Inspection on 22/01/07 for Ravensmount

This inspection was carried out on 22nd January 2007.

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

Other inspections for this house

Ravensmount 15/01/09

Ravensmount 11/08/08

Ravensmount 13/08/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Ravensmount Alnmouth Road Alnwick Northumberland NE66 2QG Lead Inspector Anne Urwin Brown Key Unannounced Inspection 22nd January 2007 08:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ravensmount DS0000060366.V327512.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.V327512.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 Mrs Margaret Walton Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 2005 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. Moorland 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 £389.24 to £426.74 per week. A Statement of Purpose and User guide is available. Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was carried out over eight hours. Before the visit the Inspector used information from the pre-inspection questionnaire to assist in planning the inspection. The inspection involved talking to the Manager, eight residents and five staff, a tour of the building and inspection of records. One resident and three relatives returned questionnaires before the inspection. What the service does well: What has improved since the last inspection? What they could do better: Systems are needed to ensure that assessments are completed prior to a resident being admitted to the home. Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 Page 6 Moving and handling assessments should contain more information about how staff support individuals. Timescales need to be set for achieving completion of outstanding maintenance items listed and all health and safety issues must be speedily addressed. The current arrangements for dealing with repairs and maintenance in the home are unsatisfactory. There are insufficient bathrooms in use to meet the needs of the number of residents cared for in the home. This issue needs urgent attention. Towels and liquid soap must be available in bathrooms and toilets. The laundry is in a poor state of repair and work is needed to bring it up to an appropriate standard. Incontinence pads must be stored in an area that is free from damp. The practice of care staff preparing the evening meal should be reviewed in view of risks of cross infection and loss of care staff time. 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.V327512.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 were inspected. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ have their needs assessed before moving into the home and are assured that these needs will be met, although two of the assessment records inspected had not been fully completed. Intermediate care is not provided. EVIDENCE: There is an appropriate assessment process. However one resident’s assessment had not been completed and one was not signed and dated. In the other records inspected comprehensive information was available about individuals’ needs. Residents said that staff came to see them before they were admitted and asked them about what help they needed. They said that when they came to live at Ravensmount the staff knew what they needed assistance with and they felt well supported. Staff said that assessments are Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 Page 9 completed before people move into the home and that records are available for them to ensure that they know about individuals’ needs. Intermediate care is not provided at Ravensmount. Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 Page 10 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 were inspected. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are partly identified within care plans, but there is insufficient information about moving and handling risk assessments. Residents’ health care needs are appropriately met and examples of good practice were available. Policies and procedures for dealing with medicines protect the residents. Residents are treated with dignity and respect and their right to privacy is upheld. EVIDENCE: Care plans based on residents’ assessed needs are in place. Information about individuals’ social care needs is limited. Limited information is provided about individual preferences and how staff meet these. Records show that plans are updated to take account of residents’ changing needs. Assessments for falls, pressure areas, nutrition and moving and handling are available for Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 Page 11 each resident. However the moving and handling risk assessments do not show in enough detail how staff support individuals. Plans and assessments are reviewed monthly. Residents said that they were satisfied that staff knew what they needed help with and provided them with appropriate support. One resident said that staff were always helpful and cheerful. Residents’ health care needs and any specific treatments are clearly recorded and all contact with the doctor, district nurse and other health care professionals is available in individual records. Risks are regularly assessed for falls prevention, nutritional needs and skin care. One resident’s record showed evidence of good practice in following up on a high number of falls with appropriate help being sought from a physiotherapist, occupational therapist and the specialist falls team. Residents said that the staff are aware of their health needs. They said they get support to attend appointments. Three residents said they were satisfied that they can access the health services that they need. Guidance is in place for staff about handling medicines. Medication records are kept in good order. Appropriate arrangements are in place for the storage of medicines. Residents said that they felt that staff respect them and treat them well. Staff were seen knocking on residents’ doors before entering rooms. There was a relaxed atmosphere in the home and staff spoke respectfully to residents during the inspection. Staff induction training includes reference to privacy and dignity. Staff guidance is available about privacy and dignity. Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 Page 12 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 were inspected. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lifestyle in the home suits residents’ preferences and expectations. Care plans and other records do not have enough information about residents’ social needs and how these are met. Residents keep in contact with family, friends and the local community. Residents have control over their lives. The dietary needs of residents are well catered for with a balanced and varied selection of food. EVIDENCE: Residents said that they are able to make choices about their daily routines, like when they get up and go to bed. Individual routines are identified within care plans, but more information about residents’ wishes about daily activities is not sufficient. There is not an organiser for activities and at times the programme is limited by lack of sufficient time. The activity record had not been updated regularly in the past month to show what events had been arranged. Residents said that they have bingo, board games and quizzes regularly. One resident said he regularly went out into Alnwick on his own. Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 Page 13 One resident said she felt happy spending time in her room, while others said they enjoyed the company of other residents. Residents said that they have regular visitors and the inspector saw this during the inspection. Residents said that they could see visitors in their own rooms or in the public areas of the home. Information is available for relatives about visiting and this is made available before a resident is admitted. Nineteen residents have a telephone fitted in their room or a mobile phone so that they can keep in touch with family and friends. Residents are encouraged to continue to manage their finances for as long as they are able and records confirm this. Residents’ rooms are well furnished with their own possessions and they said that they were encouraged to bring items from their previous home. One resident said that she thought she could look at her records, but was not sure that she wanted to. Menus show a variety of healthy food is available and residents said they could request an alternative at each mealtime. They said they enjoyed the food and that there was plenty of it. One resident responded by questionnaire and said he thought the mealtimes were too rigid. Staff were aware of residents’ likes and dislikes. The cook has had Food Hygiene training, but other staff need updating training. Care staff are responsible for cooking the evening meal and this takes time away from caring for residents. In addition the practice of using care staff to prepare food increases the risks of cross infection. At the evening meal about thirteen residents take the meal served in their rooms. Residents said they are asked about what they would like for meals. Meals are served in the dining rooms or in residents’ rooms if they prefer. The cook keeps records of residents’ likes and dislikes. She provides home baking for residents and is aware of the dietary needs of older people. Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 Page 14 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 were inspected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are confident that their complaints will be listened to and acted upon. Residents are protected from abuse and abuse training is arranged for staff. EVIDENCE: Guidance is in place for dealing with complaints and residents and/or their representatives are given a copy of the complaints procedure when they come to live at Ravensmount. An appropriate recording system is in place for complaints. No complaints have been made since the last inspection. Residents said that they felt able to raise any concerns or complaints with staff. They said that they felt able to talk to the Manager if they were unhappy and that they were sure that she would deal fairly with their concerns. Appropriate guidance is in place for dealing with allegations of abuse. Staff were clear about the procedures to be followed if an allegation is made. Staff training has been provided, and more training is arranged to update staff. No allegations have been made in the home. Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 Page 15 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, 24, 25, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The arrangements for the maintenance and renewal of the building are inadequate to ensure that a safe and well maintained environment is provided for residents. Maintenance repairs/renewals have not been addressed within appropriate timescales to ensure residents’ comfort and safety. Residents have access to comfortable indoor space, however there are a number of urgent repairs and maintenance issues identified below that are affecting health and safety. There are insufficient bathrooms available in the home for the number of residents cared for. One bathroom on the first floor has been out of use for two years. Most residents’ rooms are comfortably furnished and appointed, although there are some repairs that require attention. Some areas of the home are not as safe as they should be. Some areas of the home are not clean, pleasant and hygienic. Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 Page 16 EVIDENCE: The comfort and homeliness of the accommodation at Ravensmount is affected by the inadequate arrangements for routine maintenance and repairs to the fabric of the home. Outstanding issues identified from the maintenance log include: • Loose wiring on the chandelier in the hallway • Work on bathroom on middle floor to be completed • Overflow outside the small dining room leaking • Radiator leaking in Room 12 • Light switch in the fridge room – bare wires showing cannot be used • Kitchen window does not open • Meat slicer and grill require repairs • Curtain rail in lounge requires attention • Light fitting outside bathroom requires replacement (Fire Officer recommendation) • Room 1 - window does not open properly - this was outstanding in the last two inspection reports • Room 18 - window does not close and lino needed in en-suite, needs decorated • Ground floor lounge window does not close (security risk) • Conservatory roof leaking, replacement light fitting required • First floor lounge – roof leaking next to light fitting and fire sensor (been disconnected because of risk of water) • Room 26 - toilet leaking • Room 9 - taps dripping • Furniture to be removed from second floor landing • Room 15 - windows require repair, radiator guard requires replacement, room needs redecorated • Fridges need disposed of • Guttering requires cleaning out • Hand rail outside the conservatory is covered in pigeon dung and presents a health hazard A number of these matters have been outstanding for some time and require urgent attention. In addition other issues were identified during this inspection that will be mentioned later in this report. There are ten outstanding issues from the last environmental health report, which was carried out on 2/12/05. The grounds are attractive and there are pleasant paths round the garden. However there is rubbish lying around the garden that should be disposed of as well as old furniture and fridges near the outbuildings to the side of the home. This detracts from the attractiveness of the gardens. Pathways would benefit from cleaning as some areas could be slippery when wet. Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 Page 17 There is adequate sitting and dining space for the number of residents living at Ravensmount. Some of the chairs in the sitting areas are worn and the legs are marked and scratched. The catches on the unit doors on the furniture in the main sitting area need repair. The paintwork on the windows in this room is bubbled and cracked. Carpets are worn on the main staircase and in the corridor on the ground floor. There are gaps evident in the conservatory doors and more draught proofing is required. Residents said that generally they were happy with the facilities provided. There are insufficient assisted bathrooms to meet the National Minimum Standards. One bathroom on the first floor has been out of use for about two years. There is only one bathroom on the first floor for fifteen residents and one bathroom on the ground floor for ten residents. Residents cannot use the bathroom on the third floor when the small flat is in use as this is part of that area. Other issues identified with bathroom and toilets were: • Bathroom on first floor is bare and cold looking, there was a sick bowl, commode pan and incontinence pads lying in the sink. The flooring was marked and stained and the shower did not work. The shower would be difficult for most residents to use having two steps up to it. The vinyl flooring is lifting and is a potential trip hazard (this was identified in the last inspection report). Some baths/toilets had no liquid soap or paper towels or indeed any towel available. Bathroom on first floor that is not in use needs work to make it suitable for elderly people to use. A professional assessment is needed to ensure it meets residents’ needs and that appropriate aids are fitted. There is no hoist available in the bathroom on the second floor and most residents on this floor do not use it as it is part of a self contained flat. • • • Residents’ rooms are generally adequately furnished and appointed apart from the issues identified earlier in this report. Other issues identified during the inspection include: • Room 15 toilet is leaking, carpet needs cleaning, light fitting needs repair • Room 18 carpet at entrance to toilet needs attention to prevent it being a trip hazard • Room 5 the plasterwork is damaged and requires repair. In the previous report issues were identified about the central heating system and these matters have been remedied. At this visit there was evidence of a broken radiator guard and a leaking radiator. Lighting in the first floor lounge is affected by the leaks in the roof. Some residents’ rooms would benefit from a review of the adequacy of the lighting. The laundry is sited in a wooden building at the side of the home. The floor has been painted at one time, but now the original concrete is showing through Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 Page 18 and is not impermeable. The walls have been painted, but are now flaking and mouldy and a harbour for germs. There was dirty laundry on the floor. The laundry is damp and not suitable for storing laundered clothing or bedding. No areas are available for folding or storing laundered items. Incontinence pads are stored in the laundry and are also affected by the damp. There was no soap for washing hands or paper towels available in this area where soiled articles are dealt with. A review of the current arrangements for laundering clothing, bedding etc is urgently needed. Washing machines have appropriate cycles for washing soiled linen. Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29, 30 were inspected. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff levels are not adequate at certain times of the day to the assessed needs of the residents, size, layout and purpose of the home. There are risks of cross infection from the practice of care staff preparing evening meals. Staff have the skills to meet residents’ needs. Residents are supported and protected by the home’s staff recruitment procedures. Staff are trained and competent to do their jobs. EVIDENCE: At times there are not enough care staff when they are needed to prepare and serve meals. The Manager, one senior carer and three care staff were on duty at the time of the inspection. Two waking night staff are on duty throughout the night. However a proposal has been made by the owner to reduce staffing levels and this is not acceptable. In addition there are issues with care staff taking over work in the kitchen when they have been providing assistance with personal care. There is a potential risk of cross infection. No specific time is allowed for arranging and supporting residents with social activities. No staff are employed who are under eighteen years. Residents said that there are enough staff, one resident said “staff come quickly when I need help and they Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 Page 20 are always very nice to me”. One resident thought that there were times when the home was “under-staffed at peak periods of activity”. Twelve staff have completed national qualifications in care and a further six staff are working towards gaining qualifications. A level of over fifty per cent of qualified staff has been achieved. Staff are committed to training and recognise the importance of gaining qualifications. Recruitment procedures are in place and records show these are followed. Appropriate reference and Criminal Records Bureau checks are carried out before staff start work at Ravensmount. Training provided in the past year included Protection of Vulnerable Adults, Dementia, Moving and Handling, Health and Safety and National Vocational Qualifications at Level 2 and 3. A staff training plan is in place. Individual training records are kept. Staff said that new staff receive appropriate induction training and records confirmed this. Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 38 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is run and managed by a person who is appropriately qualified and experienced in caring for older people. The home is run in the best interests of residents and they are regularly consulted about the service by use of questionnaires. Residents’ financial interests are safeguarded. Some systems are in place to protect residents and staff from health and safety hazards, but there are outstanding issues from the Environmental Health officer’s report and maintenance log. Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 Page 22 EVIDENCE: The manager is qualified in social care and has also completed the Registered manager’s award. She is experienced in caring for older people. She has opportunities for training. A job description is in place for the manager. The owner visits the home regularly, but there are no formal arrangements in place for professional supervision of the manager. Questionnaires for residents and relatives are used as part of the quality assurance system for the home. The manager regularly audits records and an organisation audit is carried out every three months covering all aspects of the operation of the home. Guidance is in place for staff about handling residents’ money. Records are kept of any money held and all individual transactions are recorded. Appropriate arrangements are in place for the storage of money held. Training in moving and handling, first aid, fire safety, food hygiene and infection control is provided at regular intervals. Records showed this and staff said that they receive this training. Records showed that regular checks are made of electrical equipment and the central heating system. Risk assessments are in place for safe working practices. Staff said that they receive appropriate induction training and records are in place to confirm this. Records of fire alarm tests, servicing of fire equipment and the alarm, fire training and emergency lighting are kept in an appropriate manner. Full details of accidents are kept. Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 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 3 17 X 18 3 1 2 1 X X 2 1 1 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 Page 24 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 OP3 Regulation 14 Requirement Timescale for action 31/03/07 2 3 4. OP7 OP12 OP19 13 16 23 There needs to be a system in place for checking that assessments are completed prior to a resident being admitted to the home. Moving and handling 31/03/07 assessments must describe how staff support individuals. More information is needed 31/03/07 about residents’ social needs and how these are met The issues identified within this 31/03/07 report must be addressed to ensure the environment is safe, well maintained and comfortable for residents: • Loose wiring on the chandelier in the hallway • Work on bathroom on middle floor to be completed • Overflow outside the small dining room leaking • Radiator leaking in Room 12 • Light switch in the fridge room – bare wires showing cannot be used • Kitchen window does not DS0000060366.V327512.R01.S.doc Version 5.2 Ravensmount Page 25 • • • • • • • • • • • • • • • • open Meat slicer and grill require repairs Curtain rail in lounge requires attention Light fitting outside bathroom requires replacement (Fire Officer recommendation) Room 1 - window does not open properly - this was outstanding in the last two inspection reports Room 18 - window does not close and lino needed in en-suite, needs decorated Ground floor lounge window does not close (security risk) Conservatory roof leaking, replacement light fitting required First floor lounge – roof leaking next to light fitting and fire sensor (been disconnected because of risk of water) Room 26 - toilet leaking Room 9 - taps dripping Furniture to be removed from second floor landing Room 15 - windows require repair, radiator guard requires replacement, room needs redecorated Fridges need disposed of Guttering requires cleaning out Hand rail outside the conservatory is covered in pigeon dung and presents a health hazard Issues identified within the environmental health officer’s report (2/12/05) must be addressed. Version 5.2 Page 26 Ravensmount DS0000060366.V327512.R01.S.doc 5. OP21 23 There are insufficient bathrooms 31/03/07 in use to meet the needs of the number of residents cared for. Other issues that need to be addressed: • Bathroom on first floor needs to be more homely and the practice of storing equipment in the sink must be discontinued. The shower needs attention. The vinyl flooring is lifting and is a potential trip hazard (this was identified in the last inspection report). • Towels and liquid soap must be available in bathrooms and toilets. • Work on the bathroom on first floor must be completed and equipment provided to suit the needs of older people. A professional assessment is needed to ensure it meets residents’ needs and that appropriate aids are fitted. • Steps must be taken to ensure that the bathroom on the second floor is available for the use of residents on this floor. Issues identified in bedrooms require urgent attention: • • Room 15 toilet is leaking, carpet needs cleaning, light fitting needs repair Room 18 carpet at entrance to toilet needs attention to prevent it being a trip hazard Room 5 the plasterwork is damaged and requires repair. 31/03/07 6. OP24 23 • Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 Page 27 7 OP26 16 Work must be undertaken in the laundry to ensure it meet National Minimum Standards. This must include the provision of appropriate hand washing facilities, impermeable flooring and easily cleanable wall surfaces as well as providing appropriate space that is not damp for dealing with clean linen. 31/03/07 8 OP27 18 Alternative arrangements must be made for the suitable storage of incontinence pads. Staffing levels and deployment 31/03/07 must be reviewed. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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. Extracts may not be used or reproduced without the express permission of CSCI Ravensmount DS0000060366.V327512.R01.S.doc Version 5.2 Page 29 - 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. 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