by people living in the home and staff. The whole system needs to be checked and remedial action taken to ensure that residents have access to appropriate heating and hot water services as necessary for their safety and comfort. There is a lack of adequate storage facilities, which means that wheelchairs, the hoist, commodes and other equipment are being left in bathrooms, corridors and sitting areas. Proper storage should be made available for equipment. Other areas of the premises that need remedial work include: • Room 13 the ceiling in the en-suite needs to be repainted and a radiator needs to be replaced. • In room 15 the ceiling has been repaired, but not painted. • Some wardrobes are not secured to the wall and could present a hazard. • Room 19 needs redecorated. • Room 3 ceiling is cracked. Staffing arrangements must be reviewed to ensure that enough suitably trained and experienced staff are available on each shift to meet the needs of the people living in the home. Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 8 All new staff need to complete induction training appropriate to their position, this inlcudes the manager. Systems need to be put in place to support the manager to do her job. This includes involvement in budgetary control and planning as well as input into the formulation of an appropriate business plan that identifies priorities for the home’s development. She needs to have good quality professional supervision. The manager also needs support from an experienced and qualified senior staff team. The arrangements for Health and Safety and Safe Working practices in the home need to be reviewed and updated to ensure that people living at Ravensmount and the staff are protected from risk of harm. Fire training must be provided at appropriate intervals. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 9 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 Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good assessments are carried out so that people can be assured that their needs will be met at Ravensmount. Intermediate care is not provided. EVIDENCE: Pre admission assessments are carried out and records show that appropriate information is collected. Care management assessments were also available. The manager or a senior member of staff carries out an assessment of any prospective service user. An assessment format is in place and this covers the areas identified within the National Minimum Standards. Information from the assessments is used in the care planning process. Sufficient information was available about individuals to ensure that staff could make a judgement about whether or not the home could meet the individual’s needs. Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 11 Residents said that staff knew what their needs were when they were admitted. Intermediate care is not provided. Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While health and personal care needs are well met, record keeping about care needs do not consistently reflect changes to fully support people. This means that people may receive the wrong type of support if their needs change. EVIDENCE: The service is planning to introduce a new care planning system and has not been ensuring that current care pans are kept up to date. This means that care plans have not been amended when changes in care and support needs have occurred. The daily notes do show that appropriate support is provided to people living in the home, but care assessments and risk assessments have not been updated since May to reflect peoples’ changing needs. The manager said that staffing constraints have affected the implementation of the new care planning system and in some cases reviews of current care plans. Residents said that staff did know what help they needed, but often there were not Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 13 enough staff on duty. One person said that they had been unable to have a bath often enough and that staff had little or no time for a chat. She said staff are really kind and want to help, but they have such a lot to do. Evidence was available to show health care needs are identified and met from records and from talking to residents and staff. Healthcare professionals’ input is well recorded in the daily notes, however as mentioned above information is not always transferred into the actual care plans. This has happened most since May when care plans have not been updated. There is information in daily records that shows that staff identify peoples’ changing needs and seek appropriate support. New falls risk assessment information has been identified by the manager, but is still to be introduced. No nutritional assessments are in place. Guidance is in place for staff who administer medicines. Systems are in place for recording the ordering, administration and disposal of medicines. A record was available of the medicines for each person including controlled drugs for which a separate record is kept. Appropriate arrangements are in place for the storage of medicines. Staff have had training in handling medicines. People administering their own medicines are assessed to ensure that it is safe for them to do so. Not all people administering their own medicines has lockable storage available in their rooms. People are treated as individuals and staff respect peoples’ privacy and dignity. Each person has his/her own room with en-suite toilet and wash hand basin apart from one couple who occupy a double room with en-suite. People generally use their own room to entertain visitors, although there are plenty of quiet public areas in the home. There is a public telephone in one of the ground floor sitting rooms. Staff said that people are able to use the home’s telephone if they wish to make a call privately. Residents speak highly of the staff and said that they respond appropriately to them. An Equality and Diversity policy is in place, however it is not clear that all staff have seen it and they have not had any training about this and how it impacts on the care they deliver to people. During the inspection all staff were respectful of residents and knowledgeable about their preferences. Ravensmount DS0000060366.V370052.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. While people using the service continue to be well supported to keep community and family links, poor practices around ordering, storage and delivery of meals impact on the overall quality of their daily lives. EVIDENCE: People are encouraged to make choices about their routines. Residents confirmed that they could generally choose when they get up and go to bed for instance, although this might be affected by staffing levels. One relative said that her mother had expressed concerns about not having a bath because of the strain on staff. An activity organiser is employed for 30 hours per week and residents said they enjoyed the activities on offer. During the inspection carpet bowls and a quiz were both well attended and residents were enjoying both activities and taking an active part. Peoples’ interests are recorded and support is provided to people who need help with activities. Staff said that sometimes the activity Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 15 organiser helps out with care tasks when there are staff shortages and this can affect the activity timetable. Visitors are welcomed at Ravensmount and residents said that their visitors are welcomed by staff. One relative said she found staff very approachable and that they provided updates on her mother’s care. People are encouraged to retain control of their money for as long as they are able. People bring in personal items when they come to live at the home. Rooms are personalised to suit their taste. On the first day of the inspection the food stocks at Ravensmount were very low. The home ran out of coffee and biscuits and staff had to go out to the shops to get some and a resident said that this regularly happens. From discussion with staff it was evident that it was a regular occurrence for staff to have to go to the shops to get items that had not been ordered. Staff said that deliveries were due and they often have to go to the local shops to get items that are not available. Stocks of food were low for a home of this size, but from talking to staff this is normal practice. Copies of the menus had been crossed out and overwritten several times in some areas. There was no evidence that residents had been consulted about planning menus until very recently when the new manager said she asked them about likes and dislikes at a residents’ meeting. But no action has been taken to change or alter the menus to reflect residents’ comments. There is a choice of main course at lunchtime and at pudding although the alternative was always ice cream. Fresh fruit did not appear on the menu, but on the second day of the inspection a large bowl of fruit was evident in the dining room. Two residents said that the lunches are not too bad, but there is little choice at the evening mealtime one cooked item and sandwiches and things are repeated often. One resident said that “the food used to be brilliant when the last cook was employed, but the meals lack imagination and the ingredients are not good. They keep running out of things and they ran out of biscuits and coffee this morning.” Menus have not been checked by a nutritionist and individual nutritional assessments have not been completed. The kitchen cleaning records showed gaps in cleaning. The two cooks have completed Food Hygiene training while the two kitchen assistants have not. Food is stored in two outside sheds across a concrete yard. Two freezers contained little food and stocks of dry good were low, with an emphasis on supermarket basics foods. Stocks of fresh vegetables are kept in another shed and again stocks were low, although a delivery was expected. In the maintenance records an invoice indicated that a problem had been experienced with rodents in the garden, not specifically in these sheds, and said that this could continue to be a problem. Given that vegetables and other dry goods are stored outside this is a potential hazard. In the maintenance Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 16 records there is an invoice for cooker and cooker hood servicing, which shows the cooker and cooker hood as failing checks and the engineer indicated that both required replacement. The invoice was dated July and at an earlier check in the year the cooker hood was recommended for replacement. Staff said this had been reported. Ravensmount DS0000060366.V370052.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home are generally protected by Ravensmount’s policies and procedures for dealing with complaints and allegations, although not all staff are clear about the procedure to be followed. EVIDENCE: Residents said that they know how to make a complaint and are satisfied that their concerns would be taken seriously by staff. They said that they feel able to raise any issues with staff. Policies and procedures are in place for dealing with complaints. The complaints records show that 12 complaints have been made since the last inspection. Ten of these complaints were upheld. Good records were kept of the complaint, the investigation and outcome. Some of these complaints related to the heating system and all but one has been resolved. Complaints have been dealt with within appropriate timescales. Safeguarding procedures are in place. Three safeguarding issues have been dealt with by the local authority. Care staff were clear about the procedure to be followed in the event of an allegation being made. The manager has shown that she is aware of the procedure to be followed, however a staff member did not follow the safeguarding procedures and took inappropriate action without Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 18 consulting the local authority. The manager did refer this matter to the local authority when she was told about it. All three safeguarding issues are being dealt with appropriately. Most staff have had safeguarding training and further training is being arranged. Ravensmount DS0000060366.V370052.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 22, 23, 25 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although improvements have been made to the décor and maintenance, lack of effective planning, reactive maintenance and poor workmanship have resulted in a generally poor environment for people living at Ravensmount. EVIDENCE: Four items identified within the last inspection report have not been fully addressed and these include: • First floor lounge - roof continues to have a leak next to light fitting and the smoke alarm, which has been disconnected. • Guttering requires cleaning out. • The shower room on the second floor is not yet available for the use of residents. Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 20 • An annual plan of refurbishment and upgrading, and routine/ planned safety checks has not been completed that identifies priorities and timescales for work. Since the last inspection the physical standards in Ravensmount have improved particularly the exterior where concrete has been laid in place of the uneven paving. Maintenance records are in place, but are not kept up to date when work had been completed. It is disappointing that small things are left undone or badly finished that affect the overall improvement in some areas of the home including the first floor shower room, first floor bathroom and the second floor shower room. This poor finish detracts from the improvements made. The lack of adequate storage facilities means that inappropriate arrangements are in place for storing commodes, hoists, wheelchairs and other items. This is affecting the appearance of some areas including bathrooms. There is no sluice facility and some residents do regularly use commodes. The plumbing and heating system in the home continues to cause problems with leaking pipes, low water pressure, lack of hot water and radiators not working cited as issues by people living in the home and staff. Work has been done on a piecemeal basis to identify isolated problems, but the number of problems experienced suggests the whole system is not working to an appropriate standard. The accommodation is on three floors and there is a shaft lift fitted. Work has been carried out to replace some parts on the lift after some problems had been experienced. There are stairs at either end of the building, however residents mostly use the lift. New carpets have been laid on the stairs and landing on the second floor. The flat on the second floor has also been recarpeted. The conservatory has also had a carpet fitted. The first floor sitting room ceiling has a leaky roof through which rain was dripping during the inspection. The smoke detector has been disconnected in this room. The home was generally clean and tidy during the inspection. All rooms have en-suite accommodation, which residents do appreciate. The main sitting room is spacious and is decorated in a homely style. The conservatory has been carpeted and is enjoyed by residents. The dining room is well furnished. A rodent problem was identified in the garden during the past year and on occasion in two bedrooms. Action was taken about this, but information in records suggested that it was likely to be a recurring problem. This could present a risk of infection as there is food stored in sheds outside the home. Since the last inspection work has been undertaken to improve the bath and shower rooms. Paper towels and liquid soap are available in the bathrooms and toilets used by all residents. Work on the wet room on the second floor is almost completed, but minor works including aids for people with sight problems and the fitting of a radiator are stopping this being used. There is Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 21 silicone left on the new laminated boarding that is unsightly and detracts from the clean appearance achieved by putting it up in the bath and shower rooms. A bar of soap and a sponge were left in the sink in the shower room on the first floor. A label has not been removed from the toilet seat that could harbour germs or cause transfer of infection. There is baler twine on the pull cord instead of a proper cord. In the ground floor bathroom there is still a problem with water leaking on to the floor when the showerhead is used. One resident said that the water pressure on the first floor is not good and at times there is not enough hot water and that she could not have a bath because of this recently. On the first floor, room 13 the ceiling in the en-suite needs repainted and a radiator needs to be replaced. In room 15 the ceiling has been repaired, but not painted. Some wardrobes are not secured to the wall and could present a hazard. Room 19 needs redecorated. Two Stanley blades were left on the window of Room 4 and could be a hazard as the room is left open while redecorating is going on. These were still in place when the Inspector visited again. Room 3 ceiling is cracked. The open walls in the kitchen have been built up and a door opening both ways was fitted during the inspection. This has means that residents are not able to wander into the kitchen as they could before and has improved health and safety. The walls where the work has been carried out are to be redecorated and new flooring is ordered for the kitchen. The laundry floor has been repainted since the last inspection, but is to have new flooring laid. Maintenance records showed that the cooker and cooker hood had been recommended for replacement by the engineer who came to service them in July. These have not been replaced despite having failed tests for safety and being reported to the owner. The laundry is sited in an outbuilding in the garden. A washer with a sluice facility is available. As mentioned earlier the flooring covering is ordered as the floor is cracked and is not impermeable. The clean washing has to be brought into the home as the laundry is damp. There have been ongoing problems with the heating system, and some residents have complained about this. Electrical testing of appliances was being carried out while this inspection was in progress. Ravensmount DS0000060366.V370052.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are not always sufficient numbers of trained and experienced staff available to meet the needs of the people living at Ravensmount. People are protected by the recruitment procedures. EVIDENCE: From the rotas available there was evidence that there are regular occasions when staffing numbers have been inadequate to meet the needs of the people living in the home. There are several residents who could be described as having high care needs and who regularly need the assistance of two staff. At times only two care staff and one senior care have been working in the home and on four occasions in three weeks no designated senior has been identified on the rota. Staff said that at times it has been very difficult to provide the level of support needed by the resident group with this level of staffing. The manager said that four staff have left in recent months and this has meant staff have been working additional shifts to cover. Waiting for recruitment checks to be completed means that new staff have not all started work and there are gaps in the rota. The provision of induction training has been affected by the low staffing levels, meaning that there is an impetus to cover Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 23 the rota rather than making sure that staff are given the information and support they need before starting work as a shift member. From talking with residents and staff it was evident that the staffing problems are affecting the quality of care provided. Staff have little time to spend with residents. Staff morale is low and residents are aware of this. The manager said that she has found it difficult to cover the rota with the number of staff available. At present there is a high level of reliance on existing staff to cover any absences, which does place additional strain on staff. One senior care is on long term sick. The manager is regularly working shifts as senior care in the evenings and weekends. She has only been in post for ten weeks and the last manager left at the end of last year, this means that she has less time to spend time on implementing good management systems. Fifty two percent of staff have completed national qualifications in care. Training records were not in good order and it was difficult to establish what training staff had undertaken in the past year. There was a matrix for last year which showed that at that time mandatory training was up to date, and some training is arranged, however there is no system for auditing where people are with training. Copies of certificates are available in staff files but these were not in any order, and it was again difficult to find out what training had been undertaken. Four staff are enrolled for training to achieve national qualifications in care and all domestic staff are to undertake national qualifications in cleaning. The recruitment procedure was not in the policy and procedures file, so it was not possible to check its content. For new staff appropriate reference and other checks are carried out and records showed this. For existing staff files checked contained two references, evidence of Criminal Records Bureau and Protection of Vulnerable adults’ checks as required by the Regulations. Individual staff records were disorganised and information was not always easy to find. Ravensmount DS0000060366.V370052.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home does not have consistent management and health and safety systems to protect people living there. Peoples’ views are not effectively sought as part of the quality review system in place to make sure the home is run in their best interests. EVIDENCE: A new manager has been appointed and has been in post for ten weeks, but has not been registered. She is experienced in working with older people and has previously worked as a Deputy Manager in another home belonging to Moorland Care Homes. Prior to her appointment the manager left last year Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 25 and had not been replaced and there was for most of this time no deputy manager. Senior care staff work as hands on care staff and have not been involved in maintaining management systems. The current management systems do not support the manager to do a good job, she does not have any budgetary control and she does not have a deputy manager who is experienced in providing good care to support her. The manager is not involved in strategic planning and is not aware of any business plan for the home. The senior staff team has been depleted by long standing staff leaving and this also impacts on the management of the home. The manager did not receive a formal induction and does not have regular formal professional supervision to help her develop as an effective manager. The manager has completed work on the Registered Manager’s Award and is awaiting her assessment to be complete and she will be undertaking NVQ Level 4 in care. Training, development and supervision of staff have all been affected by the lack of clear management. Staff are not always aware of the home’s policies and procedures, which are not easily accessible and are not always complete. There is a lack of an effective quality assurance system that uses regular auditing and consultation with people living in the home to shape service delivery. There is no analysis of data from accidents and risk assessments to ensure that health and safety systems are continuously improved. The AQAA (Annual Quality Assurance Assessment) says that the home’s policies and procedures were updated January 2008 at the time when there was no manager in post and it is not clear who was involved in this process. Equality and Diversity policy is in place, but it is not clear that this is applied in practice and staff have not had any training about how equality and diversity impacts on people’s human rights. The manager has started a programme of supervision of staff and most staff have had one session. Records were available to confirm this. Staff said they have not felt well supported through all the changes in the past year, although most did say that they felt supported by the new manager. They said that there has been two staff meetings since the new manager started and they have felt able to contribute at these. They said they could raise issues with the manager. Records of money held on behalf of residents were in good order, and balanced with the money held. Policies and procedures are in place to guide staff with handling money belonging to residents. Some residents do not have any secure storage in their rooms in which to keep valuables. Health and Safety policies are available, but it was not clear that these are always followed. Fourteen staff have had training in Health and Safety that is up to date. Fire training has not been provided since early this year and an Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 26 immediate requirement was issued asking for this to be completed for all staff. The fire authority were also informed about this. There was also evidence that Moving and Handling training has not been provided for new staff and for some existing staff there was no evidence to suggest that updating training had been provided. The systems for recording mandatory training are not robust enough and insufficient attention has been given to ensuring staff keep up to date. Staffing constraints do not help this and with new staff starting work without having completed appropriate training residents are being put at risk. Accidents are recorded, but the slips from the accident book are kept in one large plastic pocket and not in individual residents’ files. This makes it difficult to see how many accidents occurred, what was the cause and to identify any common themes. There is no effective monitoring of themes around falls to inform a proactive apporach to falls prevention. Ravensmount DS0000060366.V370052.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 2 X 2 2 2 2 STAFFING Standard No Score 27 1 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 1 X 3 X 1 1 Ravensmount DS0000060366.V370052.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 OP19 Regulation 23 Requirement The issues listed below were identified within the last report and must be addressed to ensure the environment is safe, well maintained and comfortable for residents: First floor lounge - roof leaking next to light fitting Guttering requires cleaning out. These issues are outstanding from the last two inspection reports. 2. OP21 23 Steps must be taken to ensure that the bathroom on the second floor is available for the use of residents on this floor. 30/09/08 Timescale for action 30/09/08 3. OP19 23 This issue is outstanding from the last inspection report. An annual plan of refurbishment 30/09/08 and upgrading, and routine/ planned safety checks must be drawn up in consultation with the Manager that identifies priorities and timescales. This plan must be submitted to CSCI within this timescale. DS0000060366.V370052.R01.S.doc Version 5.2 Page 29 Ravensmount This is outstanding from the previous inspection report 4. OP7 15 Care plans and risk assessments must be kept up to date so that there is clear information for staff about peoples’ current needs and how they are being met. The arrangements for purchasing, planning menus and cooking food must be reviewed to ensure that people have a choice of good quality and wellcooked food at each mealtime. The cooker and cooker hood should be replaced. The following issues need attention to ensure that residents’ rooms are maintained to an appropriate standard. • Room 13 the ceiling in the en-suite needs repainted and a radiator needs to be replaced. • In room 15 the ceiling has been repaired, but not painted. • Some wardrobes are not secured to the wall and could present a hazard. • Room 19 needs redecorated. • Room 3 ceiling is cracked. The plumbing and heating system needs to be checked and remedial action taken to ensure that residents have access to appropriate heating and hot water services as necessary for their safety and comfort. All staff working in the home must have safeguarding training to ensure that people living at Ravensmount are protected. DS0000060366.V370052.R01.S.doc 30/09/08 5. OP15 16 30/09/08 6. OP24 23 30/09/08 7. OP25 23 30/09/09 8. OP18 13 30/10/08 Ravensmount Version 5.2 Page 30 9. OP27 18 10. 11. OP30 OP32 18 24 Staffing arrangements must be reviewed to ensure that enough suitably trained and experienced staff are available on each shift to meet the needs of the people living in the home. All new staff need to complete induction training appropriate to their position. Systems need to be put in place to support the manager to do her job. This includes involvement in reviewing and improving the quality of care, budgetary control and planning as well as input into the formulation of an appropriate business plan that identifies priorities for the home’s development. 30/09/08 30/09/08 30/10/08 12. OP38 13 The arrangements for Health and 30/09/08 Safety and Safe Working practices in the home need to be reviewed and updated to ensure that people living at Ravensmount and the staff are protected. Fire training must be provided at appropriate intervals. 30/09/08 13. OP38 23 Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 31 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 OP31 OP22 Good Practice Recommendations Arrangements must be put in place to provide professional supervision for the Manager. There is a lack of adequate storage facilities, which means that wheelchairs, the hoist, commodes and other equipment is being left in bathrooms, corridors and sitting areas. Attention needs to be given to finding appropriate alternatives to this. The manager also needs support from an experienced and qualified senior staff team. 6. OP32 Ravensmount DS0000060366.V370052.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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