Inspection on 19/10/05 for Rayner House

This inspection was carried out on 19th October 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

Rayner House 29/12/06

Rayner House 07/06/05

Rayner House 13/09/04

Rayner House 01/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Rayner House 3-5 Damson Parkway Solihull West Midlands B91 2PP Lead Inspector Amanda Lyndon Unannounced Inspection 19th October 2005 10:00 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 Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 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. Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Rayner House Address 3-5 Damson Parkway Solihull West Midlands B91 2PP 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) 0121 705 9293 Rayner House & Yew Trees Limited Zoe Margaret Collis Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 07 June 2005 Brief Description of the Service: Rayner House is a purpose built care home, which provides residential care for 26 older people. The home, which is a Not For Profit Charitable Trust, is situated in the Damson Wood area of Solihull and is within close proximity to shops, bus stops, doctors surgery and a public house. Accommodation for service users is arranged on two floors which are serviced by a passenger lift, all bedrooms are for single occupancy and provide an en suite toilet and washbasin and are suitable for wheelchair users, with the exception of one bedroom. Rayner House has four bedrooms designated for short stay residents. Also provided are two lounges, a conservatory/activity room, a dining room and three bathrooms fitted with specialist baths and hoists. The home has its own hairdressing salon. The facilities and gardens are well maintained. The Rayner House complex also accommodates a day care facility and Yew Trees sheltered accommodation. Staff at Rayner House, have some responsibility for daily verbal communication with residents at Yew Trees. The day centre and sheltered accommodation were not inspected, as there is no requirement to register these facilities with the Commission for Social Care Inspection. Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was undertaken by one Inspector and was assisted by senior staff as the Registered Manager was not available. There were twenty four residents living at the Home on the day of the inspection and two further residents were in hospital. There was a waiting list of prospective residents waiting to come to live at the Home. Information was gathered by speaking to residents and staff and observing care, medication and health and safety records. This is the second inspection of this service in the 2005/2006 inspection year and linked to the Commission’s focus on outcomes for residents and proportionate inspection, we would recommend that you read this report in conjunction with the last inspection of this service on 07 June 2005. What the service does well: What has improved since the last inspection? Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 Page 6 Individual lockable storage facilities are now available for all residents who choose to self administer their own medication in order to store it safely. Automatic door closures have now been fitted to fire doors which are activated in the event of an emergency, and therefore residents can have their bedroom doors open if they choose. Appropriate hygienic commode pot washers have now been installed and these ensure the health and safety of both residents and staff. Robust systems for the recruitment of staff are now in place and this affords full protection for residents. Staff have received training in respect of the protection of vulnerable adults. 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. Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 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 Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 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 the following standard(s): 2, 3, 4 & 5 Prior to admission, written assessments are not undertaken for all residents and this may result in the home not meeting the needs of these residents. During their stay, residents’ changing care needs are monitored and reassessed and this determines whether their care needs can continue to be best met at Rayner House. EVIDENCE: Each resident is issued with a statement of terms and conditions of residency and this included detail of the room number to be occupied and fees payable. Written assessments were not always available for residents who had previously received short stay care at the Home and were coming to live at the Home on a permanent basis, even when they had not received care at the Home for a long period of time. Prospective residents are, however encouraged to spend a day at the Home in order to ensure that the Home could meet their individual care needs and that they would be happy living there. Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 Page 9 Letters are issued to prospective residents and/or their families confirming that Rayner House stated that they were able to meet their needs prior to coming to live at the Home for a four week trial period. During their stay a the Home, staff arrange for residents to be reassessed by Social and Health Care Professionals should their care needs change. Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, 9 & 10 The care planning system failed to inform staff of the individual care needs of the residents and how these needs are to be met, however despite this, residents are well supported by the staff to meet their health care needs. Improvements were required in respect of the system for the management of medication to ensure that it is administered to residents in a safe manner. Residents are supported in a respectful manner by the staff and this ensures that their dignity and self esteem are maintained. EVIDENCE: Comprehensive assessments of residents’ holistic needs are undertaken on admission to the Home, however further development is required in respect of the care plans that are derived from these. Care plans and personal risk assessments were not always written in respect of the mental health needs of residents and were not always reviewed each month and therefore, did not always reflect the residents’ current care needs and the detail of the specific support required by staff in respect of each care need. They were not always agreed and reviewed with the involvement of the resident and/or their representative. Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 Page 11 Residents’ personal risk assessments had been undertaken including the risk of pressure area care and nutrition, however these were not reviewed regularly. Moving and handling assessments were recorded in poor detail, did not identify any risks specific to the resident and were not reviewed regularly. Risk assessments had not always been written in respect of residents deemed to be at risk of falling. Daily reports included good detail of the activities that the resident had engaged in during that day. Residents have access to Health and Social Care Professionals, for example, Specialist Nurses, Social Workers, Dentists and Chiropodists and residents have the option of retaining their own General Practitioner on admission to the Home (if the GP is in agreement). A comprehensive record of visits to the Home made by Health and Social Care Professionals was kept. One resident said “ The staff get the Doctor for me if I am not well”. Residents were well supported by the care staff to meet their health and social care needs and appropriate pressure relieving equipment was available as required following individual assessment. One resident said “ The night staff check that all is well with you during the night, if you want them to”. Detailed records were maintained in respect of the system for the management of medication, however improvements were required. • The instruction label on a prescription item had worn off and therefore did not include any instructions for administration and did not identify to whom it was prescribed, despite currently being administered by staff. One other prescription label did not identify the dose or frequency of dosage of the medication. The Home’s staff had changed the frequency of dosage of a medication on the medication administration chart (MAR) and had not signed to confirm that this was correct A risk assessment was not available in respect of a resident that had chosen to self administer their own medication Staff drug audits were not available The actual dosages administered in respect of variable doses were not always recorded on the MAR charts Discontinued prescription items were not always clearly identified as being discontinued on the MAR charts • • • • • Residents can request a key for their bedroom door and these can be overridden by staff in the event of an emergency, however a written record of the reasons why it would not be appropriate for individual residents to have a key to their bedroom door was not kept. Staff were interacting respectfully with residents during the inspection. Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 & 14 Residents are able to maintain contact with family and friends with support from the Home’s staff and are able to exercise control over their daily lives and routines which promotes their independence and individuality. EVIDENCE: The Home has an open visiting policy and residents go out of the Home with their families and friends as they wish. One resident said “ We can go out with our visitors when we want to” One resident said “ You can do as you like living here, you can mix with people if you want to or stay in your room if you want to, it’s up to you”. The food provided at the Home had met the required standard at the last inspection and was therefore, not assessed on this occasion. Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 16 The complaints procedure is comprehensive and is accessible to the residents. Complaints from residents and their relatives are dealt with in an appropriate and timely manner. EVIDENCE: The Home had produced a comprehensive complaints procedure and this was on display. The complaints log included a comprehensive record of six complaints received at the Home since the previous inspection. These were of a minor nature and were investigated in an appropriate and timely manner by the Management team. Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 25 & 26 Rayner House provides a homely, clean, comfortable and safe environment for residents to live in. The facilities and equipment available at the Home meet the needs of the residents living there and the staff working there. EVIDENCE: The environment of Rayner House had met the required standards at the last inspection, therefore a full tour of the premises was not undertaken on this occasion. The internal temperature of the Home was found to be comfortable on the day of the inspection and the Home was clean and fresh. Since the previous inspection, appropriate commode pot washers had been fitted to hygienically clean commode pots after use. A hygienic and effective system for the laundry of residents’ personal clothing and bed linen was in place. Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 29 Staff are provided in adequate numbers to meet the needs of the residents with the exception of some incidences of last minute staff sickness and the Home may fail to meet resident’s care needs during these times. The robust recruitment practice ensures that residents are protected. EVIDENCE: Kitchen, laundry, domestic and maintenance staff provide ancillary support to the care staff and a senior member of staff is on duty at all times. The staffing rotas identified that minimum staffing levels were maintained for the majority of the time. During periods of staff sickness, agency staff were not used, however the Home had established a “bank” of temporary staff. One resident said “ All of the staff are very kind and helpful”. Staff recruitment files included all required information and pre employment health declarations had been completed. All staff working at the Home had criminal records clearance and were deemed safe to work with vulnerable people. Job descriptions and contracts of terms and conditions of employment are issued to all new staff. It is recommended that a written record of notes made during prospective staff interviews be kept. Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 Page 16 Staff induction and training had met the required standards at the last inspection. Since the previous inspection staff had received training in respect of the protection of vulnerable adults. Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 & 38 The quality of the service provided at the Home is regularly monitored for quality. All of the equipment used at the Home is checked regularly to ensure that it is safe to use. Staff receive training in a number of health and safety issues and this ensures residents’ safety. EVIDENCE: The management structure, resident consultation, quality of service monitoring, the system for the management of residents’ personal allowances and the supervision of staff had met the required standards at the last inspection. Quality monitoring visits are undertaken regularly by the Registered Provider and Trustees and a report based on the findings of these are sent to CSCI. Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 Page 18 Health and safety checks are undertaken on equipment used at the Home including the fire alarm system, emergency lighting and water tank systems. Since the previous inspection, staff had undertaken training about the safe moving and handling of residents and a fire drill had been undertaken recently. Accident records were found to be fully detailed and well maintained, however it is recommended that an accident log is devised for ease of auditing accidents involving residents living at the Home. Since the previous inspection automatic door closures had been fitted to fire doors which are activated in the event of an emergency. The staff had not informed CSCI of a number of incidents that may have affected the health and welfare of a resident currently living at the Home. Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x x x x x x x 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 x 3 x x x x x 2 Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement Pre admission assessments must be undertaken for all prospective residents receiving short or long stay care at the home prior to each admission. The Registered Manager received this in the form of an immediate requirement 2. OP7 12(1) 15 timescale of 08/06/05 not met The care planning system must be further developed including: Care plans must detail the action which needs to be taken by care staff to ensure that all aspects of the current personal, mental and physical health and social care needs of residents are met. Care plans must be reviewed monthly and a detailed evaluation must be undertaken and recorded and these must be dated. Care plans must be written, agreed and reviewed with the involvement of the resident Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 Page 21 Timescale for action 19/10/05 19/12/05 and/or their representative Personal risk assessments must describe the actual care to be afforded to residents and these must be reviewed monthly to reflect residents current care needs. (time scales of 18/10/04, 10/05/05 and 07/09/05 were not met) Moving and handling risk 15/12/05 assessments must include detail of the action to be taken should a resident fall, the size and type of sling and hoist as required, must be reviewed regularly and identify any specific risks associated with individual residents. (timescales of 18/10/04, 10/05/05 and 07/09/05 were not met) Risk assessments must be written in respect of residents deemed to be at risk of falling Regular staff drug audits must be undertaken before and directly after a medication round to confirm the validity of the MAR charts and to assess staff competence in the safe handling of medicines. Appropriate action must be taken when discrepancies are found. The actual amount of medication administered for variable dosage medications must be recorded on the medication charts. A risk assessment must be undertaken for any residents who self administer their own medication. Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 Page 22 3. OP7 13(4) (5) 4. OP9 13(2) 30/11/05 (timescales of 24/02/05, 10/03/05 and 31/07/05 were not met) (staff drug audits and self administration risk assessments were not available at the time of this inspection) Any hand written amendments to medication dosage instructions on the medication administration charts must be signed and countersigned Discontinued prescription items must be clearly identified on the medication administration charts 6. OP9 13(2) Prescription labels must include clear instructions for medication administration 21/10/05 5. OP9 13(2) 15/11/05 7. OP38 37 The Registered Manager received this in the form of an immediate requirement The staff must inform CSCI of 19/10/05 any accidents and incidents that affect the health and welfare of residents living at the Home. The Registered Manager received this in the form of an immediate requirement Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 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. Refer to Standard OP7 Good Practice Recommendations It is recommended that a separate record for communications between staff and relatives be devised for ease of monitoring the care provided for each resident living at the home. A written record of the reasons why it would not be appropriate for individual residents to have a key to their bedroom door should be kept. Staff should assist residents at mealtimes in a respectful manner. This recommendation was not assessed on this occasion It is recommended that a written record of notes taken during prospective staff interviews be kept It is recommended that an accident log is devised for ease of auditing accidents involving residents living at the Home. 2. 3. OP10 OP10 4. 5. OP29 OP38 Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Rayner House DS0000004518.V258539.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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