Inspection on 12/03/09 for Ravensworth Care Home

This inspection was carried out on 12th March 2009.

CSCI found this care home to be providing an Adequate service.

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

Ravensworth Care Home 15/01/07

Ravensworth Care Home 30/06/05

Similar services:

Hillside

Applegarth

122 Scorer Street

Byars Care Home

St Marys Nursing Home

Jubilee Villa Care Home

Bramble Lodge

Parkmanor Residential Home

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

CARE HOMES FOR OLDER PEOPLE Ravensworth Care Home Markham Road Duckmanton Chesterfield Derbyshire S44 5HP Lead Inspector Susan Richards Unannounced Inspection 12th March 2009 09:00 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 Ravensworth Care Home DS0000062116.V374545.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. Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ravensworth Care Home Address Markham Road Duckmanton Chesterfield Derbyshire S44 5HP 01246 823114 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) maxine_ravensworth_carehome@yahoo.co.uk Ravensworth Care Home Limited Mr Fred Renshaw Miss Maxine Lynette Spray Care Home 26 Category(ies) of Dementia - over 65 years of age (26), Learning registration, with number disability (3), Old age, not falling within any of places other category (3) Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered provider may provide the following categories of service only whose primary care needs on admission to the home fall within the following categories Dementia - DE aged 55 years and over, maximum number of places 20, Old Age, not falling within any other category OP, maximum number of places 3, Learning Disability LD, aged 60 and over, maximum number of places 3. The maximum number of service users who can be accommodated is 26. 15th January 2007 2. Date of last inspection Brief Description of the Service: Ravensworth Care Home is registered to provide personal care and accommodation for up to twenty-six older people, including for up to twenty people with dementia, aged fifty-five years and over and three people with learning disabilities aged sixty and over. Total numbers not to exceed twentysix people. The home is located near a main bus route in the village of Duckmanton, approximately seven miles to the north east of Chesterfield, close to local shops and a pub and with close link to Junction 29 of the M1 motorway. Accommodation is provided over two levels, with a stair lift to the main stairway and with some environmental aids and equipment to assist people who may have mobility problems. There are eighteen single and four shared rooms. There are also a number of communal bathroom and toilet facilities and well-maintained enclosed gardens to the rear of the property providing level and safe access for people. Car parking spaces are provided. People are provided with care and support from a team of care, support and hotel services staff, led by the registered manager and with a high profile in the home from the registered provider. The fees for this home are £345.52 - £364.31 and are determined in accordance with peoples individually assessed needs and as per Derbyshire County Council, placing authority rates. They are subject to review from 01 April 2009. Further information about fees charged and what they cover can be obtained directly from the home. Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. For the purposes of this inspection we have taken account of all the information we hold about this service. This includes our annual quality assurance assessment questionnaire (AQAA), which we ask the home to complete on an annual basis in order to provide us with key information about the service. We also received survey returns from some people who use the service, have an interest in it and who work there. We also received a number of comments from people who use/visit the service. Some of these are referred to below. Staff is lovely, kind and helpful. I like to spend time in my room when I want and staff respect my privacy. I can choose to join activities and staff have helped me to gain confidence to go out more. At this inspection there were nineteen people accommodated. We used case tracking in our methodology, where we looked more closely at the care and services that three people receive. We did this by talking with them, observation of staff interactions with them, looking at their written care plans and associated health and personal care records and by looking at their private and communal accommodation. We spoke with staff about the arrangements for their recruitment, induction, training, deployment and supervision and we examined related records. We also spoke with the manager, who has managed the home for a number of years, about the arrangements for the management and administration of the home and we examined associated records. All of the above was undertaken with consideration to any diversity in need for people who live at the home. At the time of our visit all people accommodated are of British white backgrounds and of Christian religion. What the service does well: People are effectively supported and assisted during their admission to the home and their needs are mostly well accounted for. The home is clean and comfortable and people’s rooms are personalised. Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 6 People are well supported to engage in social, recreational and leisure activities. People can be assured that any complaints and concerns they raise will be taken seriously and acted upon by the home and that they will be protected from abuse. People receive care and support from a staff team, which for the most part is suitable recruited, inducted and trained. The home is openly and reasonably managed and run. What has improved since the last inspection? What they could do better: Develop a pro-active approach to the formal quality assurance and monitoring of their care and service provision. So as to ensure their continuous selfmonitoring and development planning for the home. To measure it’s success in meeting its own aims and objectives, policies and procedures and statement of purpose. Based on a systematic cycle of planning-audit-action-review and internal audit. Provide clearer information about service improvements made and planned in our annual quality assurance questionnaire. That is specific and measurable and objectively determined by way of the above. Ensure that medicines practises consistently adhere with recognised guidance and practise. Review infection control strategy and practises employed. To ensure safe and best practise in respect of those matters as specified in this report. Relating to staff deployment arrangements for the cleaning of the home, transportation of meals around the home and by way of regular staff training and updates necessary. Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 7 Develop systems to promote and account for people’s capacity to make key decisions about their lives, including as to their care and treatment in accordance with the Mental Capacity Act 2005. Ensure that reviews of people’s recorded risk assessments and care plan are regularly undertaken and accounted for. Review and develop menus with consideration to recognised guidance and particularly in respect of choice for people who require soft diets. Undertake and assessment of the premises and facilities with a view to developing the provision of environmental adaptations that may benefit and assist people with dementia in their orientation within the home. Seek to provide better account for choice, where people are accommodated in shared rooms. Ensure that at least fifty percent of care staff hold an NVQ level 2 or above. Ensure best practise when seeking to obtain written references for the purposes of individual staff recruitment. 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. Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1 & 3 (NMS 6 is not applicable to this service, as the home does not provide for intermediate care). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are effectively supported to assist them in their admission to the home and their needs are mostly well accounted for. EVIDENCE: At our last key inspection here we found that the home effectively determined peoples assessed needs. We made a requirement then about the review of records kept relating to people’s risk assessed needs. We saw at this inspection that more frequently recorded reviews of individual risk assessments and care plans had recently commenced with the introduction of the revised format for their recording. Although these were not always Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 10 reviewed at monthly intervals and often with no instruction as to when the next review was necessary. Since that inspection the Commission has approved a registration application submitted from the provider determining a change of service user category to accommodate people with dementia there. In our annual quality assurance completed by the home, they told us that people are not admitted to the home unless their needs are fully assessed and that people receive the information they need to assist them with their admission there. They told us about some improvements they have made since our last inspection, which include a review of their needs assessment and care planning format. They also told us about improvements they would like to make in the coming months. These relate to negotiating with their local authority to ensure they always obtain the key information and agreements they need from them in respect individual contracts for placement at the home. So as to ensure the home are able to obtain these in a timely manner to assist with the admission process. They also provided us with some statistical information that we asked for about the numbers and needs of people accommodated there. At this inspection people told us they were mostly provided with the information they needed about the home, on choosing to live at the home. And we saw that there is a statement of purpose/service user guide provided for people. This provides people with key and comprehensive service information, including details of fees charged and what they cover and the content is regularly reviewed to ensure that the information there is up to date. However, one person told us that there is often no staff available, to escort the relative to hospital appointments. Although information is provided in the service user guide about transport for hospital appointments, there is no guidance regarding staff availability for assistance and escort duty. People also told us that they usually receive the care and support they need. And we saw that their individual needs were overall well accounted for within their recorded needs assessment information. Although they did not include information as to peoples individual capacity to make key decisions about their lives and to consent to their care and treatment, including in respect of their financial affairs. Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 11 The manager advises us that she had recently attended training in respect of the Mental Capacity Act 2005 and some information about this was available in the home. She also advised of the aim to source staff training for this. Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. For the most part peoples’ health care needs are suitably accounted for. Although consistent and best practise is not always assured in respect of the management and administration of peoples medicines, which may not be in their best interests. EVIDENCE: At our last key inspection we found that the home’s care planning and risk assessment procedures generally assisted in promoting people health and welfare. Although we identified that these were not always regularly reviewed and updated, which was raised in their previous inspection report. Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 13 In our annual quality assurance questionnaire completed by the home, they told us that they ensure peoples health care needs are met, including the arrangements for their medicines. And their rights to privacy and dignity are respected at all times. They told us that they aim for continuous improvement by keeping up to date with changing legislation and guidance and in ensuring that staff receive the training they need to assist them in ensuring peoples healthcare needs are met, including in respect of their medicines. And, that people’s privacy and dignity is always upheld. They also gave us some other information that we asked for relating to medicines and nutrition At this inspection people who were able to, told us that usually receive the care and support they need, including medical support and for the purposes of routine health care screening. They also told us that staff listen and act on what they say. During our visit we saw that staff demonstrated a caring attitude and were respectful in their approaches with people. We saw that a revised care-planning format was introduced, aimed at promoting a more person centred approach to care planning and an improved standard of record keeping. For the most part peoples care plans that we saw, were comprehensive and reflective of recognised guidance concerned with the care of older persons. Although, we found that people did not have a care plan in place in respect of their medicines. One of the people we case tracked had no medicines care plan provided in respect of care observations and monitoring requirements that are required due to potential risks that may arise from one of their medicines prescribed. Discussions with staff responsible told us that although satisfactory arrangements were in place for one necessary aspect of their physical health monitoring for this. They were not conversant with those potential risks and possible side effects to observe for or the action to take should these occur. The manager advised that medicines product information leaflets, which include details as to possible side effects, are provided with some medicines supplied, although not all. However, there was no information leaflet in place in respect of this particular medicine. We discussed this with the manager who agreed to take the necessary action to ensure these issues would be addressed with immediacy. When we looked at the homes records for the administration of peoples’ medicines we found that, they did not always provide full personal details of Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 14 the person to whom medicines were to be administered to for identification purposes. Most provided the name and photograph of each person, but did not give details as to their date of birth or of any allergies known or otherwise. The list of staff identifying those responsible for the administration of peoples’ medicine did not provide a signature for some of those staff, including the person who administered medicines to people at our visit. We observed some inconsistencies in practise relating to medicines instructions, including in respect of verbal instructions for changes to these, and in the management of eye drops. This indicates that staff did not always follow the homes policy or the nationally recognised policy and procedural guidance in place at the home, for the management and administration of medicines at the home. We also saw that there was no formally recognised coding system in place for staff to use to record the reasons why a medicine is not given. There is no formal quality assurance and monitoring system in place in respect of medicines systems at the home. (See also management section of this report). The manager agreed to seek to develop this. Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 15 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): NMS 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are well supported to engage in social, recreational and leisure activities. However, peoples’ capacity to exercise personal choice and autonomy within their daily lives is not always best accounted for or promoted. EVIDENCE: At our last key inspection here we found that activities and meals provided were varied and generally met with peoples expectations and preferences. In our annual quality assurance questionnaire completed by the home they told us they ensure flexible routines for people and activities and meals to suit their needs, expectations, preferences and capacities. And, that they promote choice for people to handle their own affairs. They did not specify any improvements they have made or aim to make in respect of these. Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 16 At this inspection some people told us there are always or usually activities they can join and that they usually enjoy meals provided. They also said they can see their families and friends when they wish and who are always made welcome at the home. The activities co-ordinator demonstrated considerable enthusiasm in her role and we saw that information about activities is provided for people on the residents’ notice board and within the service guide. She also keeps a record of activities for each person, including their preferences, engagement and enjoyment. Activities regularly offered include karaoke, a variety of board games, bingo, gentle exercise, hairdressing, facials and manicures, garden, walks, singing, picture games, skittles, reminiscence, cards, music and percussion instruments, crafts and seasonal celebrations and entertainments. There is also a library and the local church provides regular visits and opportunities for worship. One person told us that they enjoy their independence found from regular shopping trips into Chesterfield and also how they were supported to achieve this. We saw lunches being served and teas provided. Some people were able to tell us that they enjoyed their lunch, although food served was not that detailed on the daily menu board. We saw that individually plated meals were taken by staff from the main kitchen to the other end of the home, down a long corridor, passing people bedrooms and bathrooms along the way, on an open trolley and with not plate covers provided, which may not promote best food hygiene and handling. Menus detailed, that there is a choice of breakfast up to 10.30 am, a set main meal at lunchtime and a lighter tea of sandwiches, crisps and cakes. There was no warm alternative stated on the teatime menu, although staff said that people could have a warm alternative at teatime, if they wished such as soup. One service user said they thought that if they asked for a warm alternative this might be provided, but also said they didn’t like to ‘bother staff.’ There were some people accommodated who may not be able to voice a direct request in this respect, due to their given mental capacity. The variety offered at teatime for people who required a soft diet was limited and was said to often comprise of mashed potatoes and other vegetables left over from lunchtime. We spoke with the manager about how they obtain feedback from people about quality of meals provided at the home and found that this is not formally sought (see management section of this report). Although we saw that some information was recorded about people known dietary likes and dislikes and Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 17 the preparation required for their food, such as ‘normal’ or ‘soft.’ And there was a formally recorded trigger tool used to determine peoples individual nutritional risk status and also regular monitoring of peoples body weight. We saw that information was provided for people about advocacy services on the residents’ notice board, although this was not relevant to Derbyshire, referring to Leeds advocacy services and contact details. And although sometimes, information was provided within people’s care records about their personal finances and arrangements. This was limited and did not include any clear information as to their individual capacity to make key decisions about these. (See also Choice of Home section of this report). Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 18 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): NMS 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be assured that any complaints or concerns they raise will be taken seriously and acted upon by the home and that they will be protected from abuse. EVIDENCE: At our last key inspection here we found that management systems assisted in ensuring people were safeguarded and that peoples were assured that. Concerns and complaints were taken seriously and acted upon by the home. In our annual quality assurance questionnaire completed by the home, they told us that people are provided with the information they need to help them to complain. That they ensure all complaints are investigated and dealt with promptly and that people are protected from harm and abuse. They referred to having made improvements in staff induction and training and monthly review processes. But did not specify how this related to this outcome section. They also stated they felt they could not improve further here and said they have received no complaints over the last twelve months. Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 19 At this inspection people told us that they know who to speak with if they are unhappy. One person told us they knew how to complain and another said they did not. We saw there is a written complaints procedure in place, which is displayed and that information about how to complain is provided within the service user guide. Staff that we spoke with was conversant with their role and responsibilities concerned with handling complaints and safeguarding people from harm and abuse. There have been no concerns or complaints raised directly with us about the home since our last key inspection there. The manager had recently attended training in respect of the Mental Capacity Act 2005 and advised that she was seeking training in this area for care staff. Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 20 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, 23 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall, people benefit from a safe, clean and comfortable environment, which for the most part suits their needs. Although more considered environmental adaptations should better assist in maximising the independence of people with dementia. EVIDENCE: At our last key inspection here we found the home to be generally well decorated, comfortable and well maintained. We made one requirement to ensure the provision of dining room chairs that are suitable to meet the Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 21 assessed needs and capabilities of people who live there. We found that this is achieved at this inspection. In our annual quality assurance questionnaire completed by the home, they told us they ensure the environment is clean and hygienic, safe and well maintained by way of an ongoing maintenance programme. And, that they seek to comply with any requirements made by the local Fire and Environmental Health Authority. They also told us they had replaced their dining chairs to ensure these better assisted people and that they aim to continue with the ongoing maintenance and redecoration of the home. At this inspection people told us that the home is usually fresh and clean. We saw that the private and communal areas accessed by people that we case tracked were odour free, clean and comfortable and reasonably decorated, furnished and equipped. Although we saw that some easy chairs in one lounge were old and worn with upholstery torn in some places. And there are a number of old hospital type beds in use. The manager advised that there is no formal written programme in place for the routine maintenance and renewal of the fabric of the premises, nor any measure of identifying any necessary bed or mattress replacement, but advised that these are undertaken where necessary. There was also no formal quality auditing undertaken in respect of the environment that may inform such a programme. (See Management section of this report). We saw that there were some aids to assist people in their orientation, including an orientation board and a large faced clock. And peoples’ bedrooms had their names on the doors in large print and photograph of the person there. However, there were no other environmental adaptations that may benefit and assist in meeting the needs of people with dementia, such as picture signs, adaptations of décor, colour schemes and sensory lighting. People have a choice of lounges, including one to the rear of the home giving access via patio door to a large enclosed garden enabling people to wander safely. Most people are provided with single room accommodation, a few of these have an en suite facility, although not all are in operation and many have a wash hand basin. There are three shared rooms although it was not clear as to how choice of rooms is promoted for people and there was no information in the home’s service guide as to how these are allocated. We saw that there are adequate hand washing facilities provided for staff and a separate laundry facility. Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 22 Since our last inspection there have been outbreaks of infection in the home, which we have been informed about. And the home has asked for advice on controlling the infection from outside NHS staff. Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. People receive care and support from a staff team, which is for the most part, suitably recruited, inducted and trained. Although who may not always be effectively deployed in people’s best interests. EVIDENCE: At our last key inspection here we found that recruitment practises assisted in safeguarding people from harm and abuse and that there was a commitment to staff training. Thereby, supporting staff in their work. In our annual quality assurance questionnaire completed by the home, they told us they ensure staff is effectively recruited, inducted, trained and deployed. They also told us about some improvements they have made and gave us some statistical information that we asked for concerning their staffing arrangements. The latter included that eight out of thirteen staff have achieved at least NVQ 2 in care and with a further two care staff working towards this. Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 24 Their improvements include reducing staff turnover and by way of providing staff with ongoing access to relevant NVQ training. They did not identify any further improvements that they aim to make over the coming months. At this inspection people told us that staff is usually available when they need them and that they enjoy good relationships with staff. We observed staff to be sensitive and respectful in their approaches with people. Staff told us about satisfactory arrangements for their recruitment, induction, training and for the most part, their deployment. Related records that we looked at reflected these. We also found that a further two care staff were due to sign up to commence their NVQ level 2 training. However, we found that there are no dedicated staffing hours provided for cleaning in the home. This meant that care staff can interchange between hotel services and care duties within the same shift. Whilst all areas of the home that we saw were clean and odour free, we discussed the potential risk of cross infection that may arise from staff interchanging roles within the same shift, with the manager. The manager advised that they had sought advice from the infection control nurse since our last key inspection due to ongoing outbreaks of infection. We saw that a comprehensive infection control policy had been developed, which meets with national guidance, but that staff had not undertaken training in this area to date. We have made a requirement about this under the Management section of this report. We also found that for some staff references, obtained for the purposes of their recruitment. That there was no indication as to what capacity the applicant was known to their referee. The Manager had recently reviewed the staff induction process and introduced a revised format to ensure that new staff will receive induction training to revised national training specification standards. Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall home is openly and reasonably managed and run and we are confident the service can affect areas of improvement that we have identified, to people’s benefit and in their best interests. EVIDENCE: At our last key inspection here, we found the home to be well run and in peoples interests, with a strong and approachable management. Thereby assisting in ensuring peoples’ health, safety and welfare. We made two recommendations relating to providing feedback to service users following any formal consultation via satisfaction surveys and annual Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 26 development planning for the home. We found at this inspection that the first is partly achieved, although the latter was not. In our annual quality assurance questionnaire completed by the home, they told us that the home continues to be effectively managed and run in consultation with people. Overall service improvements were indicated as being made via regular policy review, staff training and by involving people who live at the home or who have an interest there. They did not specify any further improvements to be made. They also gave us some, but not all of then statistical information that we asked for relating to this outcome section. Some of the information given therein, relating to the servicing and maintenance of systems and equipment at the home was not up to date. However, with the exception of two areas, we saw at our visit that up to date certificates were provided in respect of these. The manager agreed to confirm the arrangements with the provider concerning the former, to establish that these are up to date. At this inspection people held the manager in high regard and were confident in her management of the home. And we saw that she continually strives to ensure her own personal and professional development. We also found, contrary to information provided in the AQAA, that there were some specific improvements being made and with further aimed for, relating to the promotion of infection control and falls management. These referred to specific advice sought by the home regarding the former, from an outside health care professional. And also recent requirements and recommendations made by the Environmental Health Officer in respect of the latter. Staff told us about satisfactory arrangements for their support and supervision in the home and effective communication systems, providing them with most of the information they need to support people who use the service. The activities person regularly holds group meetings with service users, including consultation with them about aspects of the service. Records of those meetings are kept. A visitors’ questionnaire is also available. However, there are no formal quality assurance and monitoring systems in place for the purposes of service and systems auditing. (We have given specific examples where this would benefit under individual sections of this report). There is also no formalised annual development plan. The home does not handle people’s cash or hold money on their behalf. However, to avoid limiting people’s independence or access to money, they will pay for shopping, travel, lottery and hair dressing costs and they retain Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 27 receipts and send an itemised invoice to them or their representative at regular intervals. People who wish to retain their own personal monies are provided with lockable storage facilities for this in their own rooms, including one of the people we case tracked. Staff described mostly satisfactory arrangements for ensuring safe working practises and individual training records that we saw reflected this, with the exception of infection control training, which is not routinely provided. During our visit we also observed areas of practise, which may not promote best infection control in respect of transportation of meals around the home and staff deployment arrangements for the purposes of cleaning the home. These are detailed within the Daily Life and Social Activities and Staffing sections of this report. Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 28 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 X 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 2 X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 X X 2 Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 9, 15 Requirement For any service user with special or variable medicines instructions, including orders from a GP for administration ‘as required.’ A written care plan must be provided. This must specify clear instructions for staff to follow, including in respect of their administration, health monitoring or any potential care interventions that may be required. So as to ensure that peoples medicines are safely managed and that they are protected from harm. Where any verbal instruction is ordered by a GP in respect of changes of dosage and/or frequency of the administration of a persons’ prescribed medicine(s). These must be correctly recorded directly onto the MAR sheet and also in that persons’ care planning record. (And with both written entries signed and dated by the person writing these and countersigned and dated by a witnessing staff DS0000062116.V374545.R01.S.doc Timescale for action 30/04/09 2. OP9 13, 17 30/04/09 Ravensworth Care Home Version 5.2 Page 30 3. OP15 13, 16 & 23 member). Then home must consult with the Environmental Health Officer to determine safe practise for the transporting of peoples meals around the home. And take any action that may be deemed necessary by them. 31/05/09 4. OP19 16 So as to ensure that any unnecessary risks to people’s health and safety that may arise from current practise are identified and so far as possible, eliminated. Easy chairs that are old worn 30/06/09 and with torn upholstery must be replaced. So as to ensure these are safe and comfortable for people to use. A review of the arrangements for staff deployment must be undertaken with the aim of providing dedicated staff hours for the cleaning of the home that are performed separate to direct personal care duties. So as to ensure suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. A system must be established and maintained for reviewing at appropriate intervals and where necessary, improving the quality of care and /or service provision at the home. So as to ensure continuous selfmonitoring and development planning for the home. For the home to measure its success in meeting its own aims 5. OP27 13, 18 31/05/09 6. OP33 24 30/06/09 Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 31 7. OP38 13 and objectives, it policies and procedures and statement of purposes. Staff must receive regular training updates in respect of infection control. To ensure that staff is conversant with and translate policy into practise so as to promote good infection control practises. 30/06/09 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. Refer to Standard OP1 Good Practice Recommendations Information should be provided within the Service User Guide relating to that already stated there as ‘Fees – What’s included and what is not.’ As to the home’s policy on providing a staff escort or otherwise for service users hospital appointments. NMS OP14 also applies here. Consideration of people’s individual capacity to make key decisions about their lives, including in respect of their personal finances and to consent to their care and treatment should be included in their needs assessment (and where necessary, their care planning) records in accordance with the principles of the Mental Capacity Act 2005. Risk assessments and care plans should be reviewed at least at monthly intervals. For exceptions where it is deemed safe to set a review following a longer time period. The date of the next review should be identified in advance. So as to ensure that these are undertaken in a timely manner. Recognised and up to date product information, as provided for example the British National Formulary for Medicines, should be provided for relevant staff in respect DS0000062116.V374545.R01.S.doc Version 5.2 Page 32 2. OP3 3. OP3 4. OP9 Ravensworth Care Home 5. OP9 6. 7. OP9 OP9 8. OP9 9. OP9 10. OP15 11. OP22 12. OP23 13. 13. OP28 OP29 of all medicines kept at the home, including for their use, possible side effects and contra-indications. Personal details recorded on the front of peoples medicines administration record (MAR) sheets should always include their full name, date of birth (alongside their photographs there) and details of any known allergies or otherwise that may be relevant to their medicines administration. So as to best ensure their correct administration. A full list of staff signatures and initialling sign should be kept for all staff responsible for administering peoples’ medicines. So as to ensure a clear audit trail. Medicines instructions recorded on the MAR sheet in respect of any persons medicines to be administered as required should always detail a maximum dose not to be exceeded within any twenty four hour period. A recognised coding system should be introduced for use by staff on the medicines administration record (MAR) sheet. For the purposes of clearly identifying the reason why a medicine has not been administered to a service user as prescribed. A formal quality assurance and monitoring system should be introduced for the regular auditing of medicines systems and practises at the home. So as to provide an effective measure as to the home’s success in complying with recognised medicines policy and procedural guidance and to promote best practise. Menus should be reviewed and developed, particularly in respect of choice for people who require soft diets, in accordance with recognised guidance. Such as the Caroline Walker Trust (2004), Eating Well for Older People, 2nd edition. (Further info can be found on www. cwt.org.uk). An assessment of the premises and facilities should be undertaken with a view to developing the provision of environmental adaptations that may benefit and assist people with dementia in their orientation within the home. Arrangements to promote peoples choice for shared or single room accommodation should be specified within the home’s service guide and accounted for within their care plans. And where people are accommodated in a shared room, this should be regularly reviewed with them with an offer of a single room when one becomes vacant. A minimum of 50 of staff should hold at least an NVQ level 2 in care. For written references obtained for the purposes of staff recruitment. The actual capacity the applicant is known to the referee should be established and recorded. So as to ensure they effectively inform as to the applicants DS0000062116.V374545.R01.S.doc Version 5.2 Page 33 Ravensworth Care Home 13. OP33 suitability for employment at the home and include one that is from their most recent employer. An annual development plan should be in place for the home, based on a systematic cycle of planning-actionreview and internal audit, (preferably by way of a professionally recognised quality assurance system). Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Ravensworth Care Home DS0000062116.V374545.R01.S.doc Version 5.2 Page 35 - 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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