Inspection on 27/10/05 for Rayners Residential Care Home

This inspection was carried out on 27th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Rayners Residential Care Home 13/04/07

Rayners Residential Care Home 22/02/06

Rayners Residential Care Home 16/02/05

Rayners Residential Care Home 17/09/04

Rayners Residential Care Home 21/08/02

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Rayners Residential Care Home Weedon Hill Hyde Heath Amersham, Bucks. HP6 5RH Lead Inspector Christine Sidwell Unannounced 27 October 2005 at 9.30am th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rayners Residential Care Home 20052710 Rayners X00015 UI Stage 5 S23014 V250264 H53.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Rayners Residential Care Home Address Weedon Hill, Hyde Heath, Amersham, Bucks, HP6 5RH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01494 773606 Rayners (Extra Care Home) Limited. Christopher Matthews and Jeanne Matthews Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (OP) of places Rayners Residential Care Home 20052710 Rayners X00015 UI Stage 5 S23014 V250264 H53.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 16.02.05 Brief Description of the Service: Rayners (Extra Care home) is family owned and managed. The home was purpose built in 1990 for the care of older people within the county of Buckinghamshire. The home is situated in Hyde Heath, a Chiltern Village two miles from Amersham. The local amenities include a village store, public house and an attractive green. Access to the local town would be via the homes minibus. The home is registered for the care of forty-four older persons, not falling into any other category. The home has forty-four spacious single bedrooms a large percentage of which have en-suite facilities. All bedrooms have a hand washbasin and are in close proximity to toilet and bathing facilities. The second floor of the home is accessible via a five-person passenger lift. Communal space consists of a large lounge and dining area, which are both set in a homely and attractive fashion. A large glazed area opens out onto the terrace and landscaped gardens. The front entrance of the home is welcoming and contains a small seated area for the use of visitors. Rayners Residential Care Home 20052710 Rayners X00015 UI Stage 5 S23014 V250264 H53.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of the unannounced inspection, which took place on the 27th October 2005. Care plans, medication records, recruitment files and other records were examined. Care practices were observed. The managers, and some of the staff who were on duty at the time were spoken to. The views of four residents were sought and the care of two residents was tracked. The focus of the inspection was to assess the progress towards compliance with the requirements made at the last inspection, to assess whether the home is able to meet resident’s healthcare and related needs and whether there are sufficient staff with the necessary skills and training to meet resident’s needs. What the service does well: What has improved since the last inspection? The requirements made at the last report that fire doors are not propped open have been complied with and hold open devices connected to the fire alarms are now in place. Rayners Residential Care Home 20052710 Rayners X00015 UI Stage 5 S23014 V250264 H53.doc Version 1.40 Page 6 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. Rayners Residential Care Home 20052710 Rayners X00015 UI Stage 5 S23014 V250264 H53.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Rayners Residential Care Home 20052710 Rayners X00015 UI Stage 5 S23014 V250264 H53.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none These standards were not assessed at this inspection but have been met or almost met at previous inspections. EVIDENCE: Rayners Residential Care Home 20052710 Rayners X00015 UI Stage 5 S23014 V250264 H53.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8,and 9 The care plans generally give carers the information that they need to care for residents. Risk assessments should be individualised if they are to provide adequate guidance as to the way in which risk can be minimised for individuals. Resident’s healthcare needs are generally met, with evidence of multiprofessional working. The medication administration systems generally work well ensuring that residents receive their medication in a timely way. Residents would be further protected by recording all controlled drugs in a Controlled Drugs Register and by seeking advice from the Diabetes Nurse Specialist regarding insulin administration. EVIDENCE: Three care plans were selected at random. They contained evidence that residents had been assessed before they moved to the home. The demographic details were completed and all had clearly identified next of kin with contact numbers. There was a plan of care for each resident, which described the routine daily care needs for each resident. Generic risk assessments were in place. Developing individual risk assessments was a Rayners Residential Care Home 20052710 Rayners X00015 UI Stage 5 S23014 V250264 H53.doc Version 1.40 Page 10 requirement of the last report and progress has been made to implement these. There is a need, however, to ensure that standards templates are individualised to ensure that residents have risk assessments that are relevant to them and applicable to their care. There is also a need to ensure that the risk assessment is in line with any guidance that may be available from the Medicines and Healthcare products Regulatory Agency (MHRA). Carers had signed and dated the daily entries. The plan had been reviewed on a monthly basis and in two cases the resident had signed the care plan at this review. The residents seen were well groomed and had had their hair dressed. One resident said that staff helped her to do as much as she could for herself. The manager said that no resident had pressure damage although one resident had left hospital with pressure damage, which had now healed. There was evidence that appropriate mattresses for the relief of pressure are available. The district nurses assess those resident’s who may have continence problems and provide the appropriate aids. The residents said that there were opportunities for activity. At the time of the inspection several residents were seen to be walking in the garden with a carer and a physiotherapist was holding an exercise class to the obvious enjoyment of those participating. There is no formal nutritional screening tool. The manager said that sitting weigh scales are available and that normally residents would be weighed on admission or if there were concerns about possible weight loss. It is recommended that the care plan format is amended to include an assessment of nutritional status and that, following assessment, it is agreed how often individual residents should be weighed. There was evidence in the care plans that residents see the chiropodist and optician regularly. Residents are able to remain with their own General practitioner if they wish and a number of doctors visit the home regularly. There are medication policies and procedures in place. Records are kept of medication that is received and returned by the home. Individual residents medication administration charts were signed correctly. There is a Controlled Drug Cupboard in which controlled drugs are stored. Temazepam is stored as a controlled drug although its administration is not recorded in a controlled drugs register. Although this is not a legal requirement it is recommended as good practice. All other controlled drugs should be recorded in a controlled drugs register. The senior carers who administer medication have undertaking training. Two residents manage their own medication and policies to govern this are in place. The district nurses currently draw up insulin a week at a time for two residents who administer this themselves. The drawn up insulin was not stored in the medication refrigerator at the time of the inspection. It is a requirement of this report that the advice of the diabetic nurse specialist from thePrimary Care Trust (PCT) is sought as to whether this is the best way for these residents to receive their insulin. Rayners Residential Care Home 20052710 Rayners X00015 UI Stage 5 S23014 V250264 H53.doc Version 1.40 Page 11 Rayners Residential Care Home 20052710 Rayners X00015 UI Stage 5 S23014 V250264 H53.doc Version 1.40 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 standard(s) 15 The meals are varied, nutritious and well cooked, meeting resident’s nutritional and social needs. EVIDENCE: There is a four-week menu plan, which the chef said was changed four times a year. Residents have a choice of main meal. Breakfast was taken in the dining room or on trays in their rooms. Fresh fruit juice was offered as well as cereals, toast and tea. The menu was varied and the dining tables laid up attractively. Lunch was seen to be a pleasant and communicative time. Lunch on the day of the inspection was roast lamb and vegetables and was well cooked. The residents spoken to said that the food was always of a high standard and that they had a choice and could always ask for an alternative if they wished. Two family members were dining with their mother on the day of the inspection. Tea and cakes are provided during the afternoon and a cooked supper in the evening. There is an evening snack and hot drink for those who would like one. The chef has been at the home for six years. The kitchens have recently received the Chilton District Council Environmental Health ‘Gold Award’ for food safety. Rayners Residential Care Home 20052710 Rayners X00015 UI Stage 5 S23014 V250264 H53.doc Version 1.40 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 standard(s) 16 and 18 The home’s complaints and protection of vulnerable adults policies should protect residents and give them the opportunity to raise their concerns and have them addressed. EVIDENCE: There are complaints policies and procedures in place. The manager said that they tried to deal with concerns as promptly as possible and have not received any formal written complaints since the last inspection. There are Protection of Vulnerable Adults policies and procedures in place and staff receive in-house training. The carers spoken to were clear that they would report any concerns to the manager. The home should obtain a copy of the Buckinghamshire InterAgency policy for the Protection of Vulnerable Adults and use this to update their own policies and procedures. Rayners Residential Care Home 20052710 Rayners X00015 UI Stage 5 S23014 V250264 H53.doc Version 1.40 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 standard(s) 19 The fire safety mechanisms have been improved to enable residents to have their bedroom doors open if they wish but to protect them and others if a fire should occur. EVIDENCE: This standard was not fully assessed on this occasion. At the last inspection a number of fire doors were found to propped open and requirements were made that this practice ceases. No doors were propped open at this unannounced inspection. Some doors have now had self closure or hold-open devices fitted which are connected to the fire alarm systems. There is a maintenance system in place to ensure that these function satisfactorily. Rayners Residential Care Home 20052710 Rayners X00015 UI Stage 5 S23014 V250264 H53.doc Version 1.40 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 The home’s staffing levels and skill mix are sufficient to meet resident’s needs. The recruitment processes are thorough and protect residents from unsuitable carers. There is a commitment to training staff although the training records must be updated if the manager is to be certain that all staff have the necessary training to meet residents needs. EVIDENCE: A record is maintained as to which staff are on duty and when. The number of staff hours supplied meet Department of Health guidance. There is a flexible shift pattern and the residents spoken to said that carers usually answered their calls promptly. There is an evening twilight shift and two staff on duty between midnight and 7 am. Night staff are not asked to undertake any tasks other than personal care at night and are not asked to help people up in the mornings unless a resident wishes to get up early. The manager said that additional staff would be on duty at night if the dependency of the residents increased, for instance if a resident was receiving terminal care. The inspector felt that the staffing levels were satisfactory although the night staffing levels should be monitored on a regular basis. Two recruitment files were selected at random from those staff who have been recruited since the last inspection. The home has used an overseas recruitment agency to recruit carers from Poland. The files seen contained the documentation required by the Regulation 19 of the Care Homes Regulations Rayners Residential Care Home 20052710 Rayners X00015 UI Stage 5 S23014 V250264 H53.doc Version 1.40 Page 16 2001. Staff had received an induction programme and had had manual handling training. There are twenty-three carers of whom sixteen hold the National Vocational Qualification in Care at Level 2 or above. This exceeds the standard that 50 of carers should hold this qualification by December 2005. There is a regular training programme in place, although there is a need to update the individual training records in order to be certain that all staff have the necessary skills to care for residents. Rayners Residential Care Home 20052710 Rayners X00015 UI Stage 5 S23014 V250264 H53.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none These standards were not assessed at this inspection but were met or almost met at previous inspections. EVIDENCE: Rayners Residential Care Home 20052710 Rayners X00015 UI Stage 5 S23014 V250264 H53.doc Version 1.40 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 4 COMPLAINTS AND PROTECTION 3 x x x x x x x STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x Rayners Residential Care Home 20052710 Rayners X00015 UI Stage 5 S23014 V250264 H53.doc Version 1.40 Page 19 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 8 Regulation 12 Requirement The manager should ensure that residents nutritional needs are assessed and that they are weighed regularly. The manager should ensure that individual residents have risk assessmnets that are relevant to them. Controlled drugs should be recorded in a controlled drugs register The advice of the Diabetes Specialist nurse should be sought regarding the practice of drawing up insulin in advance for residents to administer themselves. The manager should obatin a copy of The Buckinghamshire multi-agency strategy for the pprotection of vulnerable adults. The staff training records should be updated Timescale for action 31.01.06 2. 7 13 31.01.06 3. 4. 9 9 13 13 31.12.05 31.12.05 5. 18 13 31.01.06 6. 30 18 31.01.06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Rayners Residential Care Home 20052710 Rayners X00015 UI Stage 5 S23014 V250264 H53.doc Version 1.40 Page 20 No. 1. Refer to Standard 9 Good Practice Recommendations Temazepam should be recorded in the controlled drugs register. Rayners Residential Care Home 20052710 Rayners X00015 UI Stage 5 S23014 V250264 H53.doc Version 1.40 Page 21 Commission for Social Care Inspection Cambridge House 8 Bell Business Park Smeaton Close Aylesbury, Bucks. HP19 8JR 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. 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