Inspection on 28/06/07 for Ravenswood Nursing Home

This inspection was carried out on 28th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Ravenswood Nursing Home 03/07/08

Ravenswood Nursing Home 13/12/06

Ravenswood Nursing Home 04/10/05

Ravenswood Nursing Home 13/12/04

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

CARE HOMES FOR OLDER PEOPLE Ravenswood Nursing Home 47 Lower Bristol Road Weston Super Mare North Somerset BS23 2PX Lead Inspector Juanita Glass Key Unannounced Inspection 28th June & 6th July 2007 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 Ravenswood Nursing Home DS0000062326.V345671.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. Ravenswood Nursing Home DS0000062326.V345671.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ravenswood Nursing Home Address 47 Lower Bristol Road Weston Super Mare North Somerset BS23 2PX 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) 01934 412091 01934 644343 Extrafriend Limited Mrs Deborah Margaret Crawford Care Home 36 Category(ies) of Dementia (36), Mental disorder, excluding registration, with number learning disability or dementia (36) of places Ravenswood Nursing Home DS0000062326.V345671.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) 2. Mental Disorder, excluding learning disability or dementia (Code MD) The maximum number of service users who can be accommodated is 36. 13th December 2006 Date of last inspection Brief Description of the Service: Ravenswood nursing home is located on a main bus route into the centre of Weston-super-Mare. The home has easy access to the seafront, a number of local parks and local shops. Ravenswood is a large period building adapted to meet the needs of service users requiring nursing care. The home cares for up to 36 service users with mental health or age related health problems. The home charges the local authority rate of £527 a week. Ravenswood Nursing Home DS0000062326.V345671.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two days in the presence of the home manager Mrs Deborah Crawford. . During this time a review of documentation was carried out. This included resident care records and staff personnel records. Residents were spoken to and many were able to express a view on their experience of living in the home. Residents able to express a view said they were happy and ‘nice girls’ looked after them. One gentleman said that nothing was too much for them. A tour of the premises and a review of medication were carried out. Staff and resident interactions were observed in the communal areas, and during lunch. The provision of a healthy and culturally appropriate diet was discussed with the chef. Written surveys were not received however the homes own surveys evidenced that people were happy with the care provided and praised staff for their commitment to caring for their family member. During this inspection staff were observed carrying out daily routines they had a relaxed and friendly rapport with residents and were conscious of the need to explain clearly what they were doing and why. All interventions were carried out with a clear understanding of the need to promote dignity and privacy. What the service does well: What has improved since the last inspection? What they could do better: Areas for improvement were discussed with the manager and provider. The care plans need to contain specific guidance on triggers and coping strategies Ravenswood Nursing Home DS0000062326.V345671.R01.S.doc Version 5.2 Page 6 for residents with challenging behaviours. Qualified staff need to adhere to the homes policies and procedure on the administration of medication as there were a few errors. These are noted under Outcome 2 (Health and Personal Care) of this report. The manager needs to consult publications on the best environment for people with a cognitive impairment such as dementia. This will improve the life style for many of the residents in the home, by identifying areas in the physical environment of the home that could be improved. 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. Ravenswood Nursing Home DS0000062326.V345671.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 Ravenswood Nursing Home DS0000062326.V345671.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): 1, 3 and 4. 6 does not apply Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered provider understands the importance of providing adequate information for people seeking to choose a care home. Admissions to the home only take place after a full assessment of needs is carried out. EVIDENCE: The home has a concise statement of purpose, which sets out clearly the objectives, and philosophy of the home. The statement of purpose is made available on request. Care records reviewed showed that a pre admission assessment is carried out prior to a prospective resident moving into the home. These assessments were clear and concise; they include information relevant to the mental health needs of the individual. These form the basis for the care plans, which are implemented on admission to the home. Residents spoken to were unable to comment on the admission process. Ravenswood Nursing Home DS0000062326.V345671.R01.S.doc Version 5.2 Page 9 The home offers the opportunity for prospective residents to visit before making their final decision, however a relative/representative usually carries this out on their behalf. Ravenswood Nursing Home DS0000062326.V345671.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): 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. Personal health care needs are clearly recorded in care plans, which identify the need for individual personalised care. However they lack specific guidance for people with challenging behaviour. Staff respect privacy and dignity and are sensitive to changing needs. People using the service have access to healthcare and remedial services. The home has an efficient medication policy and procedure, however staff fail to adhere to it. EVIDENCE: The care plans for five residents were reviewed they contained most of the information required by staff to adequately meet the individual needs of the resident group. Nutritional assessment had not been carried out but all care plans referred to eating and drinking. Weights were regularly recorded. For those residents who had a challenging behaviour the care plans did not give clear guidance for coping strategies. Care plans need to state clearly what Ravenswood Nursing Home DS0000062326.V345671.R01.S.doc Version 5.2 Page 11 may trigger an incident and how staff should manage the situation. These need to be tailored to the individual rather than be generic. The existing plans were very clear and showed a commitment to person centred care. Residents spoken to were unable to comment on their care plans. They did say though that they got the help they needed. One resident said that ‘they were cared for well so the care plans must be ok.’ All the plans showed evidence of regular review with qualifying comments as to why a change was or was not needed. Residents have access to health care specialists and care plans showed that the district nurse and community psychiatric nurse were consulted when the home felt they needed some expert advise. Residents are assisted to attend out patient appointments, the dentist and the chiropodist. Regular reviews are carried out with the GP regarding specific health needs and medication. During the inspection residents were observed to be well groomed, relaxed and happy. They had a friendly and open rapport with staff, chatting and laughing or asking for assistance without hesitation. Residents spoken to said they were happy and that the staff were friendly and helpful; those who could express an opinion said that they felt their privacy was respected and that they were treated kindly. Staff were observed to be open and friendly they responded to residents in an appropriate manner. It was evident that some staff did not adhere to the homes policy and procedure for the administration of medication. During a tour of the premises it was noted that creams and ointments in residents rooms were being used for people they were not prescribed for. Labels had been removed or covered and other names added. This is not good practice. During a review of the Medication Administration Record (MAR) chart it was noted that handwritten medication and changes were not signed or witnessed by another member of staff. One member of staff had administered a laxative remedy that was not listed on the agreed homely remedies list. During the first day of this inspection the need for clear protocols for as required (PRN) medication was discussed with the manager. On the second day the manager had introduced a generic policy and was reviewing the relevant care records. Residents spoken to did not express the wish to manage their own medication and those able to express an opinion were happy with the way medication was managed. Ravenswood Nursing Home DS0000062326.V345671.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): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home tries to be flexible and attempts to provide a service that is individual. However choice is limited. People using the service are offered the opportunity to take part in a variety of activities including contact with the community, family and friends. The food in the home is of a satisfactory quality, well presented and meets dietary and cultural needs. EVIDENCE: The daily routines off the home are flexible and are designed to meet the needs of the current resident group. The use of locked doors though raises concerns about lack of choice. Staff stated that residents are free to go to their rooms if they ask. This is not always easy for some residents who may prefer to just go to their room rather than be ‘a nuisance to staff.’ Care records showed that residents’ religious and cultural needs are taken into consideration. Alternative dietary arrangements had been made fro one resident. Residents spoken to said they thought the home was run in a way that meant they could change the routine if necessary. Staff are encouraged to carry out a variety of activities with residents. It was difficult to evidence Ravenswood Nursing Home DS0000062326.V345671.R01.S.doc Version 5.2 Page 13 this, as a separate record of activities was not available at the time. On the first day of the inspection residents were encouraged to make the most of a sunny afternoon in the front garden. Residents were observed exercising choice about remaining in the garden or returning in doors staff were observed supporting residents to make that choice. Residents spoken to said they could see their friends and relatives and that there were no restrictions to visiting. During the inspection the quality of food was discussed with the chef and the residents. Those residents able to express an opinion said that the meals provided were acceptable and presented well. The cook stated that they had a four weekly menu and that he is consulted regarding dietary and cultural needs. The menu showed evidence of a well-balanced and healthy diet with the use of fresh fruit and vegetables. Ravenswood Nursing Home DS0000062326.V345671.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): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure that is clearly written and easy to understand. The policies and procedures for Safeguarding Adults are available and give very clear guidance to those using them. EVIDENCE: The home has a very clear complaints policy and procedure which one visitor said they are aware of. Residents were not able to express an opinion on the complaints policy. Those who were able to comment said they could talk to the staff or the manager. Two complaints had been received since the last inspection. These were clearly recorded in the complaints book and had been dealt with appropriately. The home has a robust policy and procedure for the protection of vulnerable adults. Staff spoken to said they knew what action to take, they were aware that there was a local authority procedure and where to access the information if they needed to. Recent training on the North Somerset policy and procedure had been provided for all staff at the home. Ravenswood Nursing Home DS0000062326.V345671.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): 19, 22, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is comfortable with an ongoing programme of improvement. The physical environment does not always meet the needs of people with a cognitive impairment such as dementia. The design and decoration reflect the preferences or convenience of staff and the provider rather than residents. EVIDENCE: A tour of the premises was carried out. It was evident that there was an ongoing maintenance programme and the maintenance person was working during both days of the inspection. Of particular concern on the first day was the main downstairs bathroom where a toilet had been disconnected but no cap placed over the waste pipe. This was discussed with the manager who was informed it needed to be dealt with Ravenswood Nursing Home DS0000062326.V345671.R01.S.doc Version 5.2 Page 16 immediately. The provider informed the maintenance man and the pipe was covered straight away. During the tour of the home it was noted that most areas were painted white or magnolia including toilet and bathroom doors, which did not have clear notices on them. This was discussed with the manager who was advised to consult publications on suitable decoration for Dementia homes. Such as painting toilet doors red so they stand out from the rest of the room. The manager also needs to introduce clear notices on toilet doors for residents. On the second day of the inspection the manager stated that plans were in place to paint toilet doors. This will be assessed at the next inspection. It was also noted that most bedrooms were very clinical in appearance. Lacking personal possessions and decoration with pictures or hangings. The manager agreed to involve key workers in decorating resident’s rooms to reflect their personality and personal preferences. The provider stated that it was easier to have magnolia paint rather that a large selection of coloured paints but recognised the reason behind encouraging residents to personalise their personal space. The use of locked doors between floors needs to be reviewed. This was discussed with the manager. Residents need to be able to access their rooms exercising choice and control over their lives. It was noted with some concern that the door at the top of a flight of stairs was locked. A person with Dementia on finding a dead end such as a locked door may step backwards rather than turn round this could result in serious injury. Residents spoken to did not express an opinion they accepted that they had to ask a member of staff if they wanted to go to their room. The manager stated that those residents assessed as capable of holding a key were given keys. The home is kept clean tidy and free from offensive odours. Staff spoken to and observed during the day showed an awareness of the need to comply with the homes infection control guidelines. Ravenswood Nursing Home DS0000062326.V345671.R01.S.doc Version 5.2 Page 17 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): 27, 28, 29 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are supported by appropriate staffing levels with emphasis on busy times and a skill mix that is relevant to the needs of the resident group. This is supported by the commitment of the owner to provide opportunities for continued development of staff. EVIDENCE: Staffing rotas showed that the number of staff employed on each shift in the home meets the assessed needs of the current resident group. Staff were observed to be unhurried and residents spoken to said there were enough staff on duty at all times. Extra staff can be used when needs justify such as trips out or hospital appointments. A review of staff personnel records showed that all the relevant information had been gathered and checks done. Staff records contained two written references and POVA checks before they commenced employment. All staff had attended all mandatory training and external training in subjects’ specific to the needs of the current resident group, such as diabetes, incontinence, wound care and dementia is also provided. It was discussed with the manager that all qualified staff need to attend training in the Mental Capacity Act as it may impact on the home in the future. Ravenswood Nursing Home DS0000062326.V345671.R01.S.doc Version 5.2 Page 18 New staff are provided with a comprehensive induction. The manager and staff were able to demonstrate the induction was being used. Senior Care Staff are responsible for ensuring new staff work through the induction process and ensure that issues relating to safeguarding adults is also covered. Ravenswood Nursing Home DS0000062326.V345671.R01.S.doc Version 5.2 Page 19 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): 31, 33, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is qualified and has the necessary experience to run the home; she is now registered with the CSCI. The manager supports staff training and supervision. The homes quality assurance processes take into account peoples opinions and acts on suggestions made. EVIDENCE: The manager is a registered nurse with 18 years experience in the care of the elderly. She has completed the registration process with the CSCI and is currently half way through the Registered Managers Award. The manager stated that the course had given her plenty to think about especially in areas regarding finances. Ravenswood Nursing Home DS0000062326.V345671.R01.S.doc Version 5.2 Page 20 Both the manager and the provider provided examples of the home’s quality monitoring process. The manager was still awaiting feedback from their most recent quality assessment. It was evident from the development plan set up following the last assessment that both the manager and provider take into account the opinions of residents, relatives and out side professional. The provider has also consulted with an outside quality assessor to ensure a good quality of care provision is maintained. The manager carries out regular supervision with current members of staff. Supervision sessions include looking at working practices and identifying training needs which staff are encouraged to access either in house or through external organisations. Health and safety within the home is generally satisfactory, with very clear risk assessments that all staff were aware of. The fire log was reviewed and showed that all the relevant checks were being carried out appropriately and that all staff had attended training. As previously mention in outcomes for environment an uncapped waste pipe was discussed with the manager as this posed a health and safety risk to both residents and staff. This was dealt with immediately. The home policies and procedure for health and safety and safeguarding residents and staff are regularly reviewed and up dated as necessary. Checks showed that records were up to date and available for inspection. Ravenswood Nursing Home DS0000062326.V345671.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 3 Ravenswood Nursing Home DS0000062326.V345671.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13 (2) Requirement Staff must adhere to the homes policies and procedures for the administration of medication. This refers to:• Creams and ointments must only be used for the person they are prescribed for. • Handwritten entries must be signed by the person making the entry and witnessed. • Only medication agreed on the homely remedies list can be used without GP consultation. Timescale for action 13/08/07 Ravenswood Nursing Home DS0000062326.V345671.R01.S.doc Version 5.2 Page 23 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 OP7 OP14 Good Practice Recommendations Care plans need to identify individual triggers and coping strategies for residents with challenging behaviour. The manager needs to review the internal locked door policy to enable residents to exert choice and control over their lives. The manager needs to consult publications on the appropriate environment for people with dementia. The manager needs to identify ways in which staff can assist residents to personalise their rooms. 3 4 OP22 OP24 Ravenswood Nursing Home DS0000062326.V345671.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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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