Inspection on 29/12/06 for Rayner House

This inspection was carried out on 29th December 2006.

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 19/10/05

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 Elizabeth Mackle Key Unannounced Inspection 29 December 2006 09:30 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.V315232.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. Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 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 0121 705 9011 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.V315232.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th October 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. The current scale of charges for the home is £337 – £366.50. Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report reflects the finding of an unannounced fieldwork visit conducted over the course of one day by one inspector. During the visit the inspector was assisted by one senior officer from the home in the morning, and by the registered manager in the afternoon; both were helpful, approachable, and informative. Prior to the visit a substantial amount of written information had been submitted by the home; this included a pre-inspection questionnaire completed by the manager which provided information about the home, residents and staff. Ten completed questionnaires had been received from relatives/visitors and the comments received were all favourable. Fourteen residents had returned completed questionnaires, and the majority of the comments were complimentary about life at the home. One resident commented that there were not enough activities available. At the time of the fieldwork visit there was evidence that a good range of activities are provided but this is not always reflected on the activities programme. Six visiting health and social care professionals had returned completed questionnaires. All comments were very favourable in respect of the home, and no concerns were expressed. Information was also gathered on the day of the visit by speaking with four residents and five staff members in addition to the manager, and staff were observed performing their duties. Communal areas in the home, and a number of bedrooms were viewed. The care records of five residents were sampled, the files of three staff, and a range of other care and health and safety documentation was viewed. What the service does well: Staff turnover at the home was low and this was very good for continuity of care of the residents. The residents spoken with were very happy with the service they received, and felt safe, secure and well cared for. The home’s own staff “bank” helped to ensure continuity of staff at times when permanent staff were not available, and meant that residents were usually cared for by staff who were familiar to them. Comments from residents included: “The staff are very helpful, exceptional”. “I am very happy with the laundry system….it usually comes back the same day”. “They’re all very helpful”. Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 6 Residents were very happy with the standard of catering provided in the home. The menus and observations made during the course of the visit evidenced that the menu was interesting and varied; choices were available, and the food was tastefully presented. Residents looked forward to mealtimes. One resident commented: “The food is excellent; you are given a choice and the variety is great”. The residents enjoyed an attractive and homely environment which was clean, comfortable and well maintained. Residents were treated with respect and courtesy and their right to privacy was upheld. There were no rigid rules or routines in the home and residents were able to spend time as they wished. A number of activities were available for residents who wished to participate. Residents were aware of how to make a complaint, and this helped ensure they felt they would be listened to and action taken as appropriate. The systems in place for staff recruitment and adult protection helped to ensure that residents were safeguarded. The views of residents were actively sought, and this helped them to feel they had control over their lives. What has improved since the last inspection? What they could do better: Care planning and record keeping needed to be strengthened in order to ensure that the needs of residents are identified and planned for. A number of written records viewed had not been signed or dated by the member of staff who had completed them. Care plans had not been developed for some more Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 7 recently admitted residents. The care plans viewed were not specific enough in relation to the care needs identified, and how staff were to meet the needs. Risk assessments carried out in relation to falls, and moving and handling lacked detail about how to minimize the risk, and how it was to be managed, in order to safeguard residents. Care needed to be taken to ensure that all medicines were kept securely locked, in order to safeguard the welfare of all residents. A system of providing staff supervision needed to be re-established to ensure that staff received support and guidance in their roles. 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.V315232.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 Rayner House DS0000004518.V315232.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The information available to prospective residents is sufficient to enable them to reach an informed decision about whether the home will be able to meet their needs. Prospective residents were able to spend some time in the home, and this meant they were able to have some knowledge of what it was like to live there, before deciding to move there. EVIDENCE: The home had a Statement of Purpose that included all necessary information and was available in the reception area of the home; this included information about the organisational structure, with names of staff, their roles and qualifications. Information about the home and services and facilities were also given, together with advice on the application and admission procedure. The Service User Guide was produced in a clear format that was easy to understand, and included information about the scale of fees, together with Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 10 good quality photographs in colour of some bedrooms and communal areas in the home. Neither of the two documents had been produced in large print, audio tape, or other suitable formats for people with poor eyesight, although the manager stated this could be made available if required. It is important that potential residents with poor eyesight have equal access to information about the home and this needs to be available without having to wait for it to be produced. The copy of the Commission for Social Care Inspection Report provided in the reception area of the home was not the most recent one; however it was clear from the Statement of Purpose that the last CSCI report was also available upon request from the Manager or Administrator. The pre-admission assessment documents for three more recently admitted residents were sampled. There was evidence that the home’s own preadmission assessment form had been used, and this included information on the physical and psychological health of the prospective resident. In the case of one resident there was no pre-admission assessment on file. The documents had not been fully completed in all cases. It is necessary to conduct a comprehensive assessment, and keep records of this, to ensure that the home will able to make an informed judgement about whether the care needs of prospective residents can be met. Intermediate care is not provided by the home. Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to the service. The quality of care planning and risk assessments were variable, leading to potentially poor outcomes for some residents. The arrangements for the storage of medication needed to be more robust to ensure that residents were not placed at risk. Residents were cared for in a respectful manner, ensuring that their dignity and self esteem were maintained. EVIDENCE: The home was in the process of changing to a new system of keeping care records, and this exercise had not been completed at the time of the visit. From the care records sampled, it was clear that a good deal of useful information in relation the resident’s physical and psychological health was being collected. However, in the care plan documents, it was not clear what the nature of the care need was and how this was to be met by care staff. In order to ensure that all care staff have the necessary information to care safely Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 12 for each resident, it is essential that the system of care planning sets out clearly what the care need is and how exactly that care need is to be met. There was little evidence of regular review of the documentation, and changes in the residents’ condition were not always recorded; for example, in the case of one resident who had developed a skin condition some two weeks earlier, there was no record of this within the care plan, or of how the care needs relating to this condition were to be met. One resident admitted to the home one week before the fieldwork visit did not have a care plan. Requirements in relation to care planning have been made at previous inspections. It was concerning to note that risk assessment documentation had been completed, with information drawn from the pre-admission assessment document, before the resident was actually admitted to the home. There was no evidence that this had been reviewed or revised in consultation with the resident or their representative when they were admitted to the home. It is essential that risk assessments reflect the resident’s current condition, they should be completed with the involvement of the resident, or his/her representative, and should not be completed in advance of the resident’s admission to the home. Risk assessments were being carried out, for example, in relation to falls, continence, moving and handling, but there was no information about how the risk was to be managed and minimized even when this was identified as “high” risk. It was concerning to note that many of the entries in care records had not been signed or dated by the member of staff completing them. It is important that the care records should be able to demonstrate the care that a resident has received, and all entries in the records should be appropriately signed and dated. Daily notes were kept in relation to each resident, and indicated the general condition of the resident and any activities they may have taken part in that day. A system had been devised for recording communications with relatives, but this had been used for only a short time, and there was no evidence that any record was kept of discussions with relatives. Residents had access to a range of other professionals as required, such as district nurse, general practitioner and chiropodist, and separate records of these visits were maintained giving brief information of the intervention and outcome of the visit. The system for the management of medication was robust, and a good working relationship had been built up with the supplying pharmacy in order for an effective system to be in place. Regular audits were carried out both by the Registered Manager and pharmacy staff, and it was reported that the number of errors had reduced. All staff responsible for the administration of medication had received basic training in relation to this; two senior staff had completed a Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 13 more in-depth course run by a local college, and two staff were in the process of doing the course. Two residents were taking responsibility for their own medication, which ensured that their independence was promoted. Staff were auditing these arrangements monthly to ensure that medication was being taken as prescribed. The medicine administration records of three residents were sampled and found to be generally in order. One medication identified on a medicine administration record (MAR) was recorded as being administered by a staff member on a day when the resident was actually out on leave. Written records of all medicines returned to pharmacy were maintained; however medication awaiting collection by the pharmacy was being stored in an unlocked cupboard. A selection of tablets and eye drops brought into the home by a recently admitted resident were found in her room, and these should have been removed and safely stored. In the room of another resident a steroidal crème was not being securely stored; it was pointed out that medication must be kept securely locked at all times in order to safeguard residents who may be at risk. Medicines were given at times to suit the individual resident as far as possible. Records were also maintained of any medication taken out of the home, for example, if a resident was going out for the day with relatives. Staff were observed to be assisting residents in a sensitive and respectful way, and to knock before entering residents’ rooms, and this helped ensure that their privacy and dignity were preserved. Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The range of social activities provided in the home helped to enhance the quality of life for the residents. The dietary needs of residents were well catered for with a balanced and varied selection of food available that met their needs and tastes, and preserved their dignity. EVIDENCE: There was a variety of activities on offer for residents to participate in both in – house and outside of the Home, and records maintained of all activities residents had taken part in, and visitors they had received. The activities programme on display did not always reflect the amount of activities available; it is important that residents are aware of what activities are on offer so that they can decide if they wish to take part. One resident said “we do have piano playing and singing, and a lady who takes us for exercises”. On the day of the fieldwork visit there was a pianist/singer was conducting a musical session in the home, and many of the residents were enjoying this. Residents spoken with said they were able to exercise control over how they spent their day, and were happy with the activities offered in the home. The home had a very Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 15 pleasant conservatory which was spacious and bright; this area was used for art/craft sessions twice weekly, and for other activities as required. The home had a well equipped hairdressing salon, and a regular hairdresser who attends the home once week. In addition residents were free to make arrangements for their personal hairdresser to come in to the home, and the salon was also available for their use. Residents had opportunities for religious expression, and a service of Holy Communion was held once a month. Although this service was taken by a Church of England minister, it was open to all denominations if they wished to attend. A Roman Catholic priest also attended the home regularly and Holy Communion was administered once a month. There were no residents from non-Christian faiths in the home at the time of the fieldwork visit, but the manager said they had in the past been able to ensure that residents from other faiths had access to the relevant religious bodies. There was an open visiting policy and visitors were made to feel welcome. There were no rigid rules or routines at Rayner House and residents were able to go outside of the Home with their friends and families as they chose which was important to maintain their independence and individuality. One resident said “I went to stay with my family at Christmas and enjoyed it very much.” The home had good links with Solihull College, and offered work experience to 6th form Health and Social care students who attended the home for one week, then one day a week for a period of time. The students work under supervision helping with tasks such as serving teas and engaging residents in conversation. Young people undertaking the Duke of Edinburgh award in Community Service also spend time in the home talking with residents. The home had good links with a local primary school and offer the opportunity for 10 and 11 year olds to come in to the home to learn aspects of health and social care, to help them with career choices. It was reported that the residents very much enjoyed the opportunities to spend time with younger people. The arrangements for catering were looked at, and discussions held with the cook who displayed a good knowledge of the individual needs of residents, including those with allergies and special diets. Weekly menus identified a variety of wholesome and nutritious meals and alternatives to these were available. Fresh produce was bought from a local butcher and greengrocer, and most of the cooking was done on the premises. Supplies appeared to be plentiful and it was pleasing to note the wide selection of fresh vegetables and fruit available. Visitors were also able to have a meal if they wished, for a small charge, and this meant that residents and their visitors were able to eat together if they wished. Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 16 There were facilities in the home for residents to make snacks and drinks once a risk assessment had been carried out, and this promoted independence. Breakfast times were flexible, and this meant that residents could exercise choice over when they wished to eat. One resident said “I like to go downstairs for breakfast and lunch but I prefer to have my evening meal in my room.” The lunch time options on the day of the visit were fish, chips and peas or sausages and mash. The meal was relaxed and unhurried, with kitchen staff serving food from the adjacent kitchen. The dining room was spacious, pleasant and comfortable with tables attractively laid; condiments and a choice of drinks were available at each table. Chipped potatoes and other vegetables were placed in serving dishes on each table so that residents could serve themselves the amount they wished. This promoted the dignity of residents and ensured that it was easy for them to have extra helpings if they wished. There were adequate numbers of staff on duty and assistance was given in a discreet way. Staff were on hand to assist some residents to cut their food into small pieces, and the food could also be liquidized if necessary. Residents were observed to be enjoying the meal and also the opportunity to socialize with each other. One resident said, “The food is excellent. “You are given a choice – the variety is great”. Special diets could be prepared for reasons or health, taste or religious/cultural preferences. Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 17 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, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home had a robust system for handling complaints, and this helped ensure that residents were protected and felt that their views were listened to and acted upon. EVIDENCE: The complaints procedure was on display in a prominent position in the home and included all relevant information. Four complaints had been made directly to the Home since the last field work visit. The complaints register contained a summary of each complaint and demonstrated that these had been investigated by the management team in a timely and appropriate manner. No complaints had been received by CSCI since the last fieldwork visit. Residents were reminded at meetings how to make a complaint if they wish to, and this helped ensure that they were aware what to do about any concerns they may have. The home had recently revised the policy on Protection of Vulnerable Adults, and this was available together with a copy of Solihull multi-agency guidelines, although copies of the previous policy were also found on file. It is important that any policies no longer in use are removed from the file, and that staff are made aware of the contents of any new policy, in order to avoid confusion. The new policy needed to be more specific about what staff were required to do in the event of any allegation of abuse, for example, it should make it clear Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 18 that an internal investigation must not take place, and that an “Adult Protection” referral must be made to Social Care and Health. A number of staff had recently undertaken training about the protection of vulnerable adults and this safeguards residents. Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 19 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): 19, 20, 23, 24, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home provided residents with a pleasant, well maintained, and homely environment which helped ensure that residents were comfortable, secure and safe. EVIDENCE: The internal environment of the home was very bright and pleasant and well maintained. The reception area of the Home was warm and inviting with a variety of photographs and certificates clearly displayed. Throughout the home the standard of floor coverings, decoration, furnishings and fabrics was good. The home was clean and bright, providing a comfortable, homely environment for residents. Two lounges on the ground floor were homely in style and tastefully furnished with ornaments, pictures, a large face clock, fish tank, piano, a selection of books/magazines, and compact disc player, radio etc. This helped ensure that Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 20 residents take an interest in their surroundings, and have opportunities to socialize and engage in activities of their choice. There was a pleasant courtyard/garden area for residents to enjoy in warmer weather. This was well maintained, easily accessed and was suitable for wheelchair users. A passenger lift was provided to the first floor. The home provided a well equipped and fully self-contained flatlet for guests which allowed relatives/friends to stay for short periods of time. This popular facility was shared with Yew Trees (sheltered accommodation); the home operated a booking system and a small charge was made for use of the flatlet. It was used mainly by people who had to travel long distances to visit a resident. Residents appreciated being able to offer relatives/friends an opportunity to stay at the home, and this helped them to feel more in control of their lives. Bedrooms were spacious and had been personalised to reflect the interests, and tastes of individual residents so that they were comfortable in their surroundings. Each room had an en suite toilet and wash-basin. There was ample storage within the bedrooms for residents’ belongings and a lockable storage facility was provided in each bedroom for the safekeeping of valuables and items that residents may wish to keep private. A staff call/intercom system was provided in each bedroom and also by way of a pendant worn by some residents who were more frail. This enabled staff, who carried a pager, to identify which resident had called, and staff could also “page” and communicate with residents in their rooms. The temperature within the Home was comfortable on the day of the visit. There were suitable sluicing facilities available and an efficient system for the cleaning of residents’ personal clothing and bed linen was in place. One resident said, “I am very happy with the laundry system – it comes back the same day”. A sterilizing unit was available for dealing with commode pots, and hygienic hand washing facilities were appropriately located throughout the home. Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 21 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, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Recruitment procedures were robust, helping to ensure that residents were protected. Staff had good access to training, helping to ensure that they were able to meet the individual needs of residents in a competent manner. EVIDENCE: There were no staff vacancies at the time of the field work visit and duty rosters demonstrated adequate numbers and skill mix of staff at all times. The home had it’s own “Relief Bank” of staff and this was helpful in providing residents with a good degree of continuity in the event that permanent staff were not available for any reason. Agency staff were not used. One resident said, “The staff are very helpful – very good – exceptional”. Another resident said, “They are all very helpful.” The home had robust arrangements to ensure that there was a manager “on call” to support staff out of hours. A senior staff member was rostered to “sleep in” overnight, seven days a week; this person provided support and advice to Rayner House staff, and was also available in the event that help was needed by any of the residents in Yew Trees (the adjacent sheltered accommodation). Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 22 Staff recruitment files sampled contained all information required by regulations. All staff working at the home had had the necessary checks carried out before commencing employment and this helps ensure that residents are protected. The application form in use did not require the applicant to give the name of the most recent employer if the period of employment was less than three months. It was pointed out to the manager that requiring applicants to state the last employer is good practice, and provides further safeguards for residents. In keeping with good employment practice, notes were kept of the interview process. New staff were issued with a contract of terms and conditions of employment and these were signed by staff as confirmation that they agreed to the content. New staff undertake in house induction foundation training and this included health and safety and personal care training so that staff had the appropriate knowledge to work in a competent manner. During the previous twelve months staff had undertaken a variety of training relevant to their job roles, and these had covered areas such as: Infection control, Abuse, Moving and Handling, Food Hygiene, First Aid, Pressure area care, Incontinence, Death and Bereavement, and National Vocational Qualifications (Care) levels 2 and 3. Future training was planned and this included: Health and safety, Assessing Risk and Sight Loss and its Effects. The home had good access to training provided by “Solihull Partners In Care Training”, and was also liaising with other homes locally to co-ordinate the purchase of training for their combined staff needs. 70 of staff had completed NVQ Level 2 in care qualification and two staff members were currently working towards NVQ Level 3 to ensure that they had the appropriate knowledge and skills to work competently with residents. Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 23 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): 31, 32, 33, 35, 36, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents benefit from a well run home. There were systems in the home for obtaining the views and opinions of residents, and for monitoring the quality of the service offered; these helped ensure that residents felt they had a voice, and that there was a culture of continuous improvement which enhanced the lives of residents. EVIDENCE: The Registered Manager had been in post for a number of years and had had training opportunities provided to assist her to further develop her managerial skills. It is recommended that opportunities are explored for the manager to Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 24 have more possibilities to “network” with other registered managers for the purposes of mutual support, exchange of ideas and to share good practice. Mechanisms were in place for consultation with residents. Regular meetings were held with the resident group, and recent minutes demonstrated that residents views were sought, and that they were informed about a range of topics, including what events were planned, how to make a complaint, and the forthcoming CSCI inspection. The minutes, which were informative, were produced in large print which meant they were accessible to residents with poor eyesight. Quality monitoring visits were regularly undertaken by the Registered Provider and Trustees, and reports of these forwarded to CSCI. The Registered Manager and other staff reported very good working relationships with all the Trustees whom they felt were supportive and approachable. One member of staff said, “It’s a good place to work. “Everyone gets on well, from the Trustees through to residents and staff”. A “Quality of Services” survey was carried out annually, and information from this was collated and analysed in order to assist the management team in planning service changes. Residents were given feedback about the outcome of the survey at meetings, and written information was also posted on the notice board. There was some evidence that staff meetings were held, but minutes of these were not always produced, which meant that there was no record of what was discussed. The staff did not manage the personal finances of residents and this was the responsibility of the residents’ families. A small amount of money was held securely in the home for residents’ day to day expenses such as hairdressing, newspapers. All expenditure was signed for by two people (either the resident and one staff member, or two staff members), and receipts are kept; access to this money is strictly limited. The system for ensuring that staff received regular supervision had lapsed, and needed to be reintroduced in order that staff received adequate support and guidance. Health and safety checks of equipment used at the Home were undertaken in order to safeguard residents; this included the fire alarm system, emergency lighting, water heating and check for Legionella. Accident records were maintained and up to date, and a system to assist with the auditing of accidents had been introduced. All staff had been issued with information booklets about the fire procedure, and regular fire appliance training sessions and fire drills were carried out, and these arrangements helped to ensure the welfare of residents. Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 25 More care needed to be taken to ensure that medications are kept securely locked in order to ensure that residents were not placed at risk of harm (this is discussed in more detail on Page 14 of this report). Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 26 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 2 X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X X 3 3 3 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 3 3 X 3 2 3 3 Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 27 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. Standard 1 OP1 Regulation 5 Requirement The registered manager must ensure that the service user guide is made available in a format suitable for intended residents. The registered manager must ensure that a copy of the most recent CSCI inspection report is available in the home. The registered manager must ensure that pre-admission assessments are carried out on all prospective residents, documented and signed by the person conducting the assessment. Timescale for action 01/04/07 2 OP1 16 01/02/07 3 OP3 14, Sch 3 (1)(a) 01/03/07 Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 28 4 OP7 12(1) 15 The registered manager must ensure improvements in care planning as follows: Each newly admitted resident to the home must have a plan of care generated from a comprehensive assessment, and drawn up if possible with the involvement of the resident or his/her representative; The care plan must clearly show what the care needs of the resident are, both current and longer term, and how these are to be met by staff; Care plans must be signed and dated; Care plans must be reviewed monthly and a detailed evaluation must be undertaken and recorded and these must be dated. Requirements in relation to care plans are outstanding from previous inspections (time scales of 18/10/04, 10/05/05 and 07/09/05, 19/12/05 not met) 01/04/07 Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 29 5 OP8 13(4) (5) 6 OP9 13(2) 7 OP18 12,13 8 OP29 19(1)(a) (c) 9 OP36 18(2) The registered manager must ensure that moving and handling risk assessments include details 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. Risk assessments must indicate how the specific risk is to be minimized or managed. Requirements in relation to risk assessments are outstanding from previous inspections (timescales of 18/10/04, 10/05/05 & 07/09/05 were not met). The registered manager must ensure that arrangements are made for the safe storage of all medication. The registered manager must ensure that the home’s adult protection policy is revised to reflect that in the event of any allegation of abuse, an “adult protection” referral must be made to Social Care and Health. The registered manager must ensure that the home’s job application form requires applicants to state their most recent employer. The registered manager must ensure that care staff receive formal supervision at least 6 times a year. 01/04/07 01/02/07 14/02/07 01/06/07 01/05/07 Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 30 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 OP7 Good Practice Recommendations It is recommended that all senior staff receive refresher training in individual care planning and risk assessment. 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. This recommendation was not assessed on this occasion. It is recommended that a notice is placed in first floor sluice room stating that the large sink is for hand-washing, and not for sluicing. It is recommended that the registered manager is encouraged to “network” with other managers for mutual support and to share good practice. It is recommended that Minutes of staff meetings are maintained so that there is a record of matters discussed. 3 OP10 4 5 6 OP26 OP31 OP37 Rayner House DS0000004518.V315232.R01.S.doc Version 5.2 Page 31 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.V315232.R01.S.doc Version 5.2 Page 32 - 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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