Inspection on 04/07/05 for Ravensmount

This inspection was carried out on 4th July 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

Ravensmount 15/01/09

Ravensmount 11/08/08

Ravensmount 13/08/07

Ravensmount 22/01/07

Ravensmount 06/12/05

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 Announced 4 July 2005 09:30 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. Ravensmount B53-B03 S60366 Ravensmount V224080 220605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ravensmount Address Alnmouth Road Alnwick Northumberland NE66 2QG 01665 603 773 01665 603 773 ravensmount@tiscali.co.uk Moorlands Holdings NE Limited 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) Vacant CRH 30 Category(ies) of OP Old Age (30) registration, with number of places Ravensmount B53-B03 S60366 Ravensmount V224080 220605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: There are no conditions of registration. Date of last inspection 25 November 2004 Brief Description of the Service: Ravensmount is a large detached house, which has been extended, set in very attractive grounds on the outskirts of Alnwick. The Home is on a local bus route and a train station at Alnmouth is just a few miles away. Ravensmount is registered to accommodate up to thirty older people. The accommodation is provided on three floors and a shaft lift is fitted. All rooms have en-suite facilities. There are sitting areas on each floor as well as a large conservatory on the ground floor. Ravensmount B53-B03 S60366 Ravensmount V224080 220605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection lasted six hours and involved discussion with the Owner, Manager, twelve residents, two relatives and staff. Five residents’ records were inspected together with other records relating to the running of the home. Three staff files were seen. A tour of the building was carried out. What the service does well: What has improved since the last inspection? Criminal records bureau checks have been completed for staff in post on 1 April 2002. The quality assurance system has been developed to include the Ravensmount B53-B03 S60366 Ravensmount V224080 220605 Stage 4.doc Version 1.30 Page 6 views of residents. The registered provider is visiting the home monthly and reports are available about the operation of the service. Each resident has a written contract with the home. Work is going on to improve the facilities in one bathroom. A falls risk assessment tool is now being used with residents. A programme of regular refurbishment is in place. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ravensmount B53-B03 S60366 Ravensmount V224080 220605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Ravensmount B53-B03 S60366 Ravensmount V224080 220605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4, 5 Residents’ needs are assessed before they move into the Home and they know that the service is able to meet their needs. Prospective users are encouraged to visit the home to assess the quality, facilities and suitability of the service. EVIDENCE: Residents’ records confirmed that a full assessment is carried out. Risk assessments are also carried out. The Manager confirmed that Care Management assessments are also available and these were seen in the files inspected. Residents and one relative said that they felt satisfied that the Home had carried out an appropriate assessment. They said staff knew residents’ needs and provided appropriate support. The Manager described how prospective residents are encouraged to visit the home before they are admitted. She said a number of residents had visited the home for respite care so they were familiar with the home and the staff. Residents confirmed that they had visited the Home before coming to live there, some for respite and others on day visits. They said they had looked around the building, talked to staff and other residents and felt that this was a useful experience. Ravensmount B53-B03 S60366 Ravensmount V224080 220605 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 Residents have an individual plan setting out their health, personal and social care needs. Residents health care needs are met. Residents are protected by the home’s policies and procedures for dealing with medicines and where appropriate take responsibility for the administration of their own drugs. EVIDENCE: Records were available to confirm that each resident has an individual care plan. The plans inspected showed that appropriate information is available and that plans are regularly reviewed. Risk assessments are in place. Residents said that staff were aware of their needs and quickly responded if additional help was required. Residents knew that staff kept records about them, but did not feel that they wanted to see their records. The Manager described how health care needs are met and records confirmed that local health care services are available to residents. Risk assessments are carried out for pressure areas. Evidence of appropriate support for individual residents’ health care needs was available from records and discussion with residents and staff. Contact with local health care professionals is recorded. Residents said that they were satisfied with the support they received for their health care. Ravensmount B53-B03 S60366 Ravensmount V224080 220605 Stage 4.doc Version 1.30 Page 10 Written guidance is in place for dealing with medicines. Staff have had appropriate training provided. Four residents keep and administer their own medicines and staff support them with this. Risk assessments are in place. Records are maintained of the administration of all residents’ medication. Arrangements for the storage of medication are satisfactory. Records of the administration of medication are well maintained apart from one change that had not been recorded. Ravensmount B53-B03 S60366 Ravensmount V224080 220605 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 15 Residents are encouraged to maintain contact with family, friends, representatives and the local community. Residents have a wholesome, appealing diet provided. EVIDENCE: Residents said that they could have visitors at any time that suited them. Records showed evidence of how contact is maintained. Residents can use their own rooms or some of the public rooms to see visitors. Written information about the home’s policy on visitors is available. Copies of the menu were available and these show a varied diet is available. An alternative is available at each mealtime. During the inspection all but one resident said they are very satisfied with the quality and quantity of food provided. In the questionnaires completed by residents two people said they only liked the food sometimes. The meal provided during the inspection was well cooked and presented. The cook described how she asks residents for suggestions and comments regularly. Residents confirmed that they could ask for something different if they did not like the food served. The cook has recently completed qualifications in catering and is to undertake further training. The Manager confirmed that food hygiene training has been arranged for staff who have not completed this. She also said that residents are regularly consulted about the food and that she will try to address the issues raised by the resident during the inspection. Ravensmount B53-B03 S60366 Ravensmount V224080 220605 Stage 4.doc Version 1.30 Page 12 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 Residents are confident that their complaints or concerns will be taken seriously and acted upon. EVIDENCE: Residents felt satisfied that their concerns will be taken seriously. Records showed that there has been one complaint made since the last inspection. The records showed that this matter has been resolved and that the complainant had responded in writing to say they were satisfied. Written guidance is in place for staff about dealing with complaints. Staff were able to confirm that they were aware of the guidance and that they knew the steps to be taken to help a resident to make a complaint. Ravensmount B53-B03 S60366 Ravensmount V224080 220605 Stage 4.doc Version 1.30 Page 13 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 Ravensmount is well maintained and safe. Residents have access to comfortable indoor and outdoor communal facilities. Residents have en-suite accommodation and sufficient bathrooms are available. Residents have specialist equipment supplied if they need it. The call system is not fitted within one sitting room and the conservatory on the ground floor. Residents’ bedrooms are comfortable and they have their own possessions around them. The home is clean, pleasant and hygienic. EVIDENCE: Ravensmount is well located in a pleasant residential area. Evidence was available that a maintenance programme is in place and that regular upgrading of the décor is undertaken. The grounds are attractive and well maintained. Sitting areas are well furnished and decorated apart from the sitting area outside the second floor flat. The Manager said that this area is to be redecorated and refurbished shortly. Residents highlighted that call system points are not fitted in the conservatory to allow residents to call for assistance. One sitting room also needs a point to be fitted. Each bedroom has its own en-suite. Bedrooms are well furnished and Ravensmount B53-B03 S60366 Ravensmount V224080 220605 Stage 4.doc Version 1.30 Page 14 residents said that they were able to bring in items from their previous homes. Residents said they were happy with their rooms. Bedroom door locks have not been replaced as recommended within the last inspection report. One bathroom is being refurbished and it is planned that another will be refitted. Bathrooms are fitted with aids that are appropriate to residents’ needs. Rooms are well ventilated and lighting is adequate. Central heating is fitted and residents are able to adjust the temperature within their rooms. Emergency lighting is fitted and regular checks are carried out. Written guidance is in place for the control of infection and staff training is provided. Appropriate arrangements are in place for washing residents’ clothing and bedding. Ravensmount B53-B03 S60366 Ravensmount V224080 220605 Stage 4.doc Version 1.30 Page 15 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, 29 Staffing levels at the time of this inspection were sufficient to meet the needs of the residents. Residents are supported and protected by the home’s recruitment policy and practice. EVIDENCE: There are three care staff and one senior member of staff on duty throughout the day. Two waking staff, one of whom is a senior, are on duty at night. Rotas showed that this level of staffing is maintained. Residents said that they felt satisfied that there were enough staff on duty and that staff knew what they needed help with. Questionnaires completed by residents at the time of the inspection confirmed that residents felt that they were well cared for and that staff treated them well. The Manager reported that all staff except for one has gained qualifications in care. Written guidance is available describing appropriate recruitment procedures. Inspection of staff files confirmed that appropriate reference and Criminal Records Bureau checks are carried out for all staff. Ravensmount B53-B03 S60366 Ravensmount V224080 220605 Stage 4.doc Version 1.30 Page 16 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) 33, 37, 38 Residents are consulted about how the home is run. Copies of the provider’s reports are not supplied to the Commission for Social Care as required at the time of the last inspection, although they are available in the home. Arrangements are in place to safeguard residents’ rights and best interests by the Home’s record keeping, policies and procedures. Health, safety and welfare of residents is promoted and protected EVIDENCE: A system is in place that involves staff and management regularly asking for the views of residents about the care they receive and carrying out quality checks of systems, records and procedures. The Manager confirmed that the system is updated every three months. Copies of the reports prepared following visits by the provider are available in the home, but are not being supplied to the Commission for Social Care Inspection. Ravensmount B53-B03 S60366 Ravensmount V224080 220605 Stage 4.doc Version 1.30 Page 17 The records seen during this inspection were in good order. Residents said that they could ask to see their records, but most did not think that they wanted to. Arrangements for storing records were satisfactory. Fire records are maintained and show that appropriate checks and tests are carried out and recorded. Staff fire training is arranged. Written guidance is in place for Health and Safety and risk assessments are carried out. Evidence was available that regular updating of Moving and Handling, First Aid and Food Hygiene training is arranged. Staff said that there is regular training arranged and that opportunities to access training are available. Accidents are recorded appropriately. Staff confirmed that an appropriate induction training programme is available for new staff. During the inspection a relative of expressed concerns that some staff were not following good Moving and Handling procedures. The Manager said that she would look into this. Ravensmount B53-B03 S60366 Ravensmount V224080 220605 Stage 4.doc Version 1.30 Page 18 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 x x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 3 2 3 2 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 2 x x x 3 2 Ravensmount B53-B03 S60366 Ravensmount V224080 220605 Stage 4.doc Version 1.30 Page 19 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 22 Regulation 23 Requirement Call system points must be fitted in the two sitting areas identified within the report to ensure that residents are able to summon assistance as required. The sitting area outside the second floor flat must be redecorated. The carpet in this area and at the entrance to the lift on the second floor should be replaced. These matters are outstanding from the last inspection report. Copies of the reports prepared by the provider must be supplied to the Commission for Social Care Inspection. A review of the Moving and Handling techniques used in the home must be carried out and training provided where necessary. Timescale for action 30.09.05 2. 19 23 31.10.05 3. 33 26 30.08.05 4. 18 38 30.09.05 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 Good Practice Recommendations B53-B03 S60366 Ravensmount V224080 220605 Stage 4.doc Version 1.30 Page 20 Ravensmount 1. Standard 24 Locks should be fitted to residents bedrooms that allow residents to lock their rooms, but also allow staff to access the room in an emergency. Residents should be provided with a key to their rooms unless a risk assessment suggests this may present a hazard. This matter is outstanding from the last inspection report. Ravensmount B53-B03 S60366 Ravensmount V224080 220605 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection NOrthumbria House Manor Walks, Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ravensmount B53-B03 S60366 Ravensmount V224080 220605 Stage 4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!